Caregivers and dental professionals play an important role in helping children to develop healthy oral hygiene habits and to feel comfortable at the dentist. For youngsters with ADHD, their introduction to dentistry often sets the tone for how they relate to oral healthcare for the rest of their lives.

ADHD often makes it difficult for a child to pay attention and control impulsive behaviors. When it comes to going to the dentist, children with ADHD may tend to feel anxious or stressed, which can make it hard for them to focus and sit still during a dental appointment. Their dentists can help them by using a positive, patient approach. Coordinated efforts between parents and providers create support that is essential for children with ADHD.

Cavities are the most common dental issue that dentists see in children with ADHD​. It can sometimes be difficult for these children to perform routine activities like brushing their teeth or flossing, and their poor oral hygiene practices put them at greater risk for cavities. In a study published by the National Center for Biotechnology Information, only 48% of children with ADHD brushed their teeth every morning and only 48% brushed their teeth every evening. This low percentage proves why it’s important to instill a dental care routine from a very young age. Another study showed that children with ADHD had nearly 12 times the odds of having a high number of diseased, missing, and filled teeth.

The second reason children with ADHD are at risk for cavities is because of medication. Medications used to manage ADHD can lead to changes in diet and appetite, which can increase a child’s risk for cavities. Side effects such as dry mouth also make these children highly prone to cavities.

First, you’ll want to find a pediatric dentist for your child with ADHD. The American Dental Association (www.ada.org) has a directory you can use to search by city, state, and specialty. You can also contact local dental clinics in your area. Here are a few questions you can ask that will help you decide which dentist is best for your loved one:

1. Do you have experience working with patients with ADHD?
   When speaking with potential dentists, listen to specific examples of when they worked with patients with ADHD. Dentists with previous experience will be more comfortable overall in ensuring that your child’s visits run smoothly.
2. Are you comfortable working with someone who has ADHD?
   The dentist you choose should be comfortable working with a patient who has additional needs. Dentists who specialize in special needs care have two to three years of extra schooling. This extra training will help them be able to care and accommodate for your child as well as help them guide you for successful dental care at home.
3. Can any special accommodations be made?
   A good dentist should be able to answer yes to this question. It should be their goal to make your child feel as comfortable as possible. Some accommodations that you may want to request include whether you can stay with them throughout their appointment, whether they can have a specific flavor of toothpaste, or if waiting room times can be reduced. These small adjustments can make a huge difference in your child’s overall dental experience.

Remember, as a parent or caregiver you are in charge, so ask any additional questions that come to your mind. The more information you can gather, the better your choice can be.

To find a dentist who accepts Medicaid, contact your state’s dental association. If you need help finding your state’s dental association, you can search for it on the American Dental Association website.

Additional questions to ask before your child’s appointment

To help prepare your child with ADHD for a dental appointment, you may find you need to ask the dentist more questions. His or her answers can help you feel confident in your child’s dental care. You will also need to discuss any specific accommodations to be made for your child ahead of time. Here are some questions to get you started.

1. Do you have anything available—such as television, music, or toys—for my child to focus on during their appointment?
   Your dentist may have movies, music, toys, or other items for your child to use during their appointment. These can be used if a child is feeling anxious about the appointment and wants something else to focus on. You can also ask to bring your child’s favorite toy or blanket or whatever would make them feel most comfortable. If your child is feeling nervous, talk with your dentist about possible ways to help ease those feelings.
2. If needed, what is your office’s plan or procedure for sedation?
   If your child is feeling extreme anxiety around their dental appointment or procedure, dental sedation may be available. Ask your dentist the types of sedation they offer and if it is the safest option for your child. If your child has any conditions or illnesses, make sure that dental sedation will not complicate anything. Your child’s safety is the number one priority for dentists and they will not want to endanger them in any way.
3. Are there any videos, brochures, or books that you have to help prepare for the appointment?
   Your dentist may have materials available to you to help prepare for your child’s dental appointment. Videos, brochures, books and other tools can help visualize for your child what their dental appointment will be like. Ask if your dentist has any tools or tips on preparing for the appointment.
4. Can I schedule a desensitization/familiarization appointment for my child?
   A desensitization appointment is an appointment for you and your child to visit the dentist office before any work or procedures are done. This is an opportunity for your child to meet the dentist and staff members as well as become familiar with sounds, tools, and other elements of a dental appointment. Most dentists are willing to schedule these kinds of appointments, so be sure to ask yours to do so.

