Behavioral Management of Pediatric Patients with Attention-Deficit/Hyperactivity Disorder in Dentistry: Clinical and Educational Strategies

Authors

DOI:

https://doi.org/10.29105/innoacad.v2i3.95

Keywords:

Attention Deficit Disorder with Hyperactivity, Pediatric Dentistry, Dental education

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood and is characterized by inattention, impulsivity, and hyperactivity, which can hinder cooperation during dental care. The objective of the present paper is to analyze recent scientific evidence on behavioral management strategies in pediatric dentistry for patients with ADHD. A narrative review was conducted through searches in PubMed, Scopus, and Google Scholar, prioritizing studies from the last five years related to
ADHD, behavioral management, and dentistry. Structured techniques, such as guided communication, positive reinforcement, and distraction, improve cooperation and reduce anxiety. The application of strategies adapted to the neurobehavioral profile of patients with ADHD optimizes dental care and promotes positive clinical experiences.

Downloads

Download data is not yet available.

Author Biographies

Dra.Zenaida García , Universidad Autónoma de Nuevo León

Dental surgeon graduated from the Autonomous University of Nuevo León (UANL) with a Master’s degree in Endodontics. She has experience as a faculty member in a postgraduate endodontics program, teaching both theoretical and clinical courses. She has worked as a general dentist and endodontist in the metropolitan area. She has participated in academic programs such as Women in Science and in international exchanges in Peru and Brazil. She is a member of the College of Endodontists of Nuevo León and has attended and presented at national and international conferences, receiving recognition for research and professional development.

Dra.Perla bueno , Universidad Autónoma de Nuevo León

Doctor Perla Bueno works for the Autonomous University of Nuevo Leon (UANL, for its acronym in Spanish). She has a degree in Applied Linguistics. She concluded her master's degree in Educational Psychology. She is a lecturer at the Faculty of Philosophy and Arts at the UANL. She teaches subjects such as Psycholinguistics, Psychology of Language Learning, and Communicative Competence in English. Also, she´s an English teacher at the Language Department of the UANL. She belonged to a doctoral program of Psychology with an orientation in Education. She proposes the use of guided academic tandems as a method to help students develop self-efficacy learning and improve their communicative competence.

Dra.Idalia Rodríguez , Universidad Autónoma de Nuevo León

Full-time Professor at the Faculty of Dentistry of the Autonomous University of Nuevo León (UANL). PhD in Philosophy with a specialization in International Relations, Business, and Diplomacy from the Faculty of Political Sciences and International Relations at UANL (2023). PhD in Dental Research from the University of Granada, Spain (2009). Master’s degree in Dental Sciences with a specialization in Endodontics from the Faculty of Dentistry at UANL. Undergraduate instructor in Endodontics, as well as graduate-level professor and research advisor. Member of the Academic Body of Endodontics. Author of publications in peer-reviewed and indexed journals and co-author of book chapters. Active participant in national and international conferences. Publications include: Public policy through a teleodontological education model; Antimicrobial effectiveness of root canal sealers against Enterococcus faecalis; In Vivo Evaluation of 3 Electronic Apex Locators: Root ZX Mini, Apex ID, and Propex Pixi; In vitro antimicrobial activity of CatDex against Porphyromonas endodontalis; Antimicrobial effect of Microdacyn 60, OxOral, and sodium hypochlorite 5.25% in anaerobic bacteria; and Gigantism, a pituitary pathology of relevance in interdisciplinary dentistry.

DR. Luis Angel, Universidad Autónoma de Nuevo León

Physician specialized in Pediatrics with a subspecialty in Neonatology, trained at the Autonomous University of Nuevo León (UANL). He has experience in clinical care, teaching, and research, with participation in national and international conferences and scientific publications. He has held academic and clinical positions, including Chief Resident in Pediatrics and faculty member in the Department of Embryology. He currently works as a pediatrician in university medical services and hospital emergency departments, while also serving as an academic advisor.

