Caries in Children with Attention Deficit Hyperactivity Disorder

shutterstock_ADHD child

Dental caries is a preventable chronic health problem that presents an ongoing public health challenge. About 90% of children in low- and middle-income countries are affected and a smaller but significant number of children from high income countries. Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorders of childhood that can persist into adulthood. Features include inattentiveness, hyperactivity, and impulsivity which can affect social interactions and academic skills and occupational development. ADHD may have an adverse impact on oral health behaviours increasing risk of dental caries.

The aim of this review was to assess whether children and adolescents with attention deficit with hyperactivity disorder (ADHD) had more dental caries than children and adolescents without ADHD.

Methods

A protocol for the review was registered on the PROSPERO database. Searches were conducted in the Medline/PubMed, Embase, Scopus, Web of Science, OpenGrey and Google Scholar databases. Observational studies (cohort, case-control, and cross-sectional) in which children with ADHD had been compared with children without ADHD regarding dental caries were considered. Two reviewers independently selected studies extracted data and assessed risk of bias using the  Joanna Briggs Institute critical appraisal tools.  Meta-analysis was conducted with results presented as mean difference (MD) or odds ratio (OR) with 5% confidence intervals (CIs).

Results

  • 13 studies (2 case-control, 11 cross-sectional with controls) involving a total of 2008 patients (954 with ADHD, 1124 without) were included.
  • All the studies were published in English between 2004-2020.
  • 3 studies were from Brazil, 2 each from Sweden and the USA and one study each from China, Germany, India, Iran, New Zealand, and Thailand.
  • Meta-analysis showed that children with ADHD had a significantly higher DMFT index than those without ADHD but no differences were detected for DMFS or DS/Ds indicies (see table)
  No of studies Mean difference (95% CI)
DMFT index 6 0.75 (0.38 to 1.13)
DMFS index 4 0.39 (-0.02 to 0.80)
DS/ds index 2 0.35 (−0.63 to 1.33)
  • Children with ADHD had higher odds of having dental caries than their healthy peers, Odds ratio (OR) = 3.31 (95%CI; 1.25 to 8.73).

Conclusions

The authors concluded: –

The main shortcoming of the included studies is the high risk of bias regarding the strategies to deal with confounding factors. Within its limitations, this systematic review and meta-analysis demonstrated that children with ADHD were more likely to develop dental caries than their healthy counterparts.

Comments

A broad range of databases were searched for this review yielding 13 English language studies from a number of countries. The studies were mainly cross-sectional and ADHD status was assessed using difference approaches nit all of which involved a trained professional, Caries status assessment typically involved a trained and calibrated examiner/s although the was some variation in the indices employed.  The review authors noted that although there was a low risk of bias in the selected control patients there was concern related to the identification of confounding factors eg socioeconomic factors).   The age range across the included studies varied which may also impact on the caries assessment.  While significant differences were seen for DMFT in children with ADHD other indices were not.  The findings also demonstrated higher odds for developing caries in children with ADHD.  The review findings suggest children with ADHD are at great risk of developing caries however because of heterogeneity in the included study designs including the lack of adjustments for confounding factors the findings should be interpreted cautiously.

Links

Primary Paper

Drumond VZ, Souza GLN, Pereira MJC, Mesquita RA, Amin M, Abreu LG. Dental Caries in Children with Attention Deficit/Hyperactivity Disorder: A Meta-Analysis. Caries Res. 2022;56(1):3-14. doi: 10.1159/000521142. Epub 2021 Dec 20. PMID: 34929707.

Review protocol in PROSPERO

Other references

Dental Elf – 11th Jun 2021

Early childhood caries: Global prevalence

Dental Elf – 19th Jul 2019

Caries experience and dental care in children with and without learning disabilities

 

 

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. He is a former editor of the Evidence-Based Dentistry Journal, the chief blogger for the Dental Elf website and a past president of the British Association for the Study of Community Dentistry. He has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Retired from the NHS he is currently a part-time senior lecturer at Dundee Dental School.

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