ADHD Attention Deficit Hyperactivity Disorder

1. ADHDAttention Deficit Hyperactivity Disorder Norma Lopez

2. Disease Description It’s a life long neurodevelopmental disorder that is characterized by noticeable symptoms of inattention and/or hyperactivity impulsivity. Biologic and social conditions, injuries to the CNS, genetics, and prenatal exposure to smoking or alcohol may be the cause. Often times, this disorder becomes apparent prior to the age of 7. Behaviors are intensified by stress, unstructured or group situations, or with the demand for complex performance.

3. Symptoms Poor impulse control Inattentiveness Difficulty waiting turn Interrupting Failing to pay close attention to detail Difficulty organizing Fidgety with hands and feet Difficulty staying seating and participating in leisurely activities Failing to complete tasks or following through on instructions Often seeming like they are not listening when being spoken to

4. Common Medications Many of the medications that are given to those with ADHD are stimulant drugs that inhibit dopamine or norepinephrine reuptake in the brain, which results in increased attention.

5. Assessment Evaluate the presence of symptoms and determine if they have an impairment. Use a comprehensive patient history, information from patients, care providers, and teachers in order to gather complete diagnosis data. Primary care physicians should be consulted if there are any questions or concerns about the patient’s treatment, behavior management, and/or medications. Evaluation should include oral habits, medications and their side effects, and dietary habits.

6. Oral Manifestations Many of the medications given to those with ADHD can cause xerostomia. Patients with ADHD may have difficulty brushing for full 2 minutes, which can lead to poor oral hygiene and greater plaque build up. Increase risk of caries due to xerostomia and difficulty brushing for recommended amount of time. Bruxism High risk of dental/oral trauma

7. Tx Planning Considerations Dental appointments should be early in the morning and/or approximately 30-60 minutes after they have taken their medication. If possible, the patient should be scheduled for several short appointments. Use local anesthesia with caution, so that endogenous epinephrine is not released which could react with medications being taken by the patient. If there is important information for the patient to remember when at home, it is best to write that information down on paper.

8. Implementation • Let the patient know what will be accomplished. • If directions or instructions are given, do them one step at a time. • Use positive reinforcement • When doing patient education, use the “tell-show-do” model and use visual aid, such as a toothbrush and teeth. Model tooth brushing and flossing techniques for the patient while giving only one instruction at a time. Give patient several breaks Inform patient when breaks are coming and when they are almost over.

9. Questions • What is the best time to schedule a patient with ADHD? • A) 12:00 noon • B) 4:00 PM • C) 9:00 AM • D) Any time works best • Which of the following is NOT a side effect of the medication given to ADHD patients? • A) Increased blood pressure • B) Loss of feeling in the tongue • C) Xerostomia • D) Bruxism • Which of the following can intensify the behavior of an ADHD patient? • A) Stress • B) Unstructured situations • C) Demand for complex performance • D) Caffine

10. Resources Efron, Lisa A.; Sherman, Jeffery. Attention Deficit Hyperactivity Disorder: Implications for Dental Practice.Dentistry Today. 1 Feb. 2005. web. March 2013 <www.dentsitrytoday.com> Frese, Patricia; McClure, Elizabeth. Dental Implications of the ADHD Patient. Dental Care. 6 May 2010. Web. Feb 2013 <http://media.dentalcare.com> Pani, Sharat Chandra. ADHD and It’s Implications for Dental Care. Special Dentistry. 22 Dec 2008. web. March 2013 <http://specialdentistry.blogspot.com>