الفهرس 
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Abstract
Background: Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder affecting children and adolescents. Behavior of ADHD children may affect maintaining proper oral hygiene measures. Dysfunction of hypothalamic pituitary adrenal (HPA) axis has been implicated in its pathophysiology. Aim of the study: This study aimed to compare oral health status and salivary cortisol level between ADHD children versus normal children. It also compared salivary cortisol level of ADHD children before treatment and one-month after treatment with methylphenidate. Materials and Methods: The present study was designed as case control study and clinical trial. A total of 120 children aged 6 to 12 years participated in the study. group 1: sixty ADHD children were selected from child and adolescent outpatient clinic of psychiatry department, Mansoura University hospital and group 2: sixty normal children were selected from primary schools in Mansoura city. A questionnaire including oral habits, clinical examination including (DMFT - deft - plaque index) and unstimulated salivary samples were taken for both groups. Salivary samples were taken from ADHD group before treatment and one-month after treatment with methylphenidate. Salivary samples were stored at -20c then sent for laboratory analysis using ELISA kit. Data were collected and statistically analysed. Results: Regarding dental caries experience and plaque index this study showed no statistically significant differences between the two groups concerning DMFT, deft and plaque index (p=0.723, 0.676, 0.842 respectively). As regard to oral habits, this study showed no statistically significant differences between the two groups concerning digit sucking, tongue thrust, lip biting, mouth breathing and self- injurious habits (p=0.163, 1.0, 0.136, 1.0, 0.107 respectively). It also showed that bruxism and nail biting were statistically significant increase in ADHD group compared to control group (p=0.001). Regarding salivary cortisol level, it demonstrated statistically significant decrease in salivary cortisol level of ADHD group specifically hyperactive/impulsive subtype compared to control group (p=0.038). Concerning the effect of one-month treatment with methylphenidate on salivary cortisol level of ADHD children, it showed statistically significant increase of salivary cortisol level after treatment compared to before treatment in ADHD group (p=0.035). Conclusions: ADHD children have no additional risk for dental caries and plaque accumulation than normal children. ADHD children are more subjected to have nail biting and bruxism habits than normal children. HPA axis dysfunction may be related to the pathophysiology of ADHD specifically hyperactive/impulsive subtype. Methylphenidate positively affects HPA axis of ADHD children.