Traumatic dental injuries and attention-deficit/hyperactivity disorder: is there a link?

Do binge drinking adolescents have a greater number of traumatised teeth? A longitudinal study with 12-year-olds in Brazil

BACKGROUND

Binge drinking has been linked to traumatic dental injury (TDI). Once drunk, adolescents are more prone to accidents, which may result in orofacial injury.

AIM

This study evaluated the possible association of binge drinking with a number of traumatised teeth in a population of 12-year-old Brazilian adolescents in 2013 and 2015.

DESIGN

This study was longitudinal, carried out with 588 adolescents at two moments, 2013 and 2015. TDI, overjet and lip protection were assessed by calibrated examiners. Binge drinking data were collected through the Alcohol Use Disorders Identification Test. Sociodemographic indicators were obtained through a questionnaire answered by the parents/guardians. The Poisson regression model with a random effects intercept was estimated.

RESULTS

A higher prevalence of traumatised teeth was observed among adolescents who binge drink (IRR = 1.37; 95% CI: 1.05-1.80; p < .05). The prevalence was also significantly higher among adolescents in this age range with a ≥ 3-mm overjet and those with inadequate lip protection (IRR = 1.99; 95% CI: 1.44-2.76; p < .001 and IRR = 3.41; 95% CI: 2.57-4.53; p < .001, respectively).

CONCLUSION

A greater number of traumatised teeth were found among adolescents who reported binge drinking and had severe overjet and inadequate lip coverage.

What are the Characteristics of Oral Injuries Caused by Playground Equipment?

PURPOSE

Studies regarding oral injuries from playground equipment in children remain limited. This study aimed to clarify the characteristics of oral injury caused by playground equipment and identify associations with concomitant head injury.

METHODS

Children treated between 2011 and 2021 at an oral surgery clinic for oral injuries from playground equipment were retrospectively investigated. The following factors were analyzed: demographic characteristics, mechanism of injury, type of equipment causing the injury, classification of oral injury, and whether the Department of Emergency and Critical Care Medicine was consulted regarding the head injury. The data collected were statistically analyzed using the Fisher-Freeman-Halton test with significance adopted at the 5% level.

RESULTS

This study analyzed data from 82 children. Injuries were concentrated in age groups of 2 to 3 years (32.9%), 4 to 5 years (28.0%), and 6 to 7 years (25.6%). Regarding the mechanism of injury, falls were more common (89.0%) than impact/striking (11.0%). The type of equipment most frequently causing injury was slides (29.3%), followed by swings (23.2%) and iron bars (18.3%). Injuries were classified as soft tissue injury alone (56.1%) or tooth injury and/or jaw fracture (43.9%). Consultation with the Department of Emergency and Critical Care Medicine for head injury was uncommon (13.4%), and all consultations for brain injury diagnosed minor injuries.

CONCLUSION

Oral injuries caused by playground equipment were frequent between 2 and 7 years old. The most common cause was falls, with most injuries caused by slides, swings, or iron bars. Approximately half of the oral injuries were soft tissue injuries only, while the other half were associated with tooth and/or jaw injuries. Department of Emergency and Critical Care Medicine consultations for head trauma were uncommon and consistently confirmed minor injuries.

Dental trauma in children and adolescents with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis

AIM

Attention-deficit/hyperactivity disorder (ADHD) is a childhood neurodevelopmental disorder primarily characterized by inattention and hyperactivity that affects approximately 7.2% of children and adolescents worldwide. This study aimed to assess whether children and adolescents with ADHD were more likely to have dental trauma when compared to their healthy peers.

METHODS

This study was reported following the statements proposed in MOOSE (Meta-analyses Of Observational Studies in Epidemiology). PubMed, Web of Science, Scopus, Embase, APA PsycINFO, LILACS, and grey literature were searched until October 2022. Observational studies with a control group were eligible. The risk of bias was assessed using the Newcastle-Ottawa Scale. The meta-analysis was performed using the R language. GRADE (Grading of Recommendations Assessment, Development and Evaluation) was applied.

RESULTS

A total of 239 studies were detected; of these, six were included in the qualitative synthesis and four were merged in the meta-analysis (OR = 1.80 [1.16-2.80]; I2  = 18.6% [0.0%-87.5%]). The risk of bias was high. The strength of the evidence was "very low."

