Medical History

A comprehensive medical history should be completed on each patient in our dental practices. This is especially true for those patients diagnosed with ADHD.

Medical histories should include specific questions regarding:

  • ADHD diagnosis
  • Medications usage, dosage, time of day administered and if medication was taken on that day. Table 2 lists commonly prescribed medications along with side effects and interactions.17
    • Approximately 75% of those diagnosed with ADHD take medications. This represents approximately 3 million children and adolescents in the United States.13
    • ADHD medications should ideally be taken 30-60 minutes prior to the dental visit. This timing allows the medication to have its maximum drug effect (enhanced cognition and behavior).12
    • There are significant pharmacological effects that must be considered by the dental professional before treatment.3,11,12
      • Xerostomia – all medications used to treat ADHD have this as a potential side effect
      • Loss of smell acuity
      • Sinusitis – inflammation of the sinuses
      • Dysgeusia – decreased sense of taste
      • Sialadenitis – inflammation of the salivary glands
      • Stomatitis – inflammation of the mucous membranes of the mouth
      • Gingivitis
      • Glossitis – inflammation of the tongue
      • Discolored Tongue
      • Bruxism
      • Dysphagia – difficulty swallowing
      • Elevated blood pressure and heart rate - blood pressure and pulse should be performed on each ADHD patient as a significant side effect of many ADHD medications includes elevation in blood pressure.
  • Additional healthcare providers treating the patient.
    • Additional healthcare providers, including primary care physicians should be consulted if there are any questions or concerns about the patient's treatment, behavior management, and/or medications. This is especially significant if the patient has diagnosis of multiple comorbid conditions (depression, anxiety, mental retardation etc.)
  • Specific questions about illicit drugs, smoking and alcohol usage.
    • Many ADHD patients self-medicate with illicit drugs, cigarettes, and alcohol. It should be noted that those ADHD patients who are medicated with stimulants are less likely to abuse substances than their non-medicated peers.11,12
Table 2. Medications Commonly Prescribed for ADHD and their Adverse Systemic Side Effects and Interactions with Dental Therapeutics14
Drug (Trade Name)Other Common UsageSide Effects and Interactions
Methylphenidate
(Ritalin, Concerta, Methylin, Metadate)
Central Nervous StimulantMay rarely cause thrombocytopenia, leucopenia, and anemia; increased risk of experiencing myocardial infarction and cerebrovascular accident; vasoconstrictors should be used with caution, in low doses with careful aspiration; potentates arrythmogenic effects of tricyclic antidepressants.
Amphetamine and dextroamphetamine
(Adderall, Dextroamphetamine Dexedrine)
NarcolepsyAssociated with increase in pulse and blood pressure; increased risk of experiencing myocardial infarction and cerebrovascular accident; danger of hypotension and respiratory collapse with meperidine: may potentate CNS stimulation caused by large doses of propoxyphene; vasoconstrictors should be used with caution, in low doses with aspiration; potentates arrythmogenic effects of tricyclic antidepressants; anorexia and reduced weight gain in children.
Atomoxetine
(Strattera)
NoneIncreased risk of experiencing suicidal ideation; use associated with increased blood pressure and pulse; levonordefrin use should be avoided and epinephrine should be used with caution, in low doses and with careful aspiration; propoxyphene increase the stimulant effect of atomoxetine.
Bupropion
(Wellbutrin, Zyban)
Antidepressant and
Smoking Cessation
May cause CNS stimulation, including agitation, anxiety, and seizures; increased seizure activity when administered concurrently with tricyclic antidepressants
Desipramine
(Norpramin, Imipramine Tofranil)
AntidepressantMay cause orthostatic hypotension; causes antimuscarinic effects; levonordefrin should be avoided and epinephrine should be used with caution, in low doses and with careful aspiration; increases sedation of other CNS depressants