Is there a relationship between hyperactivity/inattention symptoms and poor oral health? Results from the GINIplus and LISAplus study

Clin Oral Investig. 2013 Jun;17(5):1329-38. doi: 10.1007/s00784-012-0829-7. Epub 2012 Aug 29.


Objectives: A few clinical observations reported that children with attention deficit hyperactivity disorder (ADHD) have poor oral health compared to children without ADHD. However, evidence is not conclusive. We assess the association between hyperactivity/inattention and oral health in a population-based study.

Material and methods: As part of the ongoing birth cohort studies German Infant Nutritional Intervention-plus (GINIplus) and Influences of lifestyle-related factors on the immune system and the development of allergies in childhood-plus (LISAplus), 1,126 children at age 10 years (±10.2) from Munich (Germany) were included in the present analysis. During the dental examination, oral hygiene, non-cavitated and cavitated caries lesions, dental trauma, and enamel hypomineralization (EH) in the permanent dentition (MIH/1) were recorded. Children with a Molar-Incisor-Hypomineralization were subcategorized into those with EH on at least one first permanent molar (MIH/1A), and on at least one first permanent molar and permanent incisor (MIH/1B). Data on children's hyperactivity/inattention symptoms were collected by parent-reported Strength and Difficulties Questionnaire. Logistic regressions and zero-inflated Poisson regression models were applied adjusted for gender, parental education, parental income, and methylphenidate or atomoxetine medication.

Results: Logistic regressions showed that non-cavitated caries lesions were positively related with the presence of hyperactivity/inattention (ORadj = 1.51,CI95% = 1.08-2.11). When adjusted for parental background, an association showed between hyperactivity/inattention symptoms and MIH/1A but did not reach statistical significance (ORadj = 1.59,CI95% = 1.00-2.53).

Conclusions: Children with borderline and abnormal values of hyperactivity/inattention symptoms showed more non-cavitated caries lesions. Severe levels of hyperactivity/inattention may contribute to a higher risk for MIH/1A in school age.

Clinical relevance: Adequate dental preventive care for children with hyperactivity/inattention, especially from a low social background, is of importance for optimal caries prevention.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Atomoxetine Hydrochloride
  • Attention Deficit Disorder with Hyperactivity / drug therapy
  • Attention Deficit Disorder with Hyperactivity / etiology*
  • Child
  • Cohort Studies
  • DMF Index
  • Dental Caries / complications*
  • Dental Enamel Hypoplasia / complications*
  • Dentition, Permanent
  • Female
  • Germany
  • Health Surveys
  • Humans
  • Logistic Models
  • Male
  • Methylphenidate / therapeutic use
  • Oral Health
  • Oral Hygiene
  • Parents
  • Propylamines / therapeutic use
  • Social Class
  • Surveys and Questionnaires
  • Tooth Injuries / complications


  • Propylamines
  • Methylphenidate
  • Atomoxetine Hydrochloride