Are Pediatric Antibiotic Formulations Potentials Risk Factors for Dental Caries and Dental Erosion?

Abstract

Introduction: One of the most frequent parents’ concerns is that oral antibiotic formulations induce dental damage in their children’s. This study aimed to assess the cariogenic and erosive potentials of 29 pediatric antibiotics.Materials and Methods: Replicates of each antibiotic were analyzed for the concentration of sugars (sucrose, glucose and fructose) and sorbitol by high performance liquid chromatography (HPLC). The pH was determined by digital pHmeter. Titratable acidity was determined in triplicate using the same pHmeter by gradual addition of 0.1N sodium hydroxide (NaOH) until pH 7.0. Viscosity measurements were carried out using a viscosimeter. In order to rank the relative performance of each medicine, the DEA (Data Envelopment Analysis) methodology was used. Results:Sucrose was present in most samples (n=24) with concentrations ranging from 26 to ≈ 100g% (w/w). Only one antibiotic contained sorbitol (66.9g%). Twenty seven antibiotics presented pH values ranging from 4.1 to 6.9 and most of them (n=15) showed the pH below the critical value for dissolution of hydroxyapatite. The values of titratable acidity and viscosity ranged from 0.26 to 40.48 ml and from 20 to 1780cP, respectively. DEA methodology showed that two medicines were distant from the performance frontier (Klaricid® 50mg and Zinnat® 250mg), which means that these medicines showed the worst performance and, therefore, greater potential for dissolution of dental enamel.Conclusion:Many antibiotics presented high concentration of sugars, high titratable acidity, pH below the critical value and high viscosity which can be considered risk factors for dental caries and erosion, when consumed frequently.

Cariogenic and erosive potential of liquid oral pediatric medicines of long-term use for children: an in vitro analysis

“…Therefore, recommendations for limiting caries in these children include measures targeting parents, medical/dental professionals and the pharmaceutical industry. [18] Parental instructions by practitioners to immediate water rinsing and delayed tooth-brushing with fluoridated toothpaste after syrup medicines' ingestion could be proposed at the time of prescription [12], chewing sugar-free gum after taking the medicine; if possible, taking the medicine in tablet form, at meal-times rather than between meals; avoiding ingestion of the medicine before bed, home and dental-office fluoride applications and seeking regular preventive dental care. [27] The role of dietary control with regards to carbohydrates is paramount; a British survey reported that it would be futile to administer sugarfree medicine to a child consuming lot of sweets.…”

“…[4] The pharmaceutical industry should provide sugar-free medications [9] and include medicine's labels that alert parents for potential to cause dental caries and erosion when consumed for prolonged periods, several times a day, without adequate oral hygiene. [12] In a survey, 75% of pharmacists in Northern Ireland stated that they had not received formal education concerning sugar in medication and its effect on dental health. The major factors influencing the provision of sugar-free medicines were parental request, health promotion literature, reports and media advertising.…”

Chronology of the First Deciduous Tooth Eruption in Brazilian Children with Microcephaly Associated with Zika Virus: A Longitudinal Study

“…The use of continuous medication is not the only causal factor for the presence of dental caries [30]; however, considering that pediatric drugs have tooth demineralization potential, these individuals will present an increased risk of erosive lesions [34,35] and caries, since pediatric medicinal products have high concentration of sugars, high titratable acidity, pH below critical value and high viscosity [36].…”

Relationship between pediatric liquid medicines (PLMs) and dental caries in chronically ill children

“…1 PLMs posses a low pH, a high concentration of sugars, and a high titratable acidity which are considered as risk factors for dental caries. [2][3][4][5] Accumulating evidence from various studies [6][7][8] has pointed out a possible relationship between dental caries and long-term consumption of liquid oral medicines. Chronically ill children suffering from various diseases, such as epilepsy, malnutrition, asthma, nephrotic syndrome, congenital heart diseases and anaemia, require intake of liquid medicines on long-term basis which predisposes them to dental caries.…”