Paediatric Over-the-Counter (OTC) Oral Liquids Can Soften and Erode Enamel

Abstract

This study investigated the softening and erosive effects of various paediatric over-the-counter (OTC) oral liquids on deciduous teeth. Twenty sectioned and polished deciduous enamel blocks were ground on the buccal surface (2 × 2 mm2) and randomly divided into five groups, immersed into four commercially-available paediatric OTC oral liquids (two for paracetamol, both sugared; and two for chlorpheniramine, one sugared and one sugar-free), with deionized water as control. The pH of the oral liquids ranged from 2.50 to 5.77. Each block was immersed into the test or control groups for 15 s, rinsed with deionized water, and Vickers micro-hardness (n = 5) was measured. After twenty cycles of immersion and hardness measurements, Scanning Electron Microscope (SEM) and Energy Dispersive X-ray Spectrometry (EDS) were used to evaluate the surface morphology and chemistry of the tooth blocks, respectively. The pH values of the liquids were also recorded. Rapidly descending trends in the micro-hardness ratios of the four test groups were observed that were statistically different from the control group (p < 0.001). EDS showed an increase of Ca/C ratio after drug immersion, whereas SEM showed an enamel loss in all the test groups. Paediatric OTC oral liquids could significantly soften the enamel and render them more susceptible to caries, such that the formulation of the oral liquids is the major factor.

Erosive potential of three different commonly used pediatric syrups on deciduous teeth enamel: an in vitro study

“…Dental erosion can be defined as the irreversible dissolution of the tooth structure caused by intrinsic or extrinsic acids without bacterial involvement. [1][2][3] It can be caused by intrinsic or extrinsic factors. 1 Intrinsic factors include contact of dental tissues with gastric acids (i.e.…”

“…[1][2][3] It can be caused by intrinsic or extrinsic factors. 1 Intrinsic factors include contact of dental tissues with gastric acids (i.e. regurgitation disorders due to gastrointestinal diseases).…”

“…13 Factors like low endogenous pH and high titratable acidity of these drugs favor dental erosion especially when there is a longer duration of contact with the tooth surface. 1 Liquid formulations that are used for a minimum of three months period are considered as a risk factor for increased incidence of caries. 14 Therefore, children who take vitamin C supplements have 4.7 times higher chance for developing dental erosion lesions.…”

“…20 Nowadays, various sugar free pediatric oral liquid formulations are available in the market which does not contain fructose, glucose or sucrose. 1 Even though sugar substitutes have been introduced, its use in the preparation of pediatric syrups is still very minimal. 2 The consumption of 'hidden sugars' by children has led to an increased concern among pediatric dentists.…”

“…22 However, data about enamel softening of commonly used over-thecounter (OTC) pediatric liquid medications is lacking. 1 Considering that some of these commonly used medicines by children may be a threat to oral health causing dental caries and erosion, the aim of this study is to assess in vitro on deciduous teeth enamel, the erosive potential of commonly used liquid oral pediatric medicines.…”