“Nobody Understands Me” – The Exact Words of Someone Who Struggles with Attention-

Deficit/Hyperactivity Disorder and How It Relates to Oral Health

Stephanie Chacón and Aubree Shreve

November 23, 2021

DNH 226: Public Health Dental Hygiene I

Associate Professor Christina Quirós, MS, RDH, CDA, MAADH

 
Introduction

Attention-deficit/Hyperactivity Disorder (ADHD) was first examined in 1902 by British

pediatrician Sir George Sill who examined children with loss of behavioral control (1). The

examination of these children revolutionized the process of diagnosing ADHD, thus presenting

correlations to other health concerns such as oral health. ADHD has been identified as

unrestrained levels of inattention, impulsivity, and hyperactivity (2).

The early signs and symptoms of ADHD can be detected and diagnosed in school-aged

children (3), which can propose complications for parents to overcome the obstacles of the

disorder in relation to acceptable oral hygiene for their children. The DSM-5 criteria for people

with ADHD that can affect their oral health include forgetfulness, lack of attention,

and reluctancy (4). For example, these symptoms can result in a decreased frequency of

toothbrushing in these individuals (5). Overall, patients with this disorder are susceptible to

risks predominantly affecting their oral health. The purpose of this paper is to discuss Attention

Deficit/Hyperactivity Disorder and its effects on oral health. The topic analyzes the oral health of

both children and adults with ADHD.

Significance of the Study

Research studies have been conducted on ADHD and its effects on oral health. It is

important to research this topic to improve the efficacy of dental care. Furthermore, this research

will bridge the gap between the lack of knowledge and awareness dental providers have of

patients with ADHD and the clinical signs, proper management, and treatment. A recent study

provided a questionnaire to dental providers revealing that 80% chose not to treat patients with

ADHD (6). The result from this study demonstrates bias towards patients with ADHD that could

lead to poor oral health and quality of life. Nevertheless, a separate study revealed that providers
who treat patients with ADHD positively impact the patients’ oral health due to their increased

awareness of the disorder (6).

Research Questions

This paper will attempt to answer the following research questions:

1. Is there a correlation between ADHD and oral health status?

2. Does the awareness of ADHD from dental providers impact patient care?

Review of the Literature

Oral manifestations connected to patients with ADHD include increased dental caries,

xerostomia effects, plaque, missing teeth, and number of filled teeth (5, 6, 7). Studies have

shown that children with ADHD had a higher Decayed, Missing, and Filled Teeth (DMFT) score

than those without the disorder (6, 8). More specifically, two groups of children were selected

during a study with one group consisting of children with ADHD, and the second control group

consisting of children without it. Those with the disorder had a DMFT score of 4.31 while those

without it had a score of 1.71 (9). Additionally, the children with ADHD had higher plaque

indexes of 36.84%, while the control group’s plaque index was 24.54% (9). This could be a

result of the children’s inability to remember to brush their teeth for the appropriate amount of

time (or at all), to focus on proper brushing techniques, and to possess the willingness or desire

to take proper care of their oral cavity. Xerostomia can also pose a risk for higher incidences of

dental caries in those with ADHD (10). The medications often used for it include

Methylphenidate and Dextroamphetamine, which have both been shown to cause dry mouth,

thus causing dental caries without appropriate oral hygiene intervention and maintenance (10). 

Socioeconomic disadvantages can also play a role in poor oral hygiene and status (11).

This can include individuals with ADHD in certain demographic areas that may not have much
awareness or treatment for the disorder, thus leading to an increased population of those with

ADHD and poor oral health statuses (11).

Equally important is recognizing the malpractice of a clinician’s approach and awareness

to caring for patients with ADHD. A particular study evaluated dental providers' education about

ADHD and proper training to their behavioral patterns (6). In total, 74% admitted to not having

received any education about the psychological disorder. Also, 85% did not receive training for

patients with ADHD (6). Consequently, these clinicians would refer their patients to a specialist

causing a further delay in treatment (6). However, 25% of dental clinicians understood the oral

manifestations and proper methods to treat ADHD patients (6). Despite the gap of efficacy to

care for ADHD patients, 87% of the dental clinicians did seek to provide dental treatment (6). In

essence, there is an interest to offer treatment, but the approach must begin at the early stages of

the diagnosis.

Patients with psychological disorders like ADHD deserve additional attention from dental

clinicians in all aspects of their health, rather than just the medication effects to their oral

mucosa. As stated earlier, ADHD is diagnosed at an early stage, so dental clinicians should use

their education on ADHD to have an intervention with the parents of the patient. A study

investigating the relationship between oral health behavior and status with psychological factors

indicated that parents with dental phobia and low education dissuaded them from taking their

children to the dentist (5). The intervention with the parents must pertain to the child’s oral

hygiene behavior, effects of medication to the oral mucosa, and proper products to combat oral

health risks. This intervention can significantly impact the adulthood of the patient and their

Quality of Life (QoL) (12). QoL is defined as the overall health, function, and well-being within

a certain group (12). One study evaluated four groups of adults with ADHD throughout a 2-year
timespan to see the impact of their QoL (12). The baseline group that only received a placebo

had a linear effect of the treatment and had little improvement on their QoL (12). Two other

groups received both medications to control their ADHD behaviors and group psychotherapy,

which. dramatically increased their QoL by 20% (12). The pursuit to better the QoL of patients

with ADHD all begins at delivering the proper attention they deserve in areas they lack

themselves. As more of the population is diagnosed with this disorder, more research should be

done to further confirm the correlation between ADHD and oral health status.

