EC Dental Science

Introduction and Objective: Attention-deficit/hyperactivity disorder (ADHD) can affect oral health and orthodontic treatment through behavioral challenges and medication side effects. The reported prevalence in Saudi Arabia is inconsistent, which has important implications for orthodontic care. This study aimed to review the prevalence of ADHD in Saudi Arabia and synthesize international evidence on its impact on oral health and orthodontic treatment, with the goal of identifying strategies to optimize clinical management.

Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. We searched PubMed, Scopus, Web of Science, and Saudi national repositories for studies published between 2010 and June 2025. Eligible studies included children or adolescents with ADHD reporting oral health status, orthodontic treatment adherence, or prevalence data. Study quality was assessed using the Joanna Briggs Institute, Newcastle-Ottawa Scale, or A Measurement Tool to Assess Systematic Reviews, version 2, depending on study type.

Results: Overall, 37 studies were included: eight Saudi epidemiologic reports and 29 international investigations addressing oral health and orthodontic outcomes. Saudi prevalence estimates ranged from 2.8% (a large national school survey) to 52.5% (a regional online sample), with a pooled meta-analytic estimate of approximately 12.4%. Children with ADHD consistently showed higher caries burden, elevated plaque and gingival scores, more frequent dental trauma, increased appliance breakage, greater absenteeism, and longer treatment durations. Stimulant medications were often associated with xerostomia and an increased risk of caries.

Conclusion: ADHD complicates orthodontic management by reducing treatment adherence and causing medication-related oral complications. In Saudi Arabia, the variable prevalence underscores the importance of screening in orthodontic practice. Tailored strategies involving caregivers, simplified treatment mechanics, enhanced preventive care, and closer follow-up are recommended.

Keywords: ADHD; Orthodontics; Treatment Compliance; Oral Hygiene; Saudi Arabia; Children

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