Attention-Deficit Hyperactivity Disorder, otherwise known as ADHD, is one of the most common neurologic disorders affecting children and adolescents, as well as adults. According to the American Psychiatric Association, an estimated 8.4 percent of children and 2.5 percent of adults have ADHD. Studies show that males are more likely to have ADHD over females and as the mind matures and age increases, there is an overall reduction in symptoms (Millstein, Wilens, Biederman, & Spencer, 1997). Attention-Deficit Hyperactivity Disorder is defined as a health condition that involves biologically active substances in the brain. ADHD may affect areas of the brain that allow us to plan ahead, solve problems, control impulses and understand others’ actions. The primary symptoms of ADHD are hyperactivity, impulsivity and inattention (American Academy of Child and Adolescent Psychiatry).
The etiology of ADHD is currently unknown or idiopathic, although scientists believe that genetics may be a component. Research suggest that individuals diagnosed with ADHD have family members that also have the disorder. Individuals with ADHD have been known to have chromosomal abnormalities called copy number variants. These are duplications and deletions of segments of chromosomes which have also been in other disorders such as autism and schizophrenia (Encyclopedia Britannica, 2018). Other factors that may contribute to ADHD are tobacco, alcohol or drug use during pregnancy along with exposure to environmental toxins during pregnancy or at a young age, low birth weight and brain injuries (National Institute of Mental Health, 2016).
Although the definite cause of ADHD is unknown, there have been multiple studies completed to help determine the exact cause. One research study found that the brain structure of a boy with ADHD and without the disorder had differences. The study found that the corpus callosum, which is a band of nerve fibers that connects the two hemispheres of the brain, had less tissue in those with ADHD than those without. Other studies showed that a person with ADHD had less blood flow through the right caudate nucleus of the brain as well as evidence that the left anterior frontal lobe metabolized less glucose in individuals with ADHD.
127 our experts are availableright now
Other studies believe that an elevated amount of norepinephrine plays a factor. Increased levels of dopamine in people with ADHD have also been noticed. An increase in dopamine may play a role by inhibiting the neuronal dopamine receptors and transporters. If there is an absence of receptors and transmitters, eventually the uptake of dopamine will no longer work properly. Dopamine plays a major role in reward, motivation, memory, attention, and regulating body movements. If the levels of dopamine are rendered, alterations in mood and behavior can be noticed. Another theory on the pathogenesis of ADHD is that it is not a disorder at all, rather it’s just a state of mind and how that person’s personality and traits are naturally (Encyclopedia Britannica, 2018).
ADHD can be diagnosed as one of three types. The types are the inattentive type, hyperactive-impulsive type, and the combination type. The complications or symptoms of the inattentive type are not being able to pay close attention to details, making careless mistakes in school or job tasks, unable to stay focused during lectures, conversations or long reading. Other complications are not being able to follow through on instructions or complete school work, issues with organizing and managing time wisely, often loses things needed for daily tasks such as car keys. The inattentive type is also known to be easily distracted and forget tasks such as running errands or doing chores (American Psychiatric Association, 2017).
The complications of the hyperactive-impulsive type of ADHD include fidgeting with hands or feet, squirming, not able to stay seated, runs or climbs in inappropriate areas and unable to do activities quietly. The hyperactive type also might talk too much or interrupt others, cut in on conversations, difficulty waiting their turn or using other people’s things without permission (American Psychiatry Association, 2017). Because symptoms vary per person, ADHD can often go unnoticed in individuals that don’t display the classic symptoms. If the disorder goes undiagnosed and untreated at a young age, it may continue into the adult years. An adult with ADHD may have a history of poor academic performance, problems at work and failed relationships (National Institute of Mental Health, 2016).
There are no clinical findings for an individual with ADHD. Although the person may be unable to sit still, distracted easily, forgetful, and unable to keep appointments, you would not be able to just determine a person has ADHD by looking at physical symptoms. Although a person on ADHD medication may have clinical oral findings such as xerostomia, swollen lymph nodes, mucocele under the tongue, bruxism, canker sores and swollen tongue (Wagner & Wagner, 2016).
A lot of time and observation goes into being diagnosed with ADHD. Symptoms must be present in more than 2 situations, such as school, work or home. Before prescribing medication, the individual must be observed in different environments to get a better idea of the behavior. To avoid the overuse of medication, behavioral interventions are typically applied first. There are different types of medication known to treat ADHD. The most common type of medication are stimulants such as Dexmethylphenidate (Focalin), Dextroamphetamine and Amphetamine mixtures (Adderall) and Lisdexamfetamine (Vyvanse). Other medications are psychiatry agents such as Atomoxetine (Strattera) and atypical antidepressants such as Bupropion (Wellbutrin) and Venlafaxine (Effexor). The type of medication prescribed is determined by the age, symptoms, and type of ADHD diagnosed (Soreff, 2018).
As dental hygienists and health professionals, it is important to review the patient’s medical history to determine if the patient has been diagnosed with ADHD or if they are taking any of the medications previously stated. Since most of the patients diagnosed with ADHD are children and adolescents, it is also important to review the diagnosis with the parent. Although ADHD doesn’t have any significant clinical findings or complications, someone with the condition might need extra education on the prevention of caries and maintaining oral health.
Since an ADHD patient has trouble staying on task and paying attention to instruction, along with not being able to sit still for long periods of time, the health provider must remain patient and sympathetic as well as extra thorough when explaining the importance of oral health care. It is also important to educate the parent the importance of oral health since they will be the one implementing it at home.