CONCLUSION

Children and adolescents with ADHD are more likely to have dental trauma than their non-ADHD peers. However, due to limitations in the design of the included studies, a causal relationship cannot be established.

Is Histamine and Not Acetylcholine the Missing Link between ADHD and Allergies? Speer Allergic Tension Fatigue Syndrome Re-Visited

Speer allergic tension-fatigue syndrome (SATFS) is a classic allergy syndrome characterized by allergy-like symptoms, muscle tension, headaches, chronic fatigue, and other particular behaviors that were initially described in the fifties. The particular behaviors displayed include symptoms such as hyperkinesis, hyperesthesia (i.e., insomnia), restlessness, and distractibility, among others. Interestingly, these symptoms are very similar to descriptions of attention deficit hyperactivity disorder (ADHD), the most prevalent neurodevelopmental disorder worldwide, which is characterized by inattention, hyperactivity, and impulsivity. The clinical description of SATFS precedes the nomination of ADHD in 1960 by Stella Chess. In this conceptual paper, we stress that there is a gap in the research on the relationship between ADHD and allergic pathologies. The hypotheses of this conceptual paper are (1) SATFS is probably one of the first and best historical descriptions of ADHD alongside a common comorbidity (allergy) displayed by these patients; (2) SATFS (ADHD) is a systemic disease that includes both somatic and behavioral manifestations that may influence each other in a bidirectional manner; (3) The role of neuroinflammation and histamine is key for understanding the pathophysiology of ADHD and its frequent somatic comorbidities; (4) The deficiency of the diamine oxidase (DAO) enzyme, which metabolizes histamine extracellularly, may play a role in the pathophysiology of ADHD. Decreased DAO activity may lead to an accumulation of histamine, which could contribute to core ADHD symptoms and comorbid disorders. Further empirical studies are needed to confirm our hypotheses.

Oral Health Status and Caries Experience in Children Diagnosed with Attention-deficit Hyperactive Disorder

Aim

The present study aimed to assess and evaluate oral hygiene status and oral hygiene behaviors among children with the attention-deficit hyperactive disorder (ADHD) and children without ADHD.

Materials and methods

A total of 34 children of ages 6-14 years were included in the study. Groups I-17 children with ADHD and group II-17 healthy children. A visual examination of dental caries and traumatic injuries was performed, and the oral hygiene status of these children was determined. The parent/guardian completed a structured questionnaire regarding the child's oral hygiene practices and food habits. Data obtained from oral examination and questionnaires were compiled and subjected to statistical analysis.

Results

The student t-test and the Chi-squared test showed that children with ADHD had significantly higher decayed, missing, and filled teeth (DMFT) scores and incidence of traumatic injuries without significant difference in oral hygiene status.

Conclusion

There is no significant difference in oral hygiene status between both the groups but caries experience, and incidence of traumatic injuries are high in children with ADHD.

How to cite this article

Reddy ER, Kiranmayi M, Mudusu SP, et al. Oral Health Status and Caries Experience in Children Diagnosed with Attention-deficit Hyperactive Disorder. Int J Clin Pediatr Dent 2022;15(4):438-441.

Knowledge of Iranian Parents of Elementary School Children about Traumatic Dental Injuries and its Management

Statement of the Probelm:

Traumatic dental injuries (TDIs) are frequent events during childhood, and emergency management of these injuries has positive outcomes.

Purpose:

The aim of this study was to evaluate the knowledge of parents of school-aged children about dental trauma and to identify the effect of demographic variables such as age, gender, and education on their responses.

Materials and Method:

300 parents of elementary school children were selected through cluster sampling from July 2012 to January 2013 in Yazd, Iran. A questionnaire was designed to collect the data on parents’ knowledge about emergency management of dental trauma, and their demographic characteristics and previous experiences. Statistical analysis of data was performed by SPSS software version 11 using T-test and ANOVA. P-values less than 0.05 were considered significant.

Results:

296 out of 300 participants returned their questionnaires (mean age 33.8± QUOTE ± 5). The parents’ knowledge about TDI managements was inadequate (average score = 7.03). According to T-test and ANOVA statistical tests, there was no significant relationship between knowledge and age (p= 0.155), gender of parents (p= 0.113), gender of children (p= 0.776), occupation (p= 0.112), and the information source (p= 0.160). The relationship between parents’ knowledge and parental educational level was statistically significant (p= 0.010), and least significant difference (LSD) test showed that knowledge score of parents with Bachelor’s degree or higher educational levels (7.83±4) was significantly more than other parents who were not educated (6.97±4), or had high school diploma (6.70±4).

