A Practical Approach to Special Care in Dentistry. Группа авторов

there is no longer the requirement that the symptoms create impairment by age 12, just that they are present

       ADHD subtypes include:Predominantly inattentivePredominantly hyperactive–impulsiveCombined subtype

       It may be further classified as mild, moderate or severe

      Management

       Behavioural therapy, emotional counselling, specialised educational help and practical support along with parental education are required

       Medication (Table 2.1.2)The selection of drugs to manage ADHD depends on the presenting featuresStimulants are the most effective treatment in both children and adultsSedatives and tranquillisers should be avoided as they may impair any associated learning ability or cause a paradoxical reaction such as aggressive behaviourIn some cases, antidepressants and antihypertensive agents have also been successfully administered

      Prognosis

       ADHD can have a serious and long‐lasting impact on a person's life

       By the age of 25, an estimated 15% of people diagnosed with ADHD as children still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives

       When symptoms are effectively managed, the quality of the person's life improves – this in turn leads to increased confidence and motivation to continue a healthy pathway towards a meaningful and fulfilling life

       Untreated ADHD is very disruptive to a person's day‐to‐day functioning and can cause negative consequences at home, work and school

       Adults with untreated ADHD are more likely to develop a substance abuse disorder as they depend on legal and illegal drugs to control their symptomsTable 2.1.2 Medical management of attention deficit and hyperactivity disorder.SymptomMedicationSystemic side‐effectsOral side‐effectsHyperactivity, inattention, impulsivityStimulantsAmphetamineDextroamphetamineMethylphenidateDexmethylphenidateTachycardiaIncrease in blood pressureMotor ticsDyskinesiasErythema multifomeXerostomiaDysgeusiaBruxismNon‐stimulantsAtomoxetineTachycardiaIncrease in blood pressureXerostomiaAntihypertensivesClonidineGuanfacineDrowsinessDizzinessXerostomiaDysgeusiaDysphagiaHyperactivity, inattention and repetitive behavioursAtypical antidepressantsBupropionSuicidal riskAngio‐oedemaXerostomiaDysgeusiaDysphagiaBruxismStomatitisGlossitisTricyclic antidepressants (TCAs)AmitriptylineDesipramineImipramineBlurred visionConstipationWeight gainTachycardiaSuicidal riskXerostomiaDysgeusiaStomatitisSialadentitisAggressive behavioursAntipsychoticsOlanzapineRisperidonePaliperidoneStiffnessRestlessnessWeight gainConstipationXerostomiaSialorrhoeaDysphagiaDysgeusiaStomatitisTongue dyskinesiaAnticonvulsantsCarbamazepineValproateLamotrigineNauseaVomitingDizzinessAngio‐oedemaXerostomiaDysgeusiaStomatitisGlossitis

       Impulsive behaviours cause workplace, financial and legal challenges

       There is a positive association between ADHD and suicidality in both sexes and in all age groups

      A World/Transcultural View

       The concept of ADHD first emerged in the USA and from there it spread to all parts of the world during the late 1950s, to be become a global phenomenon

       Recent studies have concluded that the global rate of ADHD is approximately 5%

       However, there are significant differences in how ADHD has been diagnosed and the support that is available in different countries and regions. This is largely due to variable cultural factors and how conditions associated with behavioural and educational challenges are viewed across the globe

Recommended Reading

      1 Bimstein, E., Wilson, J., Guelmann, M., and Primosch, R. (2008). Oral characteristics of children with attention deficit hyperactivity disorder. Spec. Care Dentist. 28: 107–110.

      2 Blomqvist, M., Holmberg, K., Fernell, E. et al. (2006). Oral health, dental anxiety, and behavior management problems in children with attention deficit hyperactivity disorder. Eur. J. Oral Sci. 114: 385–390.

      3  Broadbent, J.M., Ayers, K.M., and Thomson, W.M. (2004). Is attention deficit hyperactivity disorder a risk factor for dental caries? A case control study. Caries Res. 38: 29–33.

      4 Friedlander, A.H., Yagiela, J.A., Mahler, M.E., and Rubin, R. (2007). The pathophysiology, medical management and dental implications of adult attention‐deficit/hyperactivity disorder. J. Am. Dent. Assoc. 138: 475–482.

      5 Kemper, A.R., Maslow, G.R., Hill, S., et al. Attention Deficit Hyperactivity Disorder: diagnosis and treatment in children and adolescents. Report No. 18‐EHC005‐EF. Rockville, MD: Agency for Healthcare Research and Quality. (2018).

      6 Kerins, C.A., McWhorter, A.G., and Seale, N.S. (2007). Pharmacologic behavior management of pediatric dental patients diagnosed with attention deficit disorder/attention deficit hyperactivity disorder. Pediatr. Dent. 29: 507–513.

      7 Souto‐Souza, D., Mourão, P.S., Barroso, H.H. et al. (2020). Is there an association between attention deficit hyperactivity disorder in children and adolescents and the occurrence of bruxism? A systematic review and meta‐analysis. Sleep Med. Rev. 53: 101330.

      8 Weibel, S., Menard, O., Ionita, A. et al. (2020). Practical considerations for the evaluation and management of Attention Deficit Hyperactivity Disorder (ADHD) in adults. Encephale 46: 30–40.

2.2 Autism Spectrum Disorders

      Section I: Clinical Scenario and Dental Considerations

      Clinical Scenario

      A 28‐year‐old patient presents to your dental clinic due to self‐injury to the palate using a fork; he is accompanied by his mother. She suspects toothache as the trigger, as her son had previously been putting his fingers into the corner of his mouth and slapping his face on the right side.

      Medical History

       Autism spectrum disorder

       Chronic sleep disorder

       Self‐harm episodes

       Avoidant/Restrictive food intake disorder (ARFID)

       Surgery as a child to correct an aortic stricture

      Medications

       Haloperidol

       Levomepromazine

       Biperiden

      Dental History

       Dental treatment under general anaesthesia 10 years earlier

       No previous dental treatment provided with local anaesthesia

       Patient brushes his teeth himself 3 times a day (supervised/assisted by his mother twice daily, namely morning and at night)

       Still uses the same brand of children's toothpaste as he finds adult toothpastes too strong in taste

      Social History

       Lives with his parents

       His mother is highly involved in taking care of him

       During the day, the patient attends a specialised centre and participates in craft workshops

       Non‐verbal