Original article
Dental malocclusion among children with attention deficit hyperactivity disorder

https://doi.org/10.1016/j.ajodo.2019.10.016Get rights and content

Highlights

  • We assessed malocclusion in children with attention deficit hyperactivity disorder.

  • Children with ADHD have a higher severity of dental malocclusion.

  • Children with ADHD present more dental rotation.

  • Children with ADHD have more parafunctional oral habits.

  • Children with ADHD present more bruxism and pacifier use during infancy.

Introduction

Children with attention deficit hyperactivity disorder (ADHD) have more sleep breathing problems and parafunctional oral habits than individuals without ADHD. However, there is scarce information on the correlation between their dental malocclusion and these functional disorders. The objective of this study was to assess the severity of malocclusion in patients with and without ADHD and to evaluate the correlation between their functional disorders and dental malocclusion.

Methods

Eighty-eight patients aged 6-17 years were divided into 2 groups: ADHD (n = 44) and control (n = 44). A medical questionnaire to assess functional disorders and an orthodontic examination to evaluate malocclusion were completed for each patient. Distribution of the data was evaluated using Shapiro-Wilk test, whereas the 2 groups were compared with a t test, Mann-Whitney U test, Fisher exact test, and Spearman correlation. The association between parafunctional oral habits, ADHD drug intake, and malocclusion severity were assessed with a t test and Mann-Whitney U test.

Results

Patients with ADHD had significantly higher severity of malocclusion (P = 0.042), more dental rotation (P = 0.021) and more parafunctional oral habits (P = 0.001), specifically bruxism (P = 0.005), and a history of pacifier use (P = 0.009), than the control group.

Conclusions

It is important to be aware of the increased risk of parafunctional oral habits and dental malocclusion among ADHD patients to develop preventive programs, as well as therapeutic strategies for them.

Section snippets

Material and methods

This cross-sectional study was carried out at the Orthodontic Clinic of the Université de Montréal and the Division of Dentistry of the Montreal Children's Hospital in Quebec, Canada. The study received ethics approval from the ethics committees of both participating institutions, and informed consent was provided by all children and their parents.

Children aged between 6 and 17 years with a medical diagnosis of ADHD were included in this study. Eligible children were those in mixed or permanent

Results

Interrater reliability for the DAI calculated with the intraclass correlation coefficient was 0.818, which was considered as excellent for this study. A total of 88 patients were included in this study, and the sample was equally divided between the 2 groups: ADHD group (n = 44) and control group (n = 44). Characteristics of study participants are shown in Table I. Seventy percent of the participants in both groups were male, and the mean age was 11 years.

In the ADHD group, most patients were

Discussion

Dental malocclusion significantly impairs children's appearance, oral function, psychosocial well-being, and quality of life. The more severe the malocclusion, the worse are the consequences that can be expected, including multiple functional problems such as pain, traumatic occlusion, and chewing problems.18 Understanding the malocclusion of specific subgroups of the population, such as children with ADHD, is therefore critical for the development of preventive and interceptive orthodontic

Conclusions

Children with ADHD presented significantly higher DAI scores, more severe dental rotation, and more parafunctional oral habits than the control group. Considering the increased risk of parafunctional oral habits and dental malocclusion among children with ADHD, our results highlight the need for developing preventive orthodontic programs as well as therapeutic strategies for this population.

Acknowledgments

The authors thank the children who participated in this study. In addition, the authors thank the staff of the Division of Dentistry of the Montreal Children's Hospital, as well as Dr Shuvo Ghosh and Jodi Paterson, for their invaluable contributions in the recruitment of patients.

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    All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and none were reported.

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