Conclusion:

Majority of parents had little knowledge about TDI and emergency management of avulsed permanent teeth in children. Therefore, it seems that educational programs are necessary to improve parents’ knowledge.

Clarifying the effect of refractive errors and stereopsis on traumatic dental injuries in childhood

BACKGROUND/AIM

Visual acuity and stereopsis both play an important role in developing posture and balance in children. The aim of this study was to investigate whether children with traumatic dental injuries (TDI) have abnormal stereopsis, due to a reduction in visual acuity, compared to children with good dental health.

MATERIAL AND METHODS

A total of 140 participants (75 with traumatic dental injuries resulting from falls and crashes, and 65 age-matched controls without dental trauma) were enrolled in this prospective, cross-sectional study. The participants underwent complete dental and ophthalmologic examinations. After the ophthalmologic examination, the stereo acuities were assessed by a Titmus stereo test at 40 cm.

RESULTS

Titmus test scores were significantly worse in the TDI group (mean score 252.46 ± 629.12 seconds of arc) compared to the control group (mean score 56 ± 27.39 seconds of arc) (P < .05). The percentage of subjects with abnormal Titmus test scores was higher in the TDI group (28%) than in the control group (3.1%). The mean anisometropia value was 3.03 ± 2.37 D and 0.55 ± 0.41 D in the TDI group and the control group, respectively (P < .001). The severity of anisometropia correlated with the degree of stereopsis (r = .83, P < .01).

CONCLUSIONS

The presence of abnormal stereopsis may lead to postural instability which can lead to traumatic dental injuries. The prevalence of abnormal stereopsis in children with TDI was higher than in children with good binocular vision and stereopsis.

Emergency department attendance for injury and behaviours suggestive of attention deficit hyperactivity disorder (ADHD): a cross-sectional study

Background

The study aimed to investigate if the behaviours suggestive of ADHD were more frequent in a population of children attending the Emergency Department (ED) for injuries, rather than for other causes.

Methods

A cross-sectional study was carried out. Patients, aged 6 to 17 years, attending the ED for acute injuries and other causes were considered cases and controls, respectively. We used a questionnaire, which investigates the presence in the child of inattention, hyperactivity, and impulsivity. The primary outcome was the number of children with behaviours suggestive of ADHD in cases and controls.

Results

Five hundred forty-five children were enrolled, 251 with injuries and 294 with other complains. Twenty two out of two hundred fifty one (9%) children visited for injuries, and 30 out of 294 (10%) visited for other causes had behaviours suggestive of ADHD (p = 0.661). Among these cases, children with evocative ADHD scores had a higher probability (OR 4.52; 95% CI 1.45–14.04; p = 0.009) of having had more than five previous ED accesses due to injury, compared to the others.

Conclusions

This study did non shown a difference in behaviours suggestive of ADHD between cases and controls, but identified a population of children with behaviours suggestive of ADHD who more frequently access the ED for injuries.

Attention-Deficit Hyperactivity Disorder Symptoms in A Group of Children Receiving Orthodontic Treatment in Turkey

Objective

Children with attention-deficit hyperactivity disorder (ADHD) are known to have several oral health problems, particularly traumatic dental injuries, decayed or filled teeth, and poor oral hygiene. The objective of the present study was to determine the ADHD symptoms in a group of patients with malocclusion and receiving orthodontic treatment.

Methods

A total of 88 subjects with a diagnosis of malocclusion between aged 8 and 17 years were included in the study. Socio-demographic characteristics, breastfeeding history, oral habits, and dental trauma history of the subjects were acquired by a detailed questionnaire. Subjects and their parents completed questionnaires addressing ADHD, other psychiatric problems, and dental health impact on the quality of life. During the orthodontic examination, the Index of Complexity, Outcome, and Need was applied to confirm the diagnosis of malocclusion.

Results

Parent-reported psychiatric complaint occurred in almost half of the patients (n=38, 43.2%); the most frequent psychiatric complaints were inattention (n=22, 25%), opposition (n=13, 14.8%), and hyperactivity (n=11, 12.5%). The estimated ADHD prevalence according to parent measure was 15.9% (n=14). Self-report measures revealed that 18.4% (n=16) had behavioral symptoms. The most affected quality of life domain was psychological discomfort.

