In Vitro Erosive Effect of Pediatric Medicines on Deciduous Tooth Enamel

Abstract

This study evaluated, in vitro, the erosive potential of pediatric liquid medicines in primary tooth enamel, depending on the exposure time. Sixty deciduous incisors were randomly assigned to 4 groups (n=15), according to the immersion solutions: guaifenesin; ferrous sulfate; salbutamol sulfate and artificial saliva. The immersion cycles in the medicines were undertaken under a 1-min agitation, which wasperformed three times daily, during 28 days. Surface microhardness was measured at 7,14, 21 and 28 days. The titratable acidity and buffering capacity of the immersion media were determined. Data were analyzed by Analysis of Variance and Tukey's test (α=0.05). Salbutamol sulfate caused a gradual loss in enamel microhardness deciduous, observed at all times (p<0.005). Exposure to guaifenesin or ferrous sulfate resulted in significant decrease of enamel microhardness only after 28 days (p<0.005). In the control group (artificial saliva), microhardness did not changed (p>0.005) at any of the studied times. Scanning Electron Microscopy (SEM) images revealed that after 28 days the surfaces clearly exhibited structural loss, which was unlike those immersed in artificial saliva. Erosion of deciduous enamel was dependent on the type of medicine and exposure time.

Changes in Microhardness and Morphology of the Adamantine Structure as a Function of the Exposure Time to Different Drugs

“…The assessment of the mechanical and morphological characteristics of dental enamel submitted to the action of pediatric liquid medicines belonging to the therapeutic class of corticosteroids, antipsychotics, bronchodilators and antihistamines made dental erosion a clearly observable event in this study, which confirms the finding of different in vitro studies [8][9][10]12,[16][17][18][19][20], that although have made use of different experimental protocols, also highlighted the demineralizing potential of pediatric drugs.…”

“…The literature showed no consensus on the duration of acid challenges, nor on the exposure time to the drug solution [8][9][10]12,[16][17][18][19]. However, it is believed that if the erosive challenge is longer, the outer layer of the softened surface will possibly be completely dissolved, resulting in permanent loss of the mineralized enamel structure [24], often making the analysis of postimmersion findings difficult [10].…”

“…Another issue to be considered is that in most tests, a single exposure to the product is recommended, followed by immediate erosion assessment, while in some studies, multiple exposures were performed [7][8][9]. The advantage of using a series of repeated challenges is that it increases the chances of obtaining reliable results, as changes can be detected after multiple exposures, even if not identified after a single exposure [7].…”

“…The combined analysis of the individual chemical aspects of acid substances and the performance of erosion tests on the tooth structure has been widely used [7][8][9].…”

“…The in vitro assessment of the enamel structure exposed to the action of drug solutions revealed that they are able to reduce its hardness [8,9,12,16,17], increase its roughness [12], cause changes in its morphological structure [9,10,12,18,19] and induce calcium dissolution [20].…”