References

Alamri, H. (2022). Oral care for children with special healthcare needs in dentistry: Literature review. Journal of Clinical Medicine, 11(19), 5557. https://doi.org/10.3390/jcm11195557 DOI: https://doi.org/10.3390/jcm11195557

American Academy of Pediatric Dentistry [AAPD]. (2024). Behavior guidance for the pediatric dental patient. In The Reference Manual of Pediatric Dentistry (pp. 358–378). AAPD. https://www.aapd.org/globalassets/media/policies_guidelines/bp_behavguide.pdf

Armfield, J. (2006). Cognitive vulnerability model of the etiology of fear. Clinical Psychology Review, 26(6), 746–768. https://doi.org/10.1016/j.cpr.2006.03.007 DOI: https://doi.org/10.1016/j.cpr.2006.03.007

Armfield J. (2010). Development and psychometric evaluation of the Index of Dental Anxiety and Fear (IDAF-4C+). Psychological Assessment, 22(2), 279–287. https://doi.org/10.1037/a0018678 DOI: https://doi.org/10.1037/a0018678

Armfield, J., & Heaton, L. (2013). Management of fear and anxiety in the dental clinic: a review. Australian Dental Journal, 58(4), 390–531. https://doi.org/10.1111/adj.12118 DOI: https://doi.org/10.1111/adj.12118

Bagher, S., Felemban, O., Alandijani, A., Tashkandi, M., Bhadila, G., & Bagher, A. (2023). The effect of virtual reality distraction during dental treatment among anxious pediatric patients. Journal of Clinical Pediatric Dentistry, 47(4), 63–71. https://doi.org/10.22514/jocpd.2023.036 DOI: https://doi.org/10.22514/jocpd.2023.036

Bayón, G., Stiernhufvud, F., Ribas-Pérez, D., Biedma, M., & Mendoza, A. (2025). Parental anxiety disorders and dental treatment in children. Journal of Clinical Medicine, 14(6), 1869. https://doi.org/10.3390/jcm14061869 DOI: https://doi.org/10.3390/jcm14061869

Bhowmick, S., Bajana, P., Patel, K., Sharma, K., Varshini, R., & Srija, K. (2025). Impact of tell-show-do and audiovisual distraction techniques on pediatric dental anxiety. Bioinformation, 21(7), 2221–2225. https://doi.org/10.6026/973206300212221 DOI: https://doi.org/10.6026/973206300212221

Bimstein, E., Wilson, J., Guelmann, M., & Primosch, R. (2008). Oral characteristics of children with attention-deficit hyperactivity disorder. Special Care in Dentistry, 28(3), 107–110. https://doi.org/10.1111/j.1754-4505.2008.00021.x DOI: https://doi.org/10.1111/j.1754-4505.2008.00021.x

Boland, L., Graham, I. D., Légaré, F., Lewis, K., Jull, J., Shephard, A., Lawson, M., Davis, A., Yameogo, A., & Stacey, D. (2019). Barriers and facilitators of pediatric shared decision-making: Systematic review. Implementation Science, 14(7), Artículo 7. https://doi.org/10.1186/s13012-018-0851-5 DOI: https://doi.org/10.1186/s13012-018-0851-5

Candan, M., Kutlu, E., & Yilmaz, I. (2023). Predictors of parental acceptance of behavior management techniques in pediatric dentistry: a preliminary study on Turkish population. Children, 10(10), 1592. https://doi.org/10.3390/children10101592 DOI: https://doi.org/10.3390/children10101592

Carrillo-Díaz, M., Crego, A., Armfield, J., & Romero, M. (2012). Self-assessed oral health, cognitive vulnerability and dental anxiety in children: testing a mediational model. Community dentistry and oral epidemiology, 40(1), 8–16. https://doi.org/10.1111/j.1600-0528.2011.00646.x DOI: https://doi.org/10.1111/j.1600-0528.2011.00646.x

Cermak, S., Stein, L., Williams, M., Dawson, M., Lane, C., & Polido, J. C. (2015). Sensory Adapted Dental Environments to Enhance Oral Care for Children with Autism Spectrum Disorders: A Randomized Controlled Pilot Study. Journal of autism and developmental disorders, 45(9), 2876–2888. https://doi.org/10.1007/s10803-015-2450-5 DOI: https://doi.org/10.1007/s10803-015-2450-5

Chatti, M., Chebbi, N., & Baaziz, A. (2025). Attention-deficit hyperactivity disorder and oral health in children and adolescents: A systematic review. European Archives of Paediatric Dentistry. https://doi.org/10.1007/s40368-025-01096-5 DOI: https://doi.org/10.1007/s40368-025-01096-5

Chau, Y., Lai, K., McGrath, C., & Yiu, C. (2017). Oral health of children with attention deficit hyperactivity disorder. European journal of oral sciences, 125(1), 49–54. https://doi.org/10.1111/eos.12323 DOI: https://doi.org/10.1111/eos.12323

Chau, Y., Peng, S., McGrath, C., & Yiu, C. (2020). Oral health of children with ADHD: Systematic review and meta-analysis. Journal of Attention Disorders, 24(7), 947–962. https://doi.org/10.1177/1087054717743331 DOI: https://doi.org/10.1177/1087054717743331