Conclusion

The findings indicate that ADHD prevalence in children with malocclusion is high. The orthodontists should have a keen eye on behavioral problems.

Sequelae in permanent teeth after traumatic injuries to primary dentition

Traumatic injuries to the primary dentition are critical events in dentistry not only due to the need for urgent care, but also since they have potential sequelae in the permanent dentition, with a prevalence ranging from 12% to 74%. The aim of this article was to provide an overview of the prevalence, etiology, and clinical and radiographic characteristics as well as the management of permanent teeth sequelae resulting from traumatic injuries to their deciduous predecessors. An extensive literature review was performed to reveal the current evidence on enamel discoloration with or without hypomineralization/hypoplasia, crown dilaceration, odontoma-like malformation, root anomalies, partial or complete arrest of root formation, sequestration of the permanent tooth germ, and eruption disturbances.

Accident patterns in trauma surgery patients with and without self-reported ADHD

Attention deficit/hyperactivity disorder (ADHD) has been associated with a higher risk for accidents and injuries, leading to increased mortality. The objective of this study was to identify the types and mechanisms of accidents in a group of adult trauma victims with self-reported ADHD compared to a control group, based on Adult ADHD Self-Report Scale Version 1.1 (ASRSv1.1). A semi-open/qualitative accident questionnaire was conducted with 116 recruited patients from three trauma surgery units. The adult ADHD (aADHD) group differed significantly from the control group in self-reported psychiatric co-morbidities (p = 0.012), regular psychotropic medication use (p = 0.005), other accidents in the past year (p = 0.002), substance use before the accident (p = 0.007), and overconfidence in relation to the accident (p = 0.033). Most interestingly, we found significantly greater subjective ratings for stress (p = 0.002) and stressful/pressurising events before the accident (p = 0.026) in the adult ADHD group, as well as for self-reported stress at the time when conducting the interview (p = 0.016). The data demonstrate that special attention should be paid to interventions in stress reduction and sufficient treatment of ADHD in terms of preventing accidents and injuries in aADHD. Therefore, we suggest, in addition to pharmaceutical therapy, the integration of stress-management and coping strategies into aADHD management.

Oral Health of Children and Adolescents with Attention Deficit Hyperactivity Disorder

Aim

The aim of the study was to evaluate the oral health conditions of children and adolescents with attention deficit hyperactivity disorder (ADHD).

Materials and methods

Two groups were selected: a test group comprising 51 individuals with ADHD and a control group with 50 individuals without ADHD, with ages ranging from 7 to 14 years. Through an intraoral clinical examination, the numbers of decayed, missing, and filled teeth (DMFT index), the visible plaque index (VPI), the gingival bleeding index (GBI), bruxism, and dental traumatism were verified. A questionnaire confirmed oral hygiene supervision.

Results

In the test group, the average DMFT index was 3.41 while it was 2.52 in the control group (p = 0.405). The VPI in the test and control groups was 36.84% and 24.54%, respectively (p = 0.004). The GBI was 8.37% for the test group and 4.94% for the control group (p = 0.012). The DMFT index when supervised the oral hygiene by those responsible in comparison with the nonsupervision was 1.89 and 4.31, respectively, in the test group, and 1.71 and 2.94, respectively, in the control group.

Conclusion

These data suggest that children and adolescents with ADHD present with worse oral health conditions and need greater attention from dental professionals and those responsible for their diet and oral hygiene.

Clinical significance

Attention deficit hyperactivity disorder needs a special attention. This research brings this important issue focus on oral health.

How to cite this article

Begnini GJ, Brancher JA, Guimarães ATB, et al. Oral Health of Children and Adolescents with Attention Deficit Hyperactivity Disorder. Int J Clin Pediatr Dent 2019;12(6):543–547.

