The Prevalence of ADHD Patients among Pediatric Dentists in Israel and Knowledge of Dental and Behavioral Aspects of Treating Them

Objective: There are no clear guidelines for managing the dental treatment of children with attention deficit hyperactivity disorder (ADHD). The use of sedation in combination with chronic ADHD medication use is also not well defined. This study surveyed the prevalence of ADHD children, management techniques and knowledge of pharmacologic therapies of these children among Israeli dentists. Study Design: A specially designed questionnaire was distributed to all Israeli dentists attending a national conference in 2016. Results: Of the 160 dentists who attended the conference, 96 completed the survey (60% response rate), and they included 46 (51%) pediatric dental specialists and 50 (49%) general dental practitioners. The medications Ritalin and Concerta were most familiar to the respondents (98.9%). Eighty-seven (91.1%) of the practitioners responded that their ADHD patients take their usual doses of any drug for treating ADHD symptoms, regardless of whether or not the dentists intended to use sedatives. The practitioners invented their own behavior management techniques with varying degrees of success. Conclusions: There are no specific guidelines for the most effective pharmacologic protocol (co-administration of ADHD drugs and dental sedatives) or behavior management techniques for the provision of optimal dental care to children with ADHD.

ADHD, dental care, pharmacologic management, behavior management, survey

1. Friedlander AH. Attention-deficit hyperactivity disorder: setting the record straight. Spec Care Dentist 24: 249, 2004.

2. Friedlander AH, Yagiela JA, Mahler ME, Rubin R. The pathophysiology, medical management and dental implications of adult attention-deficit/hyperactivity disorder. J Am Dent Assoc 138: 475-482, 2007.

3. Atmetlla G, Burgos V, Carrillo A, Chaskel R. Behavior and orofacial characteristics of children with attention-deficit hyperactivity disorder during a dental visit. J Clin Pediatr Dent 30: 183-190, 2006.

4. Broadbent JM, Ayers KM, Thomson WM. Is attention-deficit hyperac-tivity disorder a risk factor for dental caries? A case-control study. Caries Res 38: 29-33, 2004.

5. Kerins CA, McWhorter AG, Seale NS. Pharmacologic behavior manage-ment of pediatric dental patients diagnosed with attention deficit disorder/attention deficit hyperactivity disorder. Pediatr Dent 29: 507-513, 2007.

6. Inglis SK, Carucci S, Garas P, Häge A, Banaschewski T, Buitelaar JK, et al. Prospective observational study protocol to investigate long-term adverse effects of methylphenidate in children and adolescents with ADHD: the Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) study. BMJ Open 6: e010433, 2016

7. Buoli M, Serati M, Cahn W. Alternative pharmacological strategies for adult ADHD treatment: a systematic review. Expert Rev Neurother 16:

131- 144, 2016.

8. University of Washington, School of Dentistry. Patients with special needs, dental fact sheet for children. dental.washington.edu/wp-content/media/sp_need_pdfs/ADHD-Dental.pdf Accessed June 3, 2013.

9. Subcommittee on Attention-Deficit/Hyperactivity Disorder; Steering Committee on Quality Improvement and Management. Wolraich M, Brown L, Brown RT, et al. ADHD: clinical practice guideline for the diag-nosis, evaluation and treatment of attention deficit/hyperactivity disorder in children and adolescents. Pediatrics 128: 1007-1022, 2011.

10. Malki GA, Zawawi KH, Melis M, Hughes CV. Prevalence of bruxism in children receiving treatment for attention deficit hyperactivity disorder: a pilot study. J Clin Pediatr Dent 29: 63-67, 2004.

11. Grooms MT, Keels MA, Roberts MW, McIver FT. Caries experience associated with attention-deficit/hyperactivity disorder. J Clin Pediatr Dent 30: 3-7, 2005.

12. Blomqvist M, Holmberg K, Fernell E, Ek U. Dental caries and oral health behavior in children with attention hyperactivity deficit disorder. Eur J Oral Sci 115: 91-186, 2007.

13. Arnrup K, Broberg AG, Berggren U, Bodin L. Treatment outcome in subgroups of uncooperative child dental patients: an exploratory study. Int J Paediatr Dent 13: 304–319, 2003.

14. Hidas A, Noy AF, Birman N, Shapira J, Matot I, Steinberg D, Moskovitz M. Oral health status, salivary flow rate, and salivary quality in children, adoles-cents, and young adults with ADHD. Arch Oral Biol 56: 1137-1141, 2011.

15. Lalloo R. Risk factors for major injuries to the face and teeth. Dent Trau-matol 19: 12-14, 2003.

16. Wilens TE. Drug therapy for adults with attention-deficit hyperactivity disorder. Drugs 63: 2395-2411, 2003.

17. American Academy of Pediatric Dentistry. Council on Clinical Affairs. Guideline on Management of Dental Patients with Special Health Care Needs. Pediatr Dent 34:160-155, 2012.

18. Farbstein I, Mansbach-Kleinfeld I, Auerbach JG, Ponizovsly AM, Apter A. The Israel Survey of Mental Health among adolescents: prevalence of attention-deficit/hyperactivity disorder, comorbidity, methylphenidate use, and help-seeking patterns. Isr Med Assoc J 16: 568-573, 2014.

19. Cohen R, Senecky Y, Shuper A, Inbar D, Chodick G, Shalev V, Raz R. Prevalence of epilepsy and attention-deficit hyperactivity (ADHD) disorder: a population-based study. J Child Neurol 28:120-123, 2013.

20. Gage TW, Pickett FA. Mosby’s dental drug reference. 6th edn. St. Louis: Mosby; 2003.

21. Callahan AM, Marangell LB, Ketter TA. Evaluating the clinical significance of drug interactions: a systematic approach. Harv Rev Psychiatry 4: 153-158, 1996.

22. Haas DA. Adverse drug interactions in dental practice: interactions associated with analgesics—part III in a series. J Am Dent Assoc 130: 397-407, 1999.

23. Ganzberg S. Psychoactive drugs. In: Ciancio SG, ed. ADA Guide to Dental Therapeutics. 3rd edn. Chicago: American Dental Association; 382- 411, 2003.