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Is there a relationship between hyperactivity/inattention symptoms and poor oral health? Results from the GINIplus and LISAplus study

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A few clinical observations reported that children with attention deficit hyperactivity disorder (ADHD) have poor oral health compared to children without ADHD. However, evidence is not conclusive. We assess the association between hyperactivity/inattention and oral health in a population-based study.

Material and methods

As part of the ongoing birth cohort studies German Infant Nutritional Intervention-plus (GINIplus) and Influences of lifestyle-related factors on the immune system and the development of allergies in childhood-plus (LISAplus), 1,126 children at age 10 years (±10.2) from Munich (Germany) were included in the present analysis. During the dental examination, oral hygiene, non-cavitated and cavitated caries lesions, dental trauma, and enamel hypomineralization (EH) in the permanent dentition (MIH/1) were recorded. Children with a Molar-Incisor-Hypomineralization were subcategorized into those with EH on at least one first permanent molar (MIH/1A), and on at least one first permanent molar and permanent incisor (MIH/1B). Data on children’s hyperactivity/inattention symptoms were collected by parent-reported Strength and Difficulties Questionnaire. Logistic regressions and zero-inflated Poisson regression models were applied adjusted for gender, parental education, parental income, and methylphenidate or atomoxetine medication.


Logistic regressions showed that non-cavitated caries lesions were positively related with the presence of hyperactivity/inattention (ORadj = 1.51,CI95% = 1.08–2.11). When adjusted for parental background, an association showed between hyperactivity/inattention symptoms and MIH/1A but did not reach statistical significance (ORadj = 1.59,CI95% = 1.00–2.53).


Children with borderline and abnormal values of hyperactivity/inattention symptoms showed more non-cavitated caries lesions. Severe levels of hyperactivity/inattention may contribute to a higher risk for MIH/1A in school age.

Clinical relevance

Adequate dental preventive care for children with hyperactivity/inattention, especially from a low social background, is of importance for optimal caries prevention.

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We thank all the families who participated in the GINIplus and LISAplus study. Furthermore, we thank all members of the GINIplus and LISAplus study group (see Appendix S1) for their excellent work. The GINIplus and LISAplus were funded by grants 01 EG 9732 and 01 EG 9705/2 from the Federal Ministry for Education, Science, Research, and Technology; 01 EE 9401-4 from the Federal Ministry for Education, Science, Research, and Technology; and FKZ 20462296 from the Federal Ministry of Environment, and Ludwig Maximilians Universities’ innovative research priority Project MC-Health. The dental investigation was funded by a grant of the German Research Foundation (Deutsche Forschungsgemeinschaft, FKZ KU 2518/1-1 and HE 3294/7-1). The GABA GmbH, Lörrach, Germany, supported the dental examination with oral health care packages for all participating children.

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The authors declare that they have no conflict of interest.

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Correspondence to Gabriele Kohlboeck.

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The GINIplus Study Group comprises the Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Munich (Heinrich J, Wichmann HE, Sausenthaler S, Zutavern A, Chen, Chih-Mei, Schnappinger M, and Rzehak P); Department of Pediatrics, Marien-Hospital, Wesel (Berdel D, von Berg A, Beckmann C, Groß I); Department of Pediatrics, Ludwig Maximilians University, Munich (Koletzko S, Reinhardt D, and Krauss-Etschmann S); Department of Pediatrics, Technical University, Munich (Bauer CP, Brockow I, Grübl A, and Hoffmann U); IUF–Institut für Umweltmedizinische Forschung at the Heinrich-Heine-University, Düsseldorf (Krämer U, Link E, and Cramer C); Centre for Allergy and Environment, Technical University, Munich (Behrendt H)

The LISAplus Study Group consists of the following: Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Munich (Heinrich J, Wichmann HE, Sausenthaler S, Chen CM, and Schnappinger M); Department of Pediatrics, Municipal Hospital “St.Georg”, Leipzig (Borte M and Diez U), Marien-Hospital Wesel, Department of Pediatrics, Wesel (von Berg A, Beckmann C, and Groß I); Pediatric Practice, Bad Honnef (Schaaf B); Helmholtz Centre for Environmental Research–UFZ, Department of Environmental Immunology/Core Facility Studies, Leipzig (Lehmann I, Bauer M, Gräbsch C, Röder S, and Schilde M); University of Leipzig, Institute of Hygiene and Environmental Medicine, Leipzig (Herbarth O, Dick C, and Magnus J); IUF–Institut für Umweltmedizinische Forschung, Düsseldorf (Krämer U, Link E, and Cramer C); Technical University Munich, Department of Pediatrics, Munich (Bauer CP and Hoffmann U); ZAUM–Center for Allergy and Environment, Technical University, Munich (Behrendt H, Grosch J, and Martin F)

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Kohlboeck, G., Heitmueller, D., Neumann, C. et al. Is there a relationship between hyperactivity/inattention symptoms and poor oral health? Results from the GINIplus and LISAplus study. Clin Oral Invest 17, 1329–1338 (2013).

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