A word about dental sedation

The key for any dentist is to find a strategy that works for each patient. A child with additional needs may benefit from dental sedation. This is sometimes necessary if a child needs dental work done and does not want—or is not able—to cooperate with the dentist. With safe, monitored techniques, sedation can make a huge difference.

Your dentist may offer a few types of sedation, including:

• Inhaled minimal sedation. The patient breathes in nitrous oxide combined with oxygen to help them relax. Your dentist will be in complete control of the medication with this method.
• Oral sedation. This can range from minimal to moderate. Oral sedation is most commonly associated with sedation dentistry. The patient is given a pill that makes them drowsy; a more moderate dose may make the patient fall asleep.
• IV moderate sedation. A sedation drug is given through the patient’s vein and works more quickly. Your dentist will be able to continually adjust the sedation levels.
• Deep sedation and general anesthesia. Medication is given that will make the patient nearly or totally unconscious. While under general anesthesia you cannot easily be awakened until the effects of the medication wear off or are reversed.

Preparing for the dental appointment

After you’ve chosen a dentist and scheduled an appointment for your child, it will be important to prepare the child for their dental visit. Preparing gives the child an idea of what to expect during the appointment. There are a number of things you can do; find what works best for you and your child.

• Help visualize what happens at the dentist. Using visuals is a great way to see what happens at the dentist. This can be done with storybooks or videos and gives the child a way to make a connection between the visuals and their dental appointment.
• Visit the dentist early. Visiting the dentist prior to the actual appointment can be beneficial because it allows children to familiarize themselves with the environment, such as seeing the lights and hearing the sounds. You and your child can meet the office and staff members and go over any other accommodations that need to be made.

Going to the dentist should be a good experience, so be sure to keep conversations about the dentist positive and informative.

Dental care and regular dental visits are essential to your child’s overall health and well-being. Certain behavioral issues may make it difficult for a child with ADHD to develop healthy oral hygiene habits, and their medications can put them at higher risk for cavities. As a parent or caregiver, never give up on your child or loved one’s dental health. Do your best to instill in them healthy dental hygiene practices, including regular check-ups.

Greg Grillo, DDS, is a 1995 University of Washington School of Dentistry graduate who has been practicing in North Central Washington for 17 years. He also served as a dental officer in the Navy. Dr. Grillo balances his clinical practice with a role as the content director at a rapidly growing dental software company and freelance dental copywriting. Learn more by visiting the practice website, www.grillorobeckdds.com. This article is adapted from Dr. Grillo’s patient education materials for www.Dentably.com.

RESOURCES & MORE INFORMATION

*Blomqvist M, Holmberg K, Fernell E, Ek U, Dahllöf G. Dental caries and oral health behavior in children with attention deficit hyperactivity disorder. European Journal of Oral Sciences. 2007 Jun;115(3):186-91. https://www.ncbi.nlm.nih.gov/pubmed/17587293

Broadbent JM, Ayers KM, Thomson WM. Is attention-deficit hyperactivity disorder a risk factor for dental caries? A case-control study. Caries Research. 2004 Jan-Feb;38(1):29-33. https://www.ncbi.nlm.nih.gov/pubmed/14684974

Dowst-Mayo L. How to work effectively with patients who have ADHD. Dental Economics. 2014 Sept:105-110.

For more information, visit  https://www.emergencydentistsusa.com/adhd-and-dental-care.