Toothbrushing, Oral Hygiene, and ADHD

If your child with ADHD struggles with tooth brushing or flossing, you are not alone.  A new study by researchers at the University of Hong Kong demonstrates that children with ADHD in general have worse dental hygiene than their neurotypical peers.  This was found in a variety of measures of oral hygiene including amount of gum bleeding (a common sign of gingivitis), need for assisted brushing, and brushing for less than 1 minute.   This backs up a study from earlier in the month showing that hyperactivity and inattention scores correlate with a diet that promotes cavities and with poor oral hygiene, That same study showed that patients with oppositional tendencies showed a lower frequency of  tooth brushing.  Also, it explains why cavities, or dental caries, are more common in children with ADHD. Although ADHD medication can reduce salivary flow, this does not seem to add to dental caries risk in children with ADHD. 

For many parents of children with ADHD, these findings may not be at all surprising.  Consider the following: 

• It is difficult to get a child with ADHD to remember and be motivated to carry out anything tedious and boring, like an oral hygiene routine. 
• It is  difficult to get them to stay focused for long enough to complete that routine. 
• ADHD often co-occurs with handwriting difficulties and proper tooth brushing requires a lot of the same fine motor coordination that handwriting does. 

What you can do to improve your child’s oral hygiene. 

1)      Encourage your child to avoid foods which are known to cause cavities.  Sugary foods and drinks are the main culprits here.  However foods which are high in carbohydrates can also be an issue.  The body needs some carbohydrates to function, but it’s also ok to limit noshing on crackers and cookies and to provide something like carrot sticks or apple slices instead.

2)      Use external rewards to motivate your child to stick with an oral hygiene routine.  Using a reward system puts you on your child’s side.  Instead of saying, “Brush, or else I will punish you,” you are saying, “I want to help you get your reward, go brush.”  Be aware, however, that some children will “forget” and tell you they have brushed when they haven’t.  Smell their mouth or check the toothbrush and spit cup for dampness if you aren’t sure they are remembering properly.

3)      Encourage your child to brush for longer.  For younger children, it may take you brushing with them.  For older children, using a timer (either in their head or on the counter by the sink) may be helpful.  Some people also find that listening to music can help them continue to brush if they find the brushing itself boring.  Another technique may be to brush the entire mouth once, spit, reapply toothpaste and brush the entire mouth again.

4)      Make sure that your child is ok with their brush, toothpaste, and floss.  Sometimes resistance to brushing is due to the brush being uncomfortable (think sensory processing issues) or to the paste tasting wrong (minty tooth paste can actually be painful to younger children).  Floss also can be tricky due to taste.  Most kids with ADHD should probably floss with a flosser and not plain floss until you are certain they have adequate fine motor coordination. 

5)      Visit the dentist regularly.  And see that the dentist and hygienist do their best to allay your child’s anxiety.   Not all dentists’ offices are the same in this area, and even pediatric offices may not be that well equipped to deal with a child with extreme anxiety, so if you feel uncomfortable about how your child is being handled, it’s ok to look for someone else.

Reference:

Osenberg, S. S., S. Kumar, and N. J. Williams. "Attention Deficit/hyperactivity Disorder Medication and Dental Caries in Children." Journal of Dental Hygiene 88.6 (2014): 342-47. Medline. Web. 12 Jan. 2017.

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