Prevalência de traumatismos dentários em pacientes com distúrbio neuropsicomotor: estudo controlado

Resumo Introdução Lesões dentárias por trauma constituem experiências angustiantes em crianças, que promovem alterações tanto físicas quanto emocionais e psicológicas. Objetivo Avaliar a prevalência de traumatismos dentários em pacientes com distúrbio neuropsicomotor e comparar a indivíduos normorreativos. Material e método Avaliaram-se 120 indivíduos, sendo 60 com alterações neuropsicomotoras (grupo de estudo) e 60 normorreativos (grupo controle), de ambos os sexos, de 2 a 15 anos de idade, assistidos na Fundação de Apoio ao Deficiente do Governo do Estado da Paraíba. Os dados foram coletados por meio de questionário estruturado e exame clínico. Foi realizada análise descritiva e inferencial (teste t-student; teste Exato de Fisher), adotando-se um nível de significância de 5%. Resultado A prevalência de traumatismos dentários observada em pacientes com distúrbio neuropsicomotor foi de 20,0%, enquanto que no grupo controle foi de 16,6% (p>0,05); no grupo controle a ocorrência foi maior no sexo masculino. Os grupos diferiram quanto ao tipo de atividade no momento do trauma (p<0,05) em relação à etiologia (p<0,05) e em relação ao local de ocorrência (p<0,05). Para ambos os grupos, os dentes mais afetados foram os incisivos centrais superiores. As fraturas de esmalte, seguidas pelas de esmalte e dentina sem exposição pulpar foram as lesões mais comuns nos dois grupos. Conclusão A prevalência de traumatismos dentários em indivíduos com alteração neuropsicomotora é similar à de indivíduos normorreativos, com maior ocorrência no sexo feminino, em fase anterior à adolescência, durante atividades de rotina.

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Zusammenfassung. Etwa jedes zweite europäische Kind erleidet heute einen Zahnunfall. Die Verletzungen reichen von einfachen oder komplexeren Zahnfrakturen über diverse Arten von Dislokationsverletzungen bis hin zu Avulsionen. Während im Milchgebiss maximal ein temporärer Zahnerhalt bis zum physiologischen Zahnwechsel angestrebt wird, fehlen nach schweren Zahnverletzungen oder unfallbedingten Zahnverlusten die entsprechenden Behandlungsmöglichkeiten, die erst Erwachsenen zur Verfügung stehen. Grund ist das noch nicht abgeschlossene Kieferwachstum mit eventuellem Durchbruch weiterer bleibender Zähne, was einen Zahnersatz mit Brücken oder gar Implantaten verbietet. Daher sind richtiges Verhalten unmittelbar nach einem Zahnunfall und eine professionelle zahnärztliche Erstbehandlung essenziell für die Prognose nach einem Zahntrauma.

The attention-deficit/hyperactivity disorder model for traumatic dental injuries: a critical review and update of the last 10 years

It has been more than 10 years since the proposal of attention-deficit/hyperactivity disorder (ADHD) model as an explanatory construct for traumatic dental injuries (TDIs) in children. The aim of this review was to address developments in the study of the issue after 2005-2016. A systematic literature search covering the period from 2005 to 2016 was conducted on PubMed, the Cochrane library and Google Scholar using relevant keywords. Fourteen studies exploring the relationship between ADHD and TDIs from 2005 and onward (including the proposal paper) were identified. Of the 12 controlled studies, nine reported confirming findings for a link with ADHD in the occurrence of TDIs. More than one-third of all children with ADHD may suffer from TDIs. In ADHD children, the most common types of injury were uncomplicated/complicated crown fractures and subluxation of maxillary central incisors resulting from falls and collisions. There is also evidence that ADHD represents an independent risk factor other than the well-established risk factor of incisor overjet. Over the last 10 years, convincing evidence has accumulated that ADHD is an important and common risk factor for TDIs. Increased awareness and side-by-side work of medical, dental and mental professionals at both clinical and research settings are necessary.

Evidence-Based Considerations and Recommendations for Athletic Trainers Caring for Patients With Attention-Deficit/Hyperactivity Disorder

CONTEXT

Patients with attention-deficit/hyperactivity disorder (ADHD) can be noncompliant, impulsive, and disruptive in an athletic training or physical rehabilitation facility. Athletic trainers (ATs) are valuable and essential health care providers for active patients with ADHD. However, for a patient with ADHD to have a successful outcome in a busy athletic training environment, the AT or health care provider must tailor the treatment setting to the patient's needs.

OBJECTIVE

To educate and raise awareness among ATs about patients with ADHD and to provide ATs with strategies and tools that will allow them to treat patients with ADHD more effectively.

DATA SOURCES

We retrieved and reviewed articles from PubMed, PsychINFO, and Ovid without date restrictions. Search words were attention deficit hyperactivity disorder plus 1 of the following topics or search words: athletic training, athletics, coaching, sport, or sport psychology.

