Sinais do TDAH e funções executivas associados à experiência de cárie dentária em escolares: estudo de caso-controle

Abstract

Attention deficit hyperactivity disorder (ADHD) is one of the most common behavioral disorders in childhood that is characterized by symptoms of inattention, hyperactivity/ impulsivity at higher levels than expected for the individual's age. Children with ADHD may also present impairments in executive function, ability related to planning and organizational ability, and may trigger changes throughout the life trajectory of the individual and his family. Worse oral hygiene habits and higher prevalences of dental caries have been reported in children with ADHD. However, the scientific literature is still inconclusive, due to the scarcity of studies that evaluate the association between dental caries and ADHD in representative samples, since most of the studies are carried out in convenience samples. The aim of the present study was to evaluate the association between signs of ADHD (inattention, hyperactivity/impulsivity), executive functions and dental caries experience in schoolchildren from 7 to 12 years of age. We also investigated possible association with socioeconomic and demographic factors. Ethical approval and consent terms were obtained. A case-control study was carried out nested in a cross-sectional study. After the sample calculation, the sample consisted of 532 randomly selected children in public and private schools in the city of Diamantina, Minas Gerais. Participants were divided into two groups according to data obtained in the cross-sectional study. The case group was formed by children with dental caries experience (n = 266) and the control group by children without dental caries experience (n = 266). The case and control groups were matched (1:1) by the variables age and sex. Socioeconomic and demographic data were collected through questionnaires sent to parents. All the children were submitted to clinical examination of dental caries experience according to the DMFT/dmft indexes, to the intellectual evaluation using the Ravens Coloured Progressive Matrices test and to the evaluation of executive functions through the Corsi block tapping test and the Digit Span test. Signs of inattention and hyperactivity/impulsivity were investigated by completing the Swanson, Nolan and Pelham - version IV (SNAP-IV) scale by parents and teachers. Statistical analysis involved the frequency distribution of the data, McNemar chi-square test and conditional logistic regression (p <0.05, 95% CI). The results of the adjusted multivariate logistic regression demonstrated that children reported as inattentive by parents (OR = 2.41, 95% CI: 1.03-5.61, p = 0.041) and the lowest monthly family income (OR: 2.44 , 95% CI: 1.71-3.48, p <0.001) were significantly associated with dental caries experience. It was concluded that children considered inattentive by their parents had a higher chance of having dental caries experience, regardless of monthly family income.