An investigation into sugar-containing and sugar-free over-the-counter medicines stocked and recommended by pharmacists in the north western region of England

A scoping review of pharmacy participation in dental and oral health care

OBJECTIVES

To explore the scope of dental and oral health care (DOHC) provided by the pharmacy profession and associated outcomes, and attitudes of pharmacy staff and other key stakeholders about pharmacy involvement in this context.

METHODS

A scoping review of full-text articles describing outcomes related to pharmacy staff/student involvement in, knowledge of or attitudes towards DOHC in any setting, and stakeholder perspectives was conducted. Articles written in English were searched for using PubMed, EMBASE, EBSCO, International Pharmaceutical Abstracts, Education Resources Information Centre, Web of Science, Google Scholar, and ProQuest for Dissertations and Theses. No date restrictions were used. Key outcomes were mapped: role and practice, knowledge and attitudes, and training and education.

RESULTS

Seventy studies met the inclusion criteria: 49 were conducted in developed countries; 60 were quantitative in design; and 38 involved community pharmacy settings only. Pharmacists and pharmacy support staff commonly managed DOHC inquiries (n = 13), including the provision of advice and products with or without a further referral. Integrated pharmacist-led services in dental settings (n = 4) showed improved prescribing and quality use of medicines but low community pharmacy referrals were identified in studies involving mystery shoppers with potential oral cancer (n = 7). DOHC promotion programmes delivered by pharmacy staff and collaborations with dentists were limited. There was interest from the pharmacy profession for a role in DOHC; however, knowledge gaps were reported and needs for further training identified. Consumer participant DOHC outcomes were not reported.

CONCLUSIONS

Community pharmacists and pharmacy staff were interested in an expanded role in DOHC; however, this scoping review identified lack of knowledge and sub-optimal practice as potential barriers. Research on development, implementation and evaluation of DOHC-related services and practice by pharmacy staff was scarce. Further evidence of consumer-related oral health outcomes and their perceptions of the role of pharmacy is needed.

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

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.

Pediatric medicines and their relationship to dental caries

The aim of this study was to evaluate mothers' knowledge about the cariogenic potential of pediatric medicines. A total of 111 mothers were interviewed using a standardized form containing 15 questions relating to the association of pediatric drug use with dental caries and oral hygiene care. Descriptive and inferential statistics (Chi-square test and Fisher's exact) were used at a significance of 5%. Most of the mothers were aged 40 years or under (77.4%), high school educated (30.6%) and not working (50.5%). The association between medication use and dental caries or defects in teeth structure was mentioned by 35 (43.2%) mothers, 33 of whom (40.7%) cited this was due to the presence of sugar in the formulations. Only 32 mothers (28.8%) performed oral hygiene for the child after drugs ingestion, although 81.1% (n = 90) had never received guidance on the importance of this practice. The type of occupation and maternal education level were not significant in these issues (p> 0.05). Pediatric medicines can create problems for the teeth and a high percentage of mothers are unable to establish a clear cause and effect relationship with this association. Therefore, the pharmaceutical industry needs to be more aware of this and should prepare pediatric medicines without the presence of sucrose.

[Perceptions and attitudes among parents and guardians on the use of pediatric medicines and their cariogenic and erosive potential]

The study assesses the perceptions of parents/guardians on the use of pediatric medicines and their cariogenic/erosive potential, interviewing them on the relationship between the use of pediatric medicines and cavities/dental erosion, as well as oral hygiene procedures after the medication. Among the interviewed parents/guardians (n=86), 24 (27.9%) mentioned the sour taste of pediatric medication, 51 (59.3%) the bitter taste, and 56 (65.1%) considered them sweet, although only 16 (28.6%) of these parents/guardians brushed their children's teeth after the medication (Fisher's Exact; p>0.05). Moreover, only 18 (20.9%) of the parents/guardians performed oral hygiene practices after the medication, of whom 8 (44.4%) received previous instructions (Fisher's Exact; p<0.05). The association between taking medications and dental caries or structural dental defects was mentioned by 61 (70.9%) of the parents/guardians, with 24 (39.3%) of them justifying this association through the presence of sugar in the formulations. Although parents/guardians consider medicines to be sweet substances and relate their use to dental caries and tooth structure flaws, most of them do not brush their children's teeth after taking medications and are unable to establish a clear cause/effect relationship for this association.

Pediatricians' perception about the use of antibiotics and dental caries--a preliminary study

OBJECTIVES

This study aimed to evaluate pediatricians' perception about the use of antibiotics and dental caries.

METHODS

One hundred pretested questionnaires containing open and closed questions were distributed to pediatricians from public hospitals in Rio de Janeiro, Brazil.