STUDY SELECTION

Any ADHD articles that were not applicable or translatable in good faith to athletic training, physical rehabilitation, or sport and exercise were excluded.

DATA EXTRACTION

Nonpharmacologic interventions were reviewed and amassed into categories from which the recommendations were created. No statistical analyses were conducted for this review.

DATA SYNTHESIS

We identified 1241 articles, and 86 met the inclusion criteria. Five groups of evidence were observed: (1) goal setting and coaching, (2) reinforcements and outcomes, (3) routines and treatment timing, (4) simplified feedback and instructions, and (5) environmental control. Reliable evidence suggests that these techniques can be translated and applied within an athletic training and physical rehabilitation setting.

CONCLUSIONS

Athletic trainers are a vital component in providing health care for patients with ADHD. Using goal contagion creates a structured environment and positive reinforcements that accommodate patients with ADHD. Furthermore, ATs may use the evidence-based recommendations in this review to create a treatment and physical rehabilitation program and space that are tailored to the needs of the ADHD patient to increase the chance of a successful outcome.

Adult attention-deficit hyperactivity disorder, risky behaviors, and motorcycle injuries: a case-control study

BACKGROUND

The aim of this study was to assess the association of motorcycle traffic injuries with motorcycle riding behavior and subtypes of attention-deficit hyperactivity disorder (ADHD) while controlling for individual correlates of motorcycle traffic injuries.

METHODS

A case-control study was carried out in 298 patients with motorcycle trauma along with 151 control patients admitted to the Shohada and Imam Reza university hospitals as the two referral specialty centers in the East Azarbyjan Province of Iran in 2013. The Persian version of the Motorcycle Riding Behavior Questionnaire and the Persian version of Conner's Adult ADHD Rating Scales (the self-report short version) were used to assess riding behavior and screen for adult ADHD, respectively. The scale has four subscales, comprising subscale A (inattention), subscale B (hyperactivity, impulsivity), subscale C (A + C), and subscale D (ADHD index). The statistical analysis was done using Stata version 11.

RESULTS

All subjects were male and aged 13-79 years. Approximately 54% of the participants were married and 13% had academic education. Approximately 18% of the motorcycle riders stated that their motorcycle riding was only for fun purposes. More than two thirds of the participants did not have a motorcycle riding license. Variables found to be significantly associated with motorcycle injuries in bivariate analysis included age, marital status, educational level, having a motorcycle riding license, using a helmet while riding, daily amount of riding, riding just for fun, riding behavior score, and ADHD scale scores. It was found in multivariate analysis that if the ADHD index (subscale D) score was used to assess the association of ADHD with motorcycle injuries, a protective role for ADHD was observed. However, the two other subscales showed a different predictive pattern for subscale A versus subscale B, with only subscale B increasing the likelihood of motorcycle traffic injuries. The score based on motorcycle rider behavior was found to be associated with motorcycle injuries. Other variables that were significant in multivariate models were the purpose of riding, educational level, economic status, and marital status.

CONCLUSION

ADHD and riding behavior scores affect the likelihood of motorcycle traffic injuries among motorcycle riders independent of other injury indicators, and include education, purpose of riding, and economic status.

Preterm birth and unintentional injuries: risks to children, adolescents and young adults show no consistent pattern

AIM

Preterm birth is associated with a number of physical and mental health issues. The aim of this study was to find out whether there was also any association between individuals born preterm in Sweden between 1984 and 2006 and the risk of unintentional injuries during childhood, adolescence and young adulthood.

METHODS

The study followed 2 297 134 individuals, including 5.9% born preterm, from 1985 to 2007 for unintentional injuries leading to hospitalization or death (n = 244 021). The males and females were divided into four age groups: 1-5 years, 6-12 years, 13-18 years and 19-23 years. Hazard ratios were calculated for falls, transport injuries and other injuries.

RESULTS

After adjusting for a comprehensive set of covariates, some of the preterm subgroups demonstrated slightly increased risks of unintentional injuries, while others showed slightly decreased risks. However, most of the estimates were borderline or non-significant in both males and females. In addition, the absolute risk differences between individuals born preterm and full term were small.

CONCLUSION

Despite the association between preterm birth and a variety of physical and mental health consequences, this study shows that there is no consistent risk pattern between preterm birth and unintentional injuries in childhood, adolescence and young adulthood.

