Dental History/Oral Exam

A comprehensive dental history should also be included as part of the dental examination. The following items should be included as part of the evaluation:23

  • Oral Habits – Those affected with ADHD have a higher prevalence of oral habits including nail biting, lip biting, and/or biting or chewing on other objects (pens and pencils).2
  • Bruxism – A higher occurrence of day and night bruxism among ADHD children who are medicated than non-medicated ADHD children or non-ADHD children. This is especially true with CNS stimulant medication (methylphenidate or amphetamines).24
  • Dyskinesia (tics) – The medications prescribed for ADHD can also cause muscular hyperactivity and dyskinesia. The physician prescribing the medication must find the appropriate medication and dosage in order to limit disruptive behavior and limit dyskinesia.24
  • Smoking – Individuals with ADHD are 2 times more likely than their non-ADHD peers to self-medicate by smoking cigarettes. In addition, they utilize other varieties of smokeless tobacco. Those addicted claim that the nicotine improves cognitive abilities, and decreases distractibility and inattention.20 The dental history should list the amount and frequency of use. Patients should be made aware that those who smoke have a higher incidence of oral cancer and periodontal disease.
  • Caffeinated Beverages – Individuals with ADHD often utilize caffeinated beverages, including coffee and soda, to improve cognitive performance. The sugar and acids contained in many of the beverages can lead to an increase in caries.20
  • Homecare Regimens – Regular and thorough oral health care behavior is less common among those affected with ADHD. One study indicated that 48% of ADHD children brushed every evening as compared 82% in a control group.6,8 These individuals have difficulties with inattention and starting and completing activities that are not simulating to them. In addition, there are often parent-child conflicts, which might influence their oral health behavior.6,8
  • Dietary Habits – The dental professional should inquire about the dietary habits of their patients with ADHD including questions about frequency of eating, and types of snacks/drinks between meals. Studies have indicated that those affected with ADHD are more likely to consume foods more than five times a day. This may increase their exposure to high carbohydrate foods thus increasing their risk of developing caries.6