Coté, C., & Wilson, S. (2019). Guidelines for monitoring pediatric patients before, during and after sedation. Pediatrics, 143(6), e20191000. https://doi.org/10.1542/peds.2019-1000 DOI: https://doi.org/10.1542/peds.2019-1000

Custódio, N., Cademartori, M., Azevedo, M., Mendes, M., Schardozim, L., Costa, L., & Goettems, M. (2021). Efficacy of audiovisual distraction using eyeglasses during dental care: a randomized clinical trial. Brazilian oral research, 35, e26. https://doi.org/10.1590/1807-3107bor-2021.vol35.0026 DOI: https://doi.org/10.1590/1807-3107bor-2021.vol35.0026

Daley, D., & Birchwood, J. (2010). ADHD and academic performance. Child: Care, Health and Development, 36(4), 455–464. https://doi.org/10.1111/j.1365-2214.2009.01046.x DOI: https://doi.org/10.1111/j.1365-2214.2009.01046.x

De Oliveira, R., Khalid, H., Zhang, Z., Chakraborty, S., Benzano, D., Kruger, J., & McKernan, S. (2025). Visit characteristics associated with pediatric dental appointment no-shows in an academic dental setting. International Journal of Dentistry, 2025 (1), 2114933. https://doi.org/10.1155/ijod/2114933 DOI: https://doi.org/10.1155/ijod/2114933

Elicherla, N., Saikiran, K., Anchala, K., Elicherla, S., & Nuvvula, S. (2024). Evaluation of the effectiveness of tell-show-do and ask-tell-ask in the management of dental fear and anxiety: A randomized trial. Journal of Dental Anesthesia and Pain Medicine, 24(1), 57–65. https://doi.org/10.17245/jdapm.2024.24.1.57 DOI: https://doi.org/10.17245/jdapm.2024.24.1.57

Feigal, R. (2001). Guiding and managing the child dental patient. Journal of Dental Education, 65(12), 1369–1377. https://pubmed.ncbi.nlm.nih.gov/11780655/ DOI: https://doi.org/10.1002/j.0022-0337.2001.65.12.tb03496.x

Ferreira, A., Rabelo-Costa, D., Barbosa, I., Baraúna, M., Cople, L., Martins, S., & Baccin, C. (2023). The relationship between temperament and dental fear and anxiety: a systematic review. Evidence-based dentistry, 24(1), 42. https://doi.org/10.1038/s41432-023-00852-0 DOI: https://doi.org/10.1038/s41432-023-00852-0

Flippin, M., Reszka, S., & Watson, L. (2010). Effectiveness of the picture exchange communication system in autism spectrum disorders: a meta-analysis. American Journal of Speech-Language Pathology, 19(2), 178–195. https://doi.org/10.1044/1058-0360(2010/09-0022) DOI: https://doi.org/10.1044/1058-0360(2010/09-0022)

Fox, C., & Newton, J. (2006). A controlled trial of the impact of exposure to positive images of dentistry on anticipatory dental fear in children. Community Dentistry and Oral Epidemiology, 34(6), 455–459. https://doi.org/10.1111/j.1600-0528.2006.00303.x DOI: https://doi.org/10.1111/j.1600-0528.2006.00303.x

Gemp, S., Ziebolz, D., Haak, R., Mauche, N., Prase, M., Dogan-Sander, E., Görges, F., Strauß, M., & Schmalz, G. (2023). Oral health-related quality of life in adult patients with depression or ADHD. Journal of Clinical Medicine, 12(22), 7192. https://doi.org/10.3390/jcm12227192 DOI: https://doi.org/10.3390/jcm12227192

Gisour, E., Beigi, M., Jahanimoghadam, F., & Nekouei, A. (2025). Determinants of pediatric dental anxiety after dental treatment under general anesthesia. Scientific Reports, 15, 10006. https://www.nature.com/articles/s41598-025-94979-y DOI: https://doi.org/10.1038/s41598-025-94979-y

Goleman, J. (2014). Cultural factors affecting behavior guidance and family compliance. Pediatric Dentistry, 36(2), 121–127. https://pubmed.ncbi.nlm.nih.gov/24717749/

Gupta, R., Randell, K., & Dowd, M. (2021). Addressing parental adverse childhood experiences in the pediatric setting. Advances in Pediatrics, 68, 71–88. https://doi.org/10.1016/j.yapd.2021.05.003 DOI: https://doi.org/10.1016/j.yapd.2021.05.003

