Oral Hygiene Products, Medications and Drugs - Hidden Aetiological Factors for Dental Erosion

Abstract

Acidic or EDTA-containing oral hygiene products and acidic medicines have the potential to soften dental hard tissues. The low pH of oral care products increases the chemical stability of some fluoride compounds and favours the incorporation of fluoride ions in the lattice of hydroxyapatite and the precipitation of calcium fluoride on the tooth surface. This layer has some protective effect against an erosive attack. However, when the pH is too low or when no fluoride is present these protecting effects are replaced by direct softening of the tooth surface. Oral dryness can occur as a consequence of medication such as tranquilizers, antihistamines, antiemetics and antiparkinsonian medicaments or of salivary gland dysfunction. Above all, patients should be aware of the potential demineralization effects of oral hygiene products with low pH. Acetyl salicylic acid taken regularly in the form of multiple chewable tablets or in the form of headache powder, as well as chewing hydrochloric acids tablets for the treatment of stomach disorders, can cause erosion. There is most probably no direct association between asthmatic drugs and erosion on the population level. Consumers and health professionals should be aware of the potential of tooth damage not only by oral hygiene products and salivary substitutes but also by chewable and effervescent tablets. Several paediatric medications show a direct erosive potential in vitro. Clinical proof of the occurrence of erosion after use of these medicaments is still lacking. However, regular and prolonged use of these medicaments might bear the risk of causing erosion. Additionally, it can be assumed that patients suffering from xerostomia should be aware of the potential effects of oral hygiene products with low pH and high titratable acidity.

Do pediatric medicines induce topographic changes in dental enamel?

“…3,4,8,13 Many of these medicines, such as antibiotics and antihistamines, are usually used to treat children for long periods. 9 So, acidic medicines likely promote surface degradation of the tooth and increase dental roughness.…”

“…1,2,3 However, some of the inactive agents used in pediatric liquid medications can cause damage to dental tissues because of their low pH. 3 Some medicines have acid in their compositions in order to preserve their chemical stability and control their tonicity.…”

“…1,2,3 However, some of the inactive agents used in pediatric liquid medications can cause damage to dental tissues because of their low pH. 3 Some medicines have acid in their compositions in order to preserve their chemical stability and control their tonicity. 4 Certain properties of acidic products in general may be related to the loss of surface structure of dental enamel: low endogenous pH, high titratable acidity, and minimal quantities of minerals such as calcium or phosphate, in their compositions.…”

“…4 Certain properties of acidic products in general may be related to the loss of surface structure of dental enamel: low endogenous pH, high titratable acidity, and minimal quantities of minerals such as calcium or phosphate, in their compositions. 3,5,6,7,8 Acidic medications may cause dental erosion with loss of dental tissue. 1,4 Besides the presence of acids in some children's medications, other factors may also be related to changes in the surface morphology of dental enamel: high frequency of medication intake, bedtime consumption, high viscosity, and reduction in salivary flow.…”

Esthetic and functional rehabilitation of soft-drink eroded teeth with prosthodontic approach: A case report

“…They may occur on all accessible dental surfaces, triggered by extrinsic or intrinsic factors (Hellwig and Lussi, 2014). The frequent use of acidic medications that come in direct contact with teeth has also been identified as an extrinsic etiologic factor in dental erosion, not only for adults but also for children and adolescents (Salas et al, 2015).…”