Pay Attention While Encountering Deficit of Attention

Editorial

Often in the clinical practice, Dental surgeons deal with children with fear and anxiety and many of them are found unwilling to undergo any dental procedure. They are nervous and restless and not attentive enough to what the doctor is saying to them. In most of the cases they are tried to be managed with common behavioural management techniques. But sometimes there can be a deeply rooted reason: Attention Deficit Hyperactivity Disorder (ADHD). Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood behavioral disorders usually seen to be manifested in the preschool and early school years. American Psychiatric Association defines ADHD as “a behavioral and neurocognitive condition characterized by developmentally inappropriate and impairing levels of gross motor over activity, inattention, and impulsivity” [1]. It is a neurodevelopment disorder that usually is seen in children younger than 7 years and can continue throughout life. In adults, ADHD is characterized by a persistent pattern of inattention, restlessness and impulsivity that impairs day-to-day vocational, social and family functioning [2]. A short attention span is evident preventing the person from focusing continuously on verbal and written instructions that results in difficulties in learning new skills [3]. Restlessness hinders the ability to relax and exacerbates their inattention (for example, being unable to sit at a desk for long periods) along with fidgeting (for example, persistent pencil tapping, foot tapping etc.) [4]. Impulsivity can lead to interrupt others during their works and completing the sentences of others while communicating with them [5].

Children with ADHD are found to be at a greater risk of developing carious lesions, poor oral hygiene and poor dietary habits. Higher rates of bruxism have also been reported. Harmful oral habits including nail biting and lip biting are common. Children with ADHD can develop adverse health behaviors like overeating, consumption of alcohol and tobacco use in later life [6]. Medications used for the treatment of ADHD have also been found to cause deleterious effects on oral health, for example, Amphetamine can cause bruxism and dysguesia; Bupropion is found to be associated with xerostomia, stomatitis, and glossitis; Imipramine causes oral edema and sialadenitis [2, 7]. However, dental management of children with ADHD usually requires only minimal modification, because their behavior in the dental office often does not differ significantly from the children without ADHD [2]. Morning appointments (as most of the drug regimens are designed for the maximum effect to occur during the early part of the day), obtaining a detailed case history with all the past and present prescribed drugs, positive reinforcements, multiple short visits instead of single prolonged visit and consultation with the primary care physician are the modifications necessary in the management of a child with ADHD. As the prevalence of Attention Deficit Hyperactivity Disorder is high among children, the Dental surgeon frequently encounters such patients in dental clinic. Due to higher rates of dental problems among them, it is essential to have adequate knowledge about the disease and its management. The medical management of ADHD considerably brings down the symptomatology and hence, the inattention, motor restlessness and broken appointments must not be misunderstood as simple noncompliance [2]. Apart from treating the oral problems, the patients as well as their parents/caregivers must be motivated with understanding and compassion to maintain good oral hygiene throughout their life.