Isong, I., Rao, S., Holifield, C., Iannuzzi, D., Hanson, E., Ware, J., & Nelson, L. (2014). Addressing dental fear in children with autism spectrum disorders: a randomized controlled pilot study using electronic screen media. Clinical Pediatrics, 53(3), 230–237. https://doi.org/10.1177/0009922813517169 DOI: https://doi.org/10.1177/0009922813517169

Javadinejad, S., Farajzadegan, Z., & Madahain, M. (2011). Iranian version of a face version of the Modified Child Dental Anxiety Scale: Transcultural adaptation and reliability analysis. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences, 16(7), 872–877. https://pubmed.ncbi.nlm.nih.gov/22279453/

Kohli, N., Hugar, S., Soneta, S., Saxena, N., Kadam, K., & Gokhale, N. (2022). Psychological behavior management techniques to alleviate dental fear and anxiety in children: Systematic review and meta-analysis. Dental Research Journal, 19, 47. https://pubmed.ncbi.nlm.nih.gov/35915712/ DOI: https://doi.org/10.4103/1735-3327.346405

Kumar, R., Sindgi, R., Nirmal, D., Lakshmi, P., Kumar, P., Dubey, A., & Reddy, S.(2024). Effectiveness of behavior management techniques in pediatric dentistry. Journal of Pharmacy and Bioallied Sciences, 16(Suppl 3), S2434–S2436. https://doi.org/10.4103/jpbs.jpbs_262_24 DOI: https://doi.org/10.4103/jpbs.jpbs_262_24

Li, J. (2018). Children’s reward and punishment sensitivity moderates parenting behaviors in child ADHD symptoms. Journal of Abnormal Child Psychology, 46(8), 1585–1598. https://doi.org/10.1007/s10802-018-0421-y DOI: https://doi.org/10.1007/s10802-018-0421-y

Long, N. (2014). Stress and economic hardship: Impact on children and parents. Pediatric Dentistry, 36(2), 109–114. https://pubmed.ncbi.nlm.nih.gov/24717747/

Moura, M., Firmino, R., Neves, É., Paiva, S., Ferreira, F., & Granville-Garcia, A. (2022). Family cohesion and attention deficit exert an influence on visits to the dentist. Community Dentistry and Oral Epidemiology, 50(3), 164–170. https://doi.org/10.1111/cdoe.12647 DOI: https://doi.org/10.1111/cdoe.12647

Navit, S., Johri, N., Khan, S., Singh, R., Chadha, D., Navit, P., Sharma, A., & Bahuguna, R. (2015). Effectiveness and Comparison of Various Audio Distraction Aids in Management of Anxious Dental Paediatric Patients. Journal of clinical and diagnostic research: JCDR, 9(12), ZC05–ZC9. https://doi.org/10.7860/JCDR/2015/15564.6910 DOI: https://doi.org/10.7860/JCDR/2015/15564.6910

Oliver, K., & Manton, D. (2015). Contemporary behavior management techniques in pediatric dentistry. Journal of Dentistry for Children, 82(1), 22–28. https://pubmed.ncbi.nlm.nih.gov/25909839/

Passos, M., Massignan, C., Bolan, M., Butini, L., Aydinoz, S., Dick, B., & De Luca, G. (2021). Does the presence of parents in the dental operatory room influence children's behaviour, anxiety and fear during their dental treatment? A systematic review. International journal of paediatric dentistry, 31(3), 318–336. https://doi.org/10.1111/ipd.12762 DOI: https://doi.org/10.1111/ipd.12762

Pisano, M., Bramanti, A., De Benedetto, G., Carreras-Presas, C., & Di Spirito, F. (2024). The use of audiovisual distraction tools in the dental setting of pediatric subjects with special healthcare needs: a review and proposal of a multi-session model for behavioral management. Children, 11(9), 1077. https://doi.org/10.3390/children11091077 DOI: https://doi.org/10.3390/children11091077

Polanczyk, G., Willcutt, E., Salum, G., Kieling, C., & Rohde, L. (2014). ADHD prevalence estimates across three decades. International Journal of Epidemiology, 43(2), 434–442. https://doi.org/10.1093/ije/dyt261 DOI: https://doi.org/10.1093/ije/dyt261

Rathore, A., Kalra, N., Tyagi, R., Khatri, A., Srivastava, S., & Khandelwal, D. (2024). Eye movement desensitization and reprocessing therapy in children. Journal of Dental Anesthesia and Pain Medicine, 24(5), 329–340. https://doi.org/10.17245/jdapm.2024.24.5.329 DOI: https://doi.org/10.17245/jdapm.2024.24.5.329

