Attention-deficit hyperactivity disorder and oral health in children and adolescents: a systematic review.

Purpose: This systematic review investigates ADHD's impact on oral health, comprised of dental caries, periodontal status, oral health-related behaviors and traumatic dental injuries, in children and adolescents.

Methods: A systematic search strategy was conducted on 6 electronic databases: PubMed, COCHRANE, SCOPUS, ScienceDirect, WebOfScience and Virtual Health Library. Studies investigating oral health outcomes (caries, periodontal health, oral hygiene behaviors, traumatic dental injuries) in subjects aged 6-18 years old and diagnosed with or screened positively for ADHD were included.

Results: Seventeen studies (sample sizes: 34 to 851) were reviewed. Four of fourteen studies reported significantly higher caries (DMFT scores or prevalence) in children with ADHD (e.g., $p<0.001$ ). Poorer oral hygiene was noted in 2 of 5 studies (significant plaque index differences, $p=0.022$ , 0.012). Children with ADHD were also less likely to brush daily (63.3% vs. 83.3%; OR = 0.40, 95% CI: 0.18-0.91). Dental trauma incidence was higher in 4 of 7 studies ( $p=0.022$ - $<0.001$ ). Periodontal health results were mixed. Overall, children with ADHD showed poorer oral health outcomes compared to controls.

Conclusion: Although trends suggest that children with ADHD may be at increased risk for dental caries, trauma, and suboptimal oral hygiene, current evidence remains inconclusive due to methodological limitations and variability across studies. These findings nonetheless highlight the need of heightened awareness and tailored dental care strategies from clinicians and parents. Given the prevalence of ADHD, practitioners must recognize its impact on oral health and adapt their preventive and management approaches to provide inclusive, effective care.