Diane Rochford discusses how to tailor care to provide the best service to patients.
There are a number of conditions that dental professionals have to be aware of when treating patients. Individuals with mental health disorders, in particular, can provide a number of challenges, especially if the condition in question is nuanced and affects each individual uniquely, such as Attention Deficit Hyperactivity Disorder (ADHD). It is never too late to learn more about this often-misunderstood condition and raise awareness about how the disorder can impact oral health.
What is ADHD?
Attention deficit hyperactivity disorder is a neurodevelopmental disorder that is characterised by symptoms such as inattentiveness, hyperactivity and impulsiveness. It is thought that around 1.5m individuals in the UK have ADHD, but that as few as 120,000 have been formally diagnosed with the condition.
This is due to the fact that ADHD impacts people differently and has varying severities, meaning that those with only a very mild case of ADHD can go undiagnosed for a long time. Indeed, recent estimates have said that an adult diagnosis for the condition can take up to seven years. In children, prevalence of the condition is still relatively high with one in 200 children being diagnosed, though there is space to assume that the condition is more common than this.
There’s also the fact that there are multiple types of ADHD and this can affect how fast someone is diagnosed. Typically, ADHD is categorised into three types depending on which symptoms are most evident.
Those who have inattentiveness ADHD, for example, are those who find it difficult to listen when spoken to, have trouble paying attention during activities and often avoid tasks that require concentration. On the other hand, a person with hyperactivity ADHD is more likely to fidget excessively, run and climb when not appropriate and have trouble keeping quiet. Lastly, those with impulsivity ADHD may often interrupt people, say inappropriate things without thinking and have trouble waiting.
But how does ADHD affect oral health and what can dental professionals do to help?
ADHD and oral health
All types of ADHD can impact oral health in some way. For younger individuals with the condition, the typical risk is that these individuals can find brushing their teeth difficult, as it takes concentration and patience. In fact, one study that examined how often children with ADHD brushed their teeth found that as little as 48 per cent managed to brush their teeth once a day, let alone twice.
Medication for the condition can also impact oral health. These medicines may cause changes in appetite, making individuals crave sugary, sweet snacks that are likely to promote cavities. Furthermore, these medicines often cause dry mouth – meaning that they inhibit saliva production, putting teeth at higher risk of decay. A study that examined tooth decay among children with ADHD found that these individuals are 12 times more likely to have decayed, missing or filled teeth, proving that the condition can considerably impact oral hygiene.
Another perhaps unexpected impact that ADHD can have on oral health is that research has linked it to higher incidences of bruxism. Whether this is a side effect of hyperactive tendencies or simply a stress response to the condition will depend on the individual, but bruxism is a problem that needs to be addressed as it can quickly lead to damaged, sensitive teeth.
Give tailored advice
In light of these oral health challenges, it’s paramount that professionals are able to give individuals with ADHD tailored, helpful advice and care. This means that it may be worth scheduling appointments more regularly, especially to ensure that they are keeping on top of oral hygiene routines at home.
We should also be making sure that we give advice to these patients in easy-to-understand terms and even explore different ways to communicate, such as using more visual means. This way, you can help prevent advice becoming too difficult to understand or too long-winded, as well as engaging with patients in a way that is likely to keep their attention. We can also suggest measures such as tooth-brushing charts for use at home for younger patients – these are a good way to help everyone keep track of their oral health and to add a sense of accomplishment. If there are signs of bruxism, it’s also a good idea to talk about the options of mouth guards and other preventive measures that can help tackle this problem.
Raising awareness, providing care
In the end, it is important for dental hygienists and dental therapists to understand conditions like ADHD as they can significantly impact a patient’s oral health and the way they should receive treatment and advice.
Armed with knowledge, professionals can make sure they are prepared and can also raise awareness among colleagues, helping to ensure that patients with ADHD receive the care they need.
References available on request.