Patients with attention-deficit/hyperactivity disorder (ADHD) may be at greater risk of orthodontic treatment problems and reduced behavioral cooperation, according to a systematic review published on January 17 in BMC Oral Health.
This study highlights the importance of early identification, collaboration, and customized behavioral strategies to achieve successful orthodontic outcomes in those with ADHD, the authors wrote.
“Individuals with ADHD may be at increased risk of lower orthodontic treatment adherence, more frequent parafunctional oral habits, and greater behavioral management demands compared with neurotypical peers,” wrote the authors, led by Dr. Martin Baxmann of the department of orthodontics at DTMD University in Wiltz, Luxembourg.
As a condition characterized by inattention, impulsiveness, and hyperactivity, ADHD may affect cooperation and compliance in dental settings. In orthodontics, which requires patients to adhere to long-term treatment, the presence of ADHD may pose challenges that affect treatment outcomes.
To explore whether individuals with ADHD show different patterns of compliance, appliance breakage, treatment relapse, and behavioral cooperation compared to those without the condition, 20 studies were reviewed. Studies were eligible if they reported on orthodontic treatment outcomes in individuals diagnosed with ADHD.
Of the studies, 14 were cross-sectional, three were retrospective cohorts, and three were prospective observational designs. Most of the studies had a risk of bias that ranged from moderate to serious. Only three of the studies were rated as low risk, the authors wrote.
Patients with ADHD consistently exhibited increased rates of appliance breakage, lower cooperation scores, and more frequent treatment disruptions compared to those without the condition.
Additionally, bruxism, nail biting, and poor oral hygiene were more often reported in individuals with ADHD, they wrote.
Nevertheless, this review had limitations, including that there were no adjustments for possible confounders, including socioeconomic status or neurodevelopmental conditions, the authors wrote.
“An ADHD diagnosis should heighten clinical awareness and prompt additional support: orthodontists may need to adapt time management in the clinical setting, modify communication strategies, and structure follow-up more proactively, in collaboration with caregivers and, where appropriate, mental health professionals,” Baxmann and colleagues wrote.
