Mandibular bone changes in children with ADHD: evaluation using fractal analysis and mandibular indices

Previous studies have shown that abnormalities in the oxytocin system in children with attention deficit hyperactivity disorder (ADHD) may affect bone mineral density, and that medications used to treat ADHD may cause growth suppression. This study aimed to evaluate bone structure and microarchitecture in children diagnosed with ADHD using mandibular indices and fractal dimension analysis as well as to compare these results with those of healthy children. The study included 61 children aged 4–15 years who had been diagnosed with ADHD, along with 122 healthy children matched for age and gender. Measurements of the mandibular cortical index (MCI), mental index (MI) and panoramic mandibular index (PMI) were obtained from panoramic radiographs of both the study and control groups, and fractal dimension (FD) analysis was performed in regions of interest (ROI) corresponding to the condyle, angulus and interdental areas. All measurements were performed on digital images using the ImageJ programme (ImageJ 1.38, NIH, Maryland, USA). Data were analysed using SPSS 27. A significance level of p < 0.05 was accepted. Significant differences were observed for interdental FD and for all mandibular indices (PMI, MI, and MCI). İnterdental FD measurements were higher in the study group (ADHD group) than in the control group (healthy group). Type 1 MCI was observed more frequently in the study group, while Type 2 MCI was observed more frequently in the control group. According to the PMI and MI analyses, the study group’s measurements were higher than those of the control group’s. There were no significant differences in condyle FD and angulus FD values between the study groups (ADHD and healthy control group). The differences observed in mandibular indices and interdental FD are thought to reflect region-specific changes. The potential influence of parafunctional habits cannot be confirmed without clinical evaluation.