RESULTS

The response rate was 60 percent. Considering the respondents, 73.3 percent frequently prescribed antibiotics, oral administration being the chosen mode (93.3%). Antibiotics were pointed out as being very sweet substances by 53.3 percent of the pediatricians. However, the same percentage did not know what sweetener was responsible for the sweet flavor, and just 40.6 percent recommended oral hygiene after the medicine's intake. Among the pediatricians, 56.7 percent related the use of antibiotics to the occurrence of dental effects, and 40 percent thought that antibiotics could cause a defect of tooth structure. Only one pediatrician (3.2%) associated the presence of fermentable carbohydrates in the composition of these medicines with dental caries.

CONCLUSIONS

Pediatricians in this study did not perceive the correct relationship between the presence of fermentable carbohydrates in antibiotics and dental caries. Many of them believed these medicines promoted a defect of tooth structure favoring the development of dental caries. Further studies with a larger sample are necessary.

Consumer demand in the purchase and prescription of sugar-free medicines

OBJECTIVES

To determine the current level of consumer demand in the purchase and prescription of sugar-free paediatric medicines.

DESIGN

Data were collected by administered questionnaire.

SETTING

The study was conducted in a Hospital Paediatric Dentistry Unit and a Community Dental Clinic, both within the Bro Taf area of south-east Wales.

SAMPLE AND METHODS

The parents of 240 children attending for routine dental care responded to one of two short questionnaires, depending on whether their child had received a liquid oral medicine in the preceding month.

RESULTS

Although aware of the benefits of sugar-free medicines, parents did not appear to be attempting to exercise the power of consumer demand to its full potential. They were more likely to ask a pharmacist (or pharmacist's assistant) than their general medical practitioner for a sugar-free medicine.

CONCLUSIONS

We must continue to promote sugar-free medicines. While increasing the importance that health professionals attach to such products, future campaigns should also aim to increase consumer demand.

Changing doctor prescribing behaviour

The aim of this overview was to identify interventions that change doctor prescribing behaviour and to derive conclusions for practice and further research. Relevant studies (indicating prescribing as a behaviour change) were located from a database of studies maintained by the Cochrane Collaboration on Effective Professional Practice. This register is kept up to date by searching the following databases for reports of relevant research: DHSS-DATA; EMBASE; MEDLINE; SIGLE; Resource Database in Continuing Medical Education (1975-1994), along with bibliographies of related topics, hand searching of key journals and personal contact with content area experts. Randomised controlled trials and non-equivalent group designs with pre- and post-intervention measures were included. Outcome measures were those used by the study authors. For each study we determined whether these were positive, negative or inconclusive. Positive studies (+) were those that demonstrated a statistically significant change in the majority of outcomes measured at level of p < or = 0.05 between the intervention and control groups. Negative studies (-) showed a significant change in the opposite direction and inconclusive studies (approximately) showed no significant change compared to control or no overall positive findings. We identified 79 eligible studies which described 96 separate interventions to change prescribing behaviour. Of these interventions, 49 (51%, 41%-61%) showed a positive significant change compared to the control group but interpretation of specific interventions is limited due to wide and overlapping confidence intervals.

Pharmacists' knowledge, attitudes and practices concerning sugar-free medicines

AIMS

To examine the attitudes of pharmacists to sugar in medicine and sugar-free preparations and their levels of knowledge concerning sugar-free preparations and the implications for dental health.

DESIGN

A questionnaire was designed with a mixture of closed and open-ended questions.

SETTING

Pharmacists practising in the Greater Belfast area of Northern Ireland.

METHOD

Seventy pharmacists were randomly chosen from the list of pharmacists practising in the area and were asked to participate in the study.

RESULTS

Responses were obtained from 52 of the 70 selected pharmacists, representing a response rate of 74%. Seventy-five per cent of the pharmacists stated that they had not received formal education concerning sugar in medication and it's effect on dental health. Their main source of information on the subject was dental health literature. Eighty-seven per cent felt that all medication should be available in sugar-free form. Forty-six per cent stated that sugar in medication was definitely an important cause of dental caries in children and 44% felt that it was a possible factor. The major factors influencing the provision of sugar-free medicines were parental request, health promotion literature, reports and media advertising. Thirty-nine per cent of the pharmacists always offered a sugar-free preparation for over-the-counter medication (provided that a sugar-free alternative was available), and 56% sometimes did so. Fifty per cent always offered a sugar-free form for prescribed items wherever possible, the remainder depended on it being specified by the prescriber.

CONCLUSION

There is a high level of interest in this issue among pharmacists, but there is a need for an increased educational input on a continuous basis.

A survey of factors influencing the prescribing of sugar-free medicines for children by a group of general medical practitioners in Northern Ireland

