The effects of psychostimulants on oral health and saliva in children with attention deficit hyperactivity disorder: A case-control study

Abstract

Introduction: This study investigated the dental health problems and saliva characteristics of children under psychostimulant therapy for attention‑deficit hyperactivity disorder (ADHD).

Materials and Methods: One hundred and twenty children aged 7–12 years were divided into three groups. Groups 1–2 comprised children diagnosed with ADHD: those who had not yet started psychostimulant therapy (Group 1) and those already receiving long‑term psychostimulant therapy (Group 2). Group 3 comprised healthy, nonmedicated children. Possible side effects of psychostimulants were investigated at the beginning of study in Group 2 and after 3 months drug use in Group 1. Bruxism and dental erosion prevalence, salivary Streptococcus mutans count, buffering capacity, and stimulated salivary flow rate (SSFR) were measured, and salivary α‑amylase, calcium, total protein, and proline‑rich acidic protein (PRAP) levels were quantified in the beginning of the study. Data were analyzed using the Kruskal–Wallis test.

Results: The most frequently reported side effects of psychostimulants were decreased appetite, dry mouth, and increased fluid consumption. The prevalence of bruxism and dental erosion was higher in Groups 1 and 2 than in Group 3, but the differences were not significant (P > 0.05). In Group 2, subjective dry mouth feel was reported by 32.5% of patients and 17.5% had a very low SSFR. Salivary α‑amylase, calcium, total protein, and PRAP levels were lower in Group 2 than the others, but the differences were not significant (P > 0.05).

Conclusions: ADHD and psychostimulant therapy do not appear to be significantly related to decreasing SSFR or protective saliva components against dental caries. However, a systematic investigation of the long‑term safety of psychostimulants is needed. The most effective method of maintaining dental health of children with ADHD is frequent appointments focusing on oral hygiene practices accompanied by dietary analyses.

Keywords: Attention‑deficit hyperactivity disorder, bruxism, dental erosion, dry
mouth, psychostimulants, saliva biochemical components, salivary flow rate