Attention deficit-hyperactivity disorder, comorbidities, and risk situations

OBJECTIVE

Attention deficit/hyperactivity disorder (ADHD) is highly prevalent, and its symptoms often represent a significant public health problem; thus, the aim of this study was to verify emergency situations caused by certain comorbidities, or by exposing the patient to a higher risk of accidents.

DATA SOURCE

A literature search was carried out in the PubMed database between the years 1992 and 2012, using the key words "adhd", "urgency", "comorbidity", "substance disorder", "alcohol", "eating disorder", "suicide", "trauma", "abuse", "crime", "internet", "videogame", "bullying", and their combinations. The selection considered the most relevant articles according to the scope of the proposed topic, performed in a non-systematic way.

DATA SYNTHESIS

Several situations were observed in which ADHD is the most relevant psychiatric diagnosis in relation to its urgency, such as the risk of accidents, suicide risk and addition, exposure to violence, or risk of internet abuse or sexual abuse; or when ADHD is the most prevalent comorbidity and is also correlated with emergency situations, such as in bipolar and eating disorders.

CONCLUSIONS

The results show several comorbidities and risk situations involving the diagnosis of ADHD, thus reinforcing the importance of their identification for the adequate treatment of this disorder.

Accidental injuries are more common in children with attention deficit hyperactivity disorder compared with their non-affected siblings

BACKGROUND

Accidental injuries are a leading cause of paediatric morbidity and mortality. We hypothesized that attention deficit hyperactivity disorder (ADHD), a common childhood disorder characterized by behaviours such as hyperactivity and impulsivity, is a risk factor for accidental injuries. Previous retrospective studies suggested that children with ADHD have an increased injury rate, but controlled prospective studies are lacking.

METHODS

We conducted a prospective case-control study of 29 school-aged children with ADHD and their same-sex, similarly aged, non-ADHD-affected siblings. All diagnoses were made by a paediatric neurologist according to DSM-IV criteria and the children and their parents underwent a structured psychiatric interview and a battery of complementary assessments including: Child Behavior Checklist (CBCL), ADHD Rating scale and Developmental Coordination Disorder Questionnaire (DCDQ). The parents were contacted by telephone every 3 months during a 9-month follow-up period and all injuries requiring medical attention were recorded. Incidence of injuries was compared between the pairs of siblings.

RESULTS

During the follow-up period, a total of 13 injuries in 13 children with ADHD were reported, compared with six injuries in six children from the control group (Z=-2.11, P < 0.05). ADHD severity and subtype, CBCL, DCDQ and IQ scores were not predictive of injury risk.

CONCLUSIONS

School-aged children with ADHD are at higher risk of accidental injuries than their non-ADHD siblings, regardless of ADHD subtype, co-morbid psychiatric conditions, developmental co-ordination problems and environmental/familial conditions. Awareness and adequate education of parents and caregivers of children with ADHD concerning the increased injury risks are thus warranted.

Morbidity and mortality risk among the "forgotten few": why are girls in the justice system in such poor health?

The present study assessed the physical health of a population of girls sentenced to custody in a large US State via medical examinations and clinical assessments in adolescence and young adulthood. Findings indicated that injuries, obesity, and sexually transmitted diseases were the norm, with over 50% of the population meeting criteria for each of these health problems. A dose-response relationship was documented between childhood victimization and injuries and injury risk in adolescence and self-harm, HIV risk, physical health symptoms, and hospitalizations in young adulthood. The relationship between childhood victimization and poor adult physical health was fully mediated by health-risk behaviors in adolescence. Clinical and policy implications of the high mortality and morbidity risk among female juvenile offenders are discussed.

Pediatric Dental Trauma:Wide Horizon of Ignored Etiological Factors

Trauma of the oral and peroral structures are one of the most common and frequent complaints after dental caries with which a child is being referred to a dental clinic. As an emergency, we tend to treat the injuries without understanding or neglecting the cause of trauma. The different possible etiological factors are unnoticed, not revealed or not noted while taking the history of the patient. Sometimes negligence of the etiology by the dentist himself or the accompanying person could influence the prognosis and prevention. Thus, this paper is an effort towards exploring the common yet unnoticed etiological factors of pediatric dental trauma which we tend to knowingly ignore.

Caries experience and oral hygiene status of children suffering from attention deficit hyperactivity disorder

OBJECTIVE

The study was conducted to determine the caries experience and oral hygiene status of children suffering from attention deficit hyperactivity disorder (ADHD) and was compared with that of non-ADHD children.

