Are sugars‐free medicines more erosive than sugars‐containing medicines? An in vitro study of paediatric medicines with prolonged oral clearance used regularly and long‐term by children

Abstract

Objective. The reduced use of sugars-containing (SC) liquid medicines has increased the use of other dose forms, potentially resulting in more widespread dental effects, including tooth wear. The aim of this study was to assess the erosive potential of 97 paediatric medicines in vitro . Methods. The study took the form of in vitro measurement of endogenous pH and titratable acidity (mmol). Endogenous pH was measured using a pH meter, followed by titration to pH 7.0 with 0.1-M NaOH. Results. Overall, 55 (57%) formulations had an endogenous pH of < 5.5. The mean ( ± SD) endogenous pH and titratable acidity for 41 SC formulations were 5.26 ± 1.30 and 0.139 ± 0.133 mmol, respectively; for 56 sugars-free (SF) formulations, these figures were 5.73 ± 1.53 and 0.413 ± 1.50 mmol ( P > 0.05). Compared with their SC bioequivalents, eight SF medicines showed no significant differences for pH or titratable acidity, while 15 higher-strength medicines showed lower pH ( P = 0.035) and greater titratable acidity ( P = 0.016) than their lower-strength equivalents. Chewable and dispersible tablets ( P < 0.001), gastrointestinal medicines ( P = 0.002) and antibiotics ( P = 0.007) were significant predictors of higher pH. In contrast, effervescent tablets ( P < 0.001), and nutrition and blood preparations ( P = 0.021) were significant predictors of higher titratable acidity. Conclusions. Paediatric SF medicines were not more erosive than SC medicines in vitro ; a more significant predictor of their erosive potential was dose form.

Fluoride Varnishes against Dental Erosion Caused by Soft Drink Combined with Pediatric Liquid Medicine

“…Liquid medicines are widely used for children because the facility of ingestion (5,6). However, some of inactive acidic components have low pH (5,7) and because of the high frequency of medication intake, bedtime consumption, high viscosity and reduction of the salivary flow, it may also be associated with alterations on surface morphology of dental enamel (5).…”

In Vitro Erosive Effect of Pediatric Medicines on Deciduous Tooth Enamel

“…Increased acidic food and drink consumption has become the primary extrinsic source of dental erosive agents (1), although acidic medicines and behavioral factors have also been identified as extrinsic etiologic factors in dental erosion (5)(6)(7)(8).…”

“…Acidic preparations are often necessary for drug dispersion, chemical stability maintenance, to ensure physiological compatibility and to improve flavor (6,7). In addition to the acidic components, other factors such as prolonged and frequent ingestion (i.e., two or more times daily), bedtime and between meals consumption, high viscosity and the collateral effect of reduced salivary flow, may contribute to increase the risk for medication-induced dental erosion (1,2,9).…”

Sugar-free medicines are counterproductive

“…Furthermore, some of the sugar-free medicines are not significantly less erosive than sugar-containing medicines, thus undermining the very rationale for sugar-free medicines. 6 …”