Oral health status and associated influencing factors in children with attention-deficit/hyperactivity disorder: a case-control study.

چکیده اصلی

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is the second most prevalent chronic pediatric condition worldwide. Its core ADHD symptoms-inattention, hyperactivity, and impulsivity-impair oral hygiene behaviors, and first-line medications such as methylphenidate may further increase oral disease risk. However, systematic epidemiological data on oral health status of children with ADHD remain limited in China. This study aimed to investigate oral health status of children with ADHD and identify factors associated with adverse oral health outcomes in this population. METHODS: This case-control study included 130 children with ADHD and 143 age-matched healthy controls (6-12 years old) recruited from Dezhou Maternal and Child Health Hospital, Shandong Province, China, between July and December 2025. Oral examinations assessed dental caries (using the DMFT index for permanent teeth and dmft index for primary teeth, collectively reflecting the mixed-dentition caries burden), caries activity (Cariostat), periodontal status (Plaque Index [PI], Modified Gingival Index [MGI]), malocclusion, and dental trauma. Parent-reported questionnaires collected data on oral health behaviors, socioeconomic characteristics, and medication use. Between-group differences were analyzed using the Mann-Whitney U test, chi-square test, and Fisher exact test. Multivariate logistic regression with backward likelihood ratio selection was used to examine factors associated with adverse oral outcomes after adjusting for confounders. The English versions of the questionnaires are provided in Supplementary Files 1 and 2. RESULTS: The ADHD group had significantly higher overall dental caries prevalence (80.77% vs. 52.45%, P < 0.001), higher median DMFT+dmft scores (3 vs. 1, P < 0.001), higher plaque index (PI) scores (2 vs. 1, P < 0.001), higher modified gingival index (MGI) scores (2 vs. 1, P < 0.001), and higher Cariostat values (P < 0.0001) than the control group. In contrast, the fissure sealant rate was significantly lower in the ADHD group (6.15% vs. 47.29%, P < 0.001). Multivariate analysis showed that methylphenidate use (adjusted odds ratios [aOR] = 39.65, 95% CI: 15.79-271, P < 0.001) and frequent candy consumption (aOR = 84.54, 95% CI: 12.2-584, P < 0.001) were associated with higher odds of dental caries in the adjusted model. In contrast, a higher parental education level (college degree or above) was associated with lower odds of dental caries (aOR = 0.10, 95% CI: 0.014-0.684, P = 0.019). Perfunctory toothbrushing (aOR = 8.78, 95% CI: 3.12-24.71, P < 0.001) was associated with higher odds of poor oral hygiene (PI ≥ 2), whereas higher household income (aOR = 0.29, 95% CI: 0.12-0.74, P = 0.009) and twice-daily toothbrushing (aOR = 0.14, 95% CI: 0.05-0.43, P = 0.001) were associated with lower odds of poor oral hygiene (PI ≥ 2). For gingivitis (MGI ≥ 2), higher household income (aOR = 0.33, 95% CI: 0.13-0.84, P = 0.019) and parental supervision of toothbrushing (aOR = 0.11, 95% CI: 0.04-0.31, P < 0.001) were associated with lower odds of gingivitis, whereas longer disease duration (aOR = 11.30, 95% CI: 3.78-33.75, P < 0.001) was associated with higher odds of gingivitis. Notably, the wide confidence intervals for these adjusted odds ratios indicate limited precision for quantifying exact effect magnitudes, and the case-control design precludes causal inference; all reported associations should therefore be interpreted with caution. Children with ADHD in this cohort exhibited significantly poorer oral health than healthy controls, characterized by higher rates of dental caries, poorer oral hygiene, and more severe gingival inflammation. These adverse oral health outcomes were associated with ineffective oral hygiene practices, frequent high-sugar dietary habits, ADHD-related neurobehavioral characteristics, and socioeconomic factors. Comprehensive oral health interventions integrating preventive clinical care, behavioral support, family involvement, and socioeconomic assistance are urgently needed for this population.

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