Medical History

A comprehensive medical history should be completed on each patient in our dental practices. This is especially true for those patients diagnosed with ADHD.

Medical histories should include specific questions regarding:

  • ADHD diagnosis
  • Medications usage, dosage, time of day administered and if medication was taken on that day. Table 2 lists commonly prescribed medications along with side effects and interactions.34
  • Approximately 75% of those diagnosed with ADHD take medications. This represents approximately 3 million children and adolescents in the United States.21
  • ADHD medications should ideally be taken 30-60 minutes prior to the dental visit. This timing allows the medication to have its maximum drug effect (enhanced cognition and behavior).20
  • There are significant pharmacological effects that must be considered by the dental professional before treatment.5,8,19,20
  • Xerostomia – all medications used to treat ADHD have this as a potential side effect
  • Loss of smell acuity
  • Sinusitis – inflammation of the sinuses
  • Dysgeusia – decreased sense of taste
  • Sialadenitis – inflammation of the salivary glands
  • Stomatitis – inflammation of the mucous membranes of the mouth
  • Gingivitis
  • Glossitis – inflammation of the tongue
  • Discolored tongue
  • Bruxism
  • Dysphagia – difficulty swallowing
  • Elevated blood pressure and heart rate - blood pressure and pulse should be performed on each patient with ADHD as a significant side effect of many ADHD medications includes elevation in blood pressure.
  • Additional healthcare providers, including primary care physicians should be consulted if there are any questions or concerns about the patient’s treatment, behavior management, and/or medications. This is especially significant if the patient has diagnosis of multiple comorbid conditions (depression, anxiety, developmental disability, etc.)
  • A recent study indicates a link between patients with ADHD and significant dental anxiety. Those diagnosed with ADHD are more likely to exhibit significant anxiety associated with dental treatment.9
  • Specific questions about illicit drugs, smoking and alcohol usage.
  • Some patients with ADHD self-medicate with illicit drugs, cigarettes, and alcohol. It should be noted that those patients with ADHD who are medicated with stimulants are less likely to abuse substances than their non-medicated peers.19,20
Table 2. Medications Commonly Prescribed for ADHD and their Adverse Systemic Side Effects and Interactions with Dental Therapeutics.
Drug (Trade Name)Other Common UsageSide Effects and Interactions
Methylphenidate (Ritalin®, Concerta®, Methylin®, Metadate)Central Nervous StimulantMay rarely cause thrombocytopenia, leucopenia, and anemia; increased risk of experiencing myocardial infarction and cerebrovascular accident, especially in children with pre-existing cardiac issues; vasoconstrictors should be used with caution, in low doses with careful aspiration; potentates arrythmogenic effects of tricyclic antidepressants; headache, stomach irritation, and development of a tic; potential for addiction/withdrawal symptoms; rare cases of visual or tactile hallucinations have been reported.
Amphetamine (Adderall®)
Dextroamphetamine (Dexedrine®)
NarcolepsyAssociated with increase in pulse and blood pressure; increased risk of experiencing myocardial infarction and cerebrovascular accident; danger of hypotension and respiratory collapse with meperidine:  may potentate CNS stimulation caused by large doses of propoxyphene; vasoconstrictors should be used with caution, in low doses with aspiration; potentates arrythmogenic effects of tricyclic antidepressants; anorexia and reduced weight gain in children.
Atomoxetine (Strattera®)NoneIncreased risk of experiencing suicidal ideation; use associated with increased blood pressure and pulse; levonordefrin use should be avoided and epinephrine should be used with caution, in low doses and with careful aspiration; propoxyphene increase the stimulant effect of atomoxetine.
Bupropion (Wellbutrin®, Zyban®)Antidepressant and Smoking CessationMay cause CNS stimulation, including agitation, anxiety, and seizures; increased seizure activity when administered concurrently with tricyclic antidepressants.
Desipramine (Norpramin®)
Imipramine (Tofranil™)
AntidepressantMay cause orthostatic hypotension; causes antimuscarinic effects; levonordefrin should be avoided and epinephrine should be used with caution, in low doses and with careful aspiration; increases sedation of other CNS depressants.
Lisdexamfetamine dimesylate (Vyvanse®)NoneMay cause anxiety; loss of appetite; decreased appetite; nausea; diarrhea; trouble sleeping; dizziness; upper stomach pain; dry mouth; vomiting; irritability; weight loss.
Clonidine (Catapres®, Duraclon®, Kapvay,  Nexiclon)Antihypertensive, Dysmenorrhea, Tourette’s Syndrome, Hot Flashes; Alcohol and Opiate Withdraw; and Smoking CessationMay cause depression; dizziness; nervousness; nightmares; dry eyes; bradycardia; hypotension; palpitations; xerostomia; constipation; nausea; vomiting; erectile dysfunction; rash; sweating; sodium retention; weight gain; fatigue.
Guanfacine (Tenex, Intuniv)Antihypertensive; Tic DisordersMay Cause:  difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; hives; depression; slow heart rate; unusually high or low blood pressure; fainting; severe headache; flushing of the face; unusual fatigue; dizziness; xerostomia; constipation; insomnia; nausea; vomiting; diarrhea.