Conclusion

In conclusion, there is indeed a correlation between ADHD and oral health. This disorder

can affect children and adults alike. Many oral manifestations of ADHD can be seen in both age

groups, including xerostomia, dental caries, increased plaque accumulation, and a greater

number of dental restorations. These signs and symptoms are a result of the disorder from

patients with ADHDs’ inability to focus, impulsive tendencies, and poor behavior management

skills (10). The attention that the patient lacks in his or her own oral hygiene must be conveyed

by the dental clinicians. Dental clinicians must be aware of the oral signs and symptoms ADHD

presents to provide proper treatment. In doing so, dental clinicians along with their patients can

collaboratively impact their overall oral health and influence their quality of life.

References

1. Holland, K. (2021). The history of ADHD: A timeline. Healthline.

2. Grillo, G. (2020). ADHD and dental care: Guidance for parents and caregivers. Children

and Adults with ADHD.

3. Rosenberg, S., Kumar, S., Williams, N. (2014). Attention-deficit/hyperactivity disorder

medication and dental caries in children. Journal of Dental Hygiene, 88(6), 342-347.
4. Centers for Disease Control and Prevention. (2020). Symptoms and diagnosis of ADHD.

U.S. Department of Health & Human Services.

5. Alkan, A., Cakmak, O., Yilmaz, S., Cebi, T., Gurgan, C. (2015). Relationship between

psychological factors and oral health status and behaviours. Oral health & Preventive

Dentistry, 13(4), 331–339.

6. Shahwan, M., Suliman, A., Jairoun, A., Alkhoujah, S., Mohammed, H., Abdullah, H.

(2020). Attention-deficit hyperactivity disorder: Knowledge and perception of dental care

providers at ajman. Journal of Pharmacy & Bioallied Sciences, 12(1), 16-21.

7. Hidas, A., Noy, A.F., Birman, N., Shapira, J., Matot, I., Steinberg, D., Moskovitz, M.

(2011). Oral health status, salivary flow rate and salivary quality in children, adolescents

and young adults with adhd. Archives of Oral Biology, 56(10), 1137-1141.

8. Murray, C. M., Naysmith, K. E., Liu, G. C.-H., Drummond, B. K. (2012). A review of

attention-deficit/hyperactivity disorder from the dental perspective. New Zealand Dental

Journal, 108(3), 95–101.

9. Begnini, G. J., Brancher, J. A., Guimarães, A. T., de Araujo, M. R., Pizzatto, E. (2019).

Oral health of children and adolescents with attention deficit hyperactivity disorder.

International Journal of Clinical Pediatric Dentistry, 12(6), 543–547.

10. Manoharan, S., Krishnamoorthy, K. (2016). Dental caries and children with attention

deficit hyperactivity disorder (ADHD) – A review. Journal of Pharmaceutical Sciences

and Research, 8(7), 1. 

11. Kohlboeck, H., Neumann, T., Heinrich, H., Hickel, K., Herbarth, Kühnisch. (2013). Is

there a relationship between hyperactivity/inattention symptoms and poor oral health?

 Results from the GINIplus and LISAplus study. Clinical Oral Investigations, 17, 1329–

1338.

12. Lücke, C., Jenkner, C., Graf, E., Matthies, S., Borel, P., Sobanski, E., Alm, B., Rösler,

M., Retz, W., Jacob, C., Colla, M., Huss, M., Jans, T., Kis, B., Abdel-Hamid, M., Müller,

H. H. O., Lam, A. P., Berger, M., Tebartz van Elst, L., Philipsen, A. (2021). Long-term

improvement of quality of life in adult ADHD – Results of the randomized multimodal

COMPAS trial. International Journal of Mental Health, 50(3), 250–270.

Abstract
Patients diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD) require

attentive treatment pertaining to their oral health. This paper examines studies about Attention

Deficit/Hyperactivity Disorder and its effects on oral health. This paper also attempts to answer

whether there is in fact a correlation between Attention-Deficit/Hyperactivity Disorder (ADHD)

and oral health or not. It also explores if there is enough awareness of the disorder amongst

dental providers, as well as if and how that awareness impacts patients with ADHD’s oral health.

Through extensive research, it has been found that there is indeed a correlation between ADHD

and oral conditions, along with awareness of the disorder and the resulting dental and health care

for patients with it. From the age of three to adulthood, Attention Deficit/Hyperactivity Disorder

can present the patient with multiple risks to their oral health and quality of life (QoL). Twelve

sources provide insight into the assessment of oral health risks and awareness of dental providers

about ADHD. Sources state health patterns such as xerostomia, high plaque index scores, and

dental caries play a role in poor oral health. Dental clinicians however, as recognized in sources,

underscore the lack of knowledge to treat ADHD patients. As a result, there is a significant gap

between the patient with an ADHD diagnosis and the approach from the dental clinician for
proper treatment. Following the lack of awareness of poor oral health in ADHD patients, their

quality of life will also be impacted. Further discussion in the paper will distinguish the

correlation of Attention Deficit/Hyperactivity Disorder and poor oral health status.

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