The Tribune

By DR ANDRE CLARKE

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood mental disorders and affects approximately 3-5 percent of children. There is a predilection for boys, affecting them two to three times more than girls. ADHD is also known to persist into adolescence and adulthood.

Sometimes parents may describe a badly behaved child as “hyperactive”, but this term should not be used in such a context. It should be reserved for children that exhibit gross behavioural abnormalities. These abnormalities include extreme fidgeting, impaired concentration, impulsiveness and uncontrolled activity. Of note, these gross behavioural abnormalities tend to occur most commonly in situations where orderliness and reticence is necessary.

The cause of ADHD is unclear. Research suggests there are a combination of factors to consider, including: minor head injuries, food additives, undetectable brain damage and a familial predisposition (runs in the family). In addition, factors influencing child-parent relationships can also play an important part.

It must be remembered that to be diagnosed with ADHD the above mentioned hyperactivity and impulsiveness needs to be pervasive, excessive and long term. These hyperactive and impulsive abnormal behaviours often appear before the age of seven years and persist for at least six months and are therefore easily diagnosed as ADHD.

Once diagnosed ADHD has to be managed and should not be ignored. Often times, it is necessary to implement behavioural therapy, emotional counselling and specialized educational help. In addition to these therapies, stimulants, antidepressants and antihypertensive agents are commonly used to control ADHD. These prescription medications all have an effect on the mouth and head and neck.

The stimulants (Ritalin and Adderall) typically cause dry mouth; changes in taste; and, grinding and clenching of teeth. The antidepressants (Tofranil, Wellbutrin) usually cause mouth tissue soreness; discomfort when swallowing; dry mouth; a discoloured tongue; salivary (spit) gland problems; grinding of teeth and generalized mouth swelling. The antihypertensive agents (Clonidine, Tenex) commonly cause dry mouth; pain and difficulty on swallowing and salivary gland problems. It is very difficult to avoid the mouth and head and neck effects of the ADHD medications.

In addition to the impact of the aforementioned medications on the mouth and head and neck, persons with ADHD also battle with the inherent effect the disorder has on their mouths. A decreased attention span can lead to poor oral hygiene, which can potentially lead to an increase in dental caries (cavities). ADHD on its own also can cause bruxism (a nonfunctional grinding or clenching of teeth). Also, there is the ever present risk of an individual with ADHD falling victim to some form of mouth trauma. They are at an increased risk by virtue of the disorder.

There are a few pearls that dental healthcare professionals commonly implement to make the experience of a person with ADHD to a dental office more amicable. They will not treat patients who are on medication “holidays”. A medication holiday is when a child goes for a period of time without taking any medication (e.g. during breaks from school). The other pearls healthcare professionals would use include:

• Scheduling appointments in the morning or at a time of the day when the person with ADHD is least fatigued, most attentive and able to remain seated in the dental chair.

• Giving singular, short and clear instructions directly to the person with ADHD.

• Using a Tell-Show-Do approach in the office.

• Telling the person with ADHD what behaviour is expected during the dental visit.

• Giving the person with ADHD small rewards (e.g. stickers) for exhibiting appropriate behaviour.

• Taking breaks as necessary during the dental treatment.

ADHD should not and does not prevent the diagnosed individual from receiving quality dental care. It is essential not to allow neglect to ruin anyone’s mouth health. It is important for persons with ADHD to visit a mouth healthcare professional. Do not delay. If you know of such a person, assist in arranging a dental visit for them. Keep their mouth alive.

• This article is for informational purposes only. It is not intended and may not be treated as, a substitute for professional medical/dental advice, diagnosis, or treatment. Always seek the advice of a physician or dental professional with any questions you may have regarding a medical/dental condition. Never disregard professional medical/dental advice or delay in seeking it because of a purely informational publication. If you have questions, please send email to dr_andreclarke@hotmail.com.