CDA Essentials 2016 • Volume 3 • Issue 8

28 | Volume 3 Issue 7 I ssues and P eople these patients. You’ll have a truly enjoyable experience and you’ll be able to build lasting, trusting relationships with these patients. Patients with ADHD: What You Need to Know � ADHD medication. Two types of drugs can be prescribed to people with ADHD: stimulants and non- stimulants. Stimulants increase the availability of dopamine and norepinephrine in the brain, which improves one’s alertness and attention span, and reduces hyperactivity. Non-stimulants also have an effect on norepinephrine, but have no impact on dopamine levels. � Appointment scheduling. Mayo recommends scheduling short morning appointments. Patients may experience increased fatigue later in the day and their medication might be wearing off by that time, making it harder for them to sit through the appointment and listen to instructions. � Oral side effects of ADHD medication. “A side effect of many stimulants is xerostomia,” Mayo explains. Other oral side effects may include bruxism, stomatitis, tongue edema, discoloured tongue, gingivitis and glossitis. � Drug interactions. ADHD medications can increase heart rate and blood pressure. When performing local anesthesia, carefully evaluate the use of vasoconstrictors and only administer low doses. Monitor the patient’s blood pressure and heart rate closely throughout the procedure. It is also important to achieve profound anesthesia to avoid endogenous epinephrine reacting with the patient’s medication. Ensure adequate aspiration and avoid intravascular injections to prevent the possibility of increasing the stimulant effect of the ADHD medication. Avoid local anesthetics containing levonordefrin for patients on atomoxetine (Strattera®) as the combination can increase blood pressure and cause cardiac dysrhythmias (irregular heartbeats). All narcotic-containing analgesics should be avoided both perioperatively and postoperatively in patients taking amphetamine and dextroamphetamine (Adderall®, Dexedrine®), especially meperidine (Demerol®), as they can increase the risk for hypotension, respiratory collapse, and serotonin syndrome. Symptoms may occur hours to days after concomitant use, particularly after dose increases. Ciprofloxacin (Cipro®), levofloxacin (Levaquin®), moxifloxacin (Avelox®) , erythromycin, azithromycin (Zithromax®), carithromycin (Biaxin®), metronidazole (Flagyl®) and fluconazole (Diflucan®) should also be avoided as they have been shown to cause irregular heart rhythms in patients currently taking amphetamine and dextroamphetamine (Adderall®, Dexedrine®). The same is also true for certain cough and allergy medications. It is therefore strongly recommended to seek medical advice before suggesting or prescribing these agents. Oral sedation can be challenging to achieve as ADHD medications affect the central nervous system. Inhalational sedation with nitrous oxide-oxygen may be the safest modality, but it is strongly suggested to seek medical advice beforehand. � Limited distractions and surprises . Sitting through a dental procedure can be an overwhelming experience for children with ADHD because of the many sensatory stimuli in the room. When treating children with ADHD, Mayo suggests limiting distractions by using music and earbuds or by turning on the television. This will help them isolate themselves from the office brouhaha. It is also important to discuss with them exactly what the appointment will entail. “Avoid surprises and let them know what will happen and when. Most of them want to know the ‘why’ behind things,” she says. “They do not like things that are just put on them with no explanation. But get to the point and do that quickly!” � Tone of voice. Keep a neutral, monotone voice, especially when giving oral care instructions. “Fluctuations in tone and volume may distract patients with ADHD, making it harder for them to pay attention to what you’re saying,” Mayo says. “Additionally, they might interpret the different tones as having different meanings.” When it comes to children with ADHD, Mayo mentions that they can be particularly sensitive to voice tones. “They’re used to getting in trouble! You don’t want them to interpret your tone as being upset with them.” � Eye contact. To keep your patient’s attention, maintain eye contact with them when performing a procedure or giving them instructions. � Time to think. When treating patients with ADHD, Mayo stresses the importance of giving them only one command at a time, and of giving them a few seconds to process the information. “Wait about 5 seconds for them to process what you’ve asked instead of repeating yourself immediately.” � Positive reinforcement. Children with ADHD respond very well to positive reinforcement. Give them praise for following your instructions and for their at-home oral health care routine. “Make sure you smile at them; give them high- fives or pats on the back,” Mayo says. “These children are usually very social and like it when adults interact them.” You can also tell them that if they follow your instructions, they will receive a reward at the end of the appointment