Attention-deficit/Hyperactivity Disorder

The essential features of attention-deficit/hyperactivity disorder (ADHD) are the presence of developmentally inappropriate degrees of inattention, hyperactivity, and impulsiveness.29-34 Its etiology is not fully understood; however, several genes have been identified that may mediate susceptibility to ADHD and it is generally accepted that ADHD is the result of a chemical imbalance in the “brain reward cascade.”

ADHD appears to be associated with two neurotransmitters.7,8 Inattention and distractibility appear to be related to low levels of norepinephrine. Impulse and behavior problems appear to be related to low levels of dopamine. ADHD includes three subtypes: primarily inattention (e.g., distracted, poor organizational skills); primarily hyperactive-impulsive behavior (e.g., fidgety, overactive, and interruptive); or a combination of the two.29-34

Drug therapy with psychostimulants such as methylphenidate, dextroamphetamine, and mixed amphetamine salts are the most effective and safe option and are first-line therapies for ADHD (Table 4).2,7,8,29-34 Other drugs approved by the U.S. Food and Drug Administration include alpha2-receptor agonists and atomoxetine, a selective inhibitor of the pre-synaptic norepinephrine transporter.2,8,10,29-34

When providing oral healthcare to patients with ADHD, the goals are to develop and implement timely preventive and therapeutic strategies. Children with ADHD, because of inattention, tend to have poor oral hygiene and increased incidence of caries activity. They tend to brux and are at risk of dental/oral trauma.32 They are fidgety, overactive, and interruptive and are likely to be a behavior-management challenge perioperatively.32

Inattention and impulsivity in adults with ADHD can lead to impaired homecare, potential nicotine dependence, and increased ingestion of caffeine and soft drinks.33 These behavioral tendencies promote increased dental caries activity and contribute to increased incidence of periodontal diseases. Significant modification of office care is not required, but broken appointments and inability to carry out optimal homecare may be a challenge.34