STUDY DESIGN

A total of 80 children, including 40 ADHD and 40 non-ADHD children were included in the study. A visual dental examination for dental caries was performed and oral hygiene status of these children was determined. The parent/guardian completed a questionnaire concerning the child's behavior followed by questionnaire to the child regarding oral hygiene practices and food habits.

RESULTS

Student-t test and chi-square test showed that children with ADHD had significantly higher defs score, mean plaque score in compared to that of non-ADHD children. Statistical significant differences were also found out in relation with frequency of tooth brushing and consumption of sugary food among the children suffering from ADHD.

CONCLUSION

Caries prevalence in the primary dentition is increased in the children suffering from ADHD due to poor oral hygiene and increased consumption of sugary foods.

[Attention Deficit Hyperactivity Disorder (ADHD) and road traffic - special considerations for the treatment of adolescents with ADHD]

Attention Deficit Hyperactivity Disorder (ADHD) is not only a childhood disorder but symptoms persist into adolescence and adulthood in approximately one third of the patients. Especially inattention and poor concentration impair driving performance in road traffic. Adolescents and young adults with ADHD are twice as likely to be involved in traffic accidents as people of the same age. This review sums up the legal situation in Germany and provides an overview of the current existing experimental studies on driving performance of adolescents and young adults with ADHD. Psychostimulant therapy seems to improve driving performance in ADHD patients. At the same time psychostimulants are prohibited, according to the road traffic act. Atomoxetine as a non-stimulant is not mentioned there. Therefore it could be unproblematically prescribed, however, the evidence for improved driving is not as unequivocal as for methylphenidate. The psychoeducation of adolescents and young adults with ADHD concerning their increased risk in road traffic often seems to be insufficient in clinical practice. Given the high number of traffic deaths in these young age groups consulting regarding this matter should be of high priority.

[Orthodontic treatment of children suffering from attention deficit disorder with hyperactivity (ADHD)]

Successful orthodontic treatment requires the child's cooperation. Yet how can this be achieved when this cooperation is compromised by a neurobehavioural disorder: the attention deficit hyperactivity disorder (ADHD)? This disorder, slightly tracked down, common in children, leads to hyperactivity, impulsiveness and a short attention span. The objective of this survey is to compare the challenges of conducting orthodontic treatment on children who have or have not been diagnosed and treated by a multi-disciplinary medical team. The data of this survey was collected from orthodontists in Paris and Strasbourg, and from graduate orthodontics students. The orthodontic treatment of 30 children (25 males and 5 females) between 8 and 15 years, affected by ADHD (half have been diagnosed and treated by a multi-disciplinary team) are compared to 30 control subjects. The results highlight the therapeutic difficulties (with behavior, attention span, cooperation, hygiene and dental trauma) encountered with children affected by ADHD (especially those who did not benefit from multidisciplinary follow up) compared to control population. In conclusion, hyperactive children present more challenges during an orthodontic treatment compared to a control population. Nevertheless, the treatment is easier when children are diagnosed and treated multimodally. Further studies are required on a wider population to confirm the differences in therapeutic difficulties.

Screening for attention-deficit/hyperactivity disorder in a select sample of injured and uninjured pediatric patients

PURPOSE

Injury is the leading cause of morbidity and mortality to children. The purpose of this study is to compare attention-deficit/hyperactivity disorder (ADHD) screening results in a select group of injured pediatric patients to noninjured patients.

METHODS

Parents of patients 6 to 12 years of age were enrolled in the study. Patients were either admitted for specific injury mechanisms (n = 133) or appendicitis (n = 157). Demographic and medical data were collected, and an ADHD screening tool was administered. Logistic regression models were used to compare screening results between groups.

RESULTS

The injured patient group was 3.25 times more likely to screen positive for ADHD (odds ratio, 3.25; 95% confidence interval, 1.57-6.72; P = .002) than the appendicitis group. Among the injured patients who screened positive for ADHD, only 34.0% reported currently receiving treatment.

CONCLUSIONS

Our results suggest that pediatric patients with certain injury mechanisms may warrant screening and referral for ADHD. Appropriate identification and treatment of undiagnosed ADHD may reduce the burden of injury recidivism. Screening and referral for ADHD within a trauma service should be evaluated for effectiveness as an injury prevention initiative.