Reddy, E., Kiranmayi, M., Mudusu, S., Raju, S., Jannapureddy, R., & Kumar, A. (2022). Oral health status in children with ADHD. International Journal of Clinical Pediatric Dentistry, 15(4), 438–441. https://doi.org/10.5005/jp-journals-10005-2420 DOI: https://doi.org/10.5005/jp-journals-10005-2420

Roberts, J., Curzon, M., Koch, G., & Martens, L. (2010). Behaviour management techniques in paediatric dentistry. European Archives of Paediatric Dentistry, 11(4), 166–174. https://doi.org/10.1007/bf03262738 DOI: https://doi.org/10.1007/BF03262738

Salam, T., Ummer, M., Alowairdhi, A., Alsubait, A., Aljuhani, S., Alzahrani, A., & Alqahtani, A. (2023). Management of ADHD children for dental procedures. Cureus, 15(4), e36989. https://doi.org/10.7759/cureus.36989 DOI: https://doi.org/10.7759/cureus.36989

Sarnat, H., Arad, P., Hanauer, D., & Shohami, E. (2001). Communication strategies in pediatric dental treatment. Pediatric Dentistry, 23(4), 337–342. https://pubmed.ncbi.nlm.nih.gov/11572493/

Seens, H., Modarresi, S., MacDermid, J., Walton, D., & Grewal, R. (2021). Prevalence of bone fractures among children and adolescents with attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. BMC Pediatrics, 21, 354. https://doi.org/10.1186/s12887-021-02821-x DOI: https://doi.org/10.1186/s12887-021-02821-x

Shapiro, M., Melmed, R. N., Sgan-Cohen, H. D., Eli, I., & Parush, S. (2007). Behavioural and physiological effect of dental environment sensory adaptation on children's dental anxiety. European journal of oral sciences, 115(6), 479–483. https://doi.org/10.1111/j.1600-0722.2007.00490.x DOI: https://doi.org/10.1111/j.1600-0722.2007.00490.x

Shim, Y., Kim, A., Jeon, E., & An, S. (2015). Dental fear and anxiety and dental pain in children and adolescents; a systematic review. Journal of Dental Anesthesia and Pain Medicine, 15(2), 53–61. https://doi.org/10.17245/jdapm.2015.15.2.53 DOI: https://doi.org/10.17245/jdapm.2015.15.2.53

Sinha, S., Praveen, P., Prathibha Rani, S., & Anantharaj, A. (2018). Pedodontic considerations in a child with attention deficit hyperactivity disorder: literature review and a case report. International Journal of Clinical Pediatric Dentistry, 11(3), 254–259. https://doi.org/10.5005/jp-journals-10005-1522 DOI: https://doi.org/10.5005/jp-journals-10005-1522

Stein, L., Polido, J., Mailloux, Z., Coleman, G., & Cermak, S. (2012). Oral care and sensory sensitivities in autism. Special Care in Dentistry, 31(3), 102–110. https://doi.org/10.1111/j.1754-4505.2011.00187.x DOI: https://doi.org/10.1111/j.1754-4505.2011.00187.x

Van Gemert, M., & Bildt, M. (2017). Dental treatment of fearful children. Nederlands Tijdschrift voor Tandheelkunde, 124(4), 215–221. https://doi.org/10.5177/ntvt.2017.04.16214 DOI: https://doi.org/10.5177/ntvt.2017.04.16214

Waschbusch, D., Cao, V., Shroff, D., Bansal, P., & Willoughby, M. (2024). Measuring children’s sensitivity to reward and punishment sensitivity: an initial psychometric evaluation of the contingency response rating scale. Assessment, 32(4), 561–576. https://doi.org/10.1177/10731911241256536 DOI: https://doi.org/10.1177/10731911241256536

Yon, M., Chen, K., Gao, S., Duangthip, D., Lo, E., & Chu, C. (2020). Dental fear and anxiety of kindergarten children in Hong Kong: a cross-sectional study. International Journal of Environmental Research and Public Health, 17(8), 2827. https://doi.org/10.3390/ijerph17082827 DOI: https://doi.org/10.3390/ijerph17082827

Published

2026-09-30

How to Cite

García Castañeda, Z. C., Bueno Reyna, B. R., Rodríguez Delgado, I., & Rodríguez Morales , L. A. (2026). Behavioral Management of Pediatric Patients with Attention-Deficit/Hyperactivity Disorder in Dentistry: Clinical and Educational Strategies. INNOVACADEMIA, 2(3), 80–92. https://doi.org/10.29105/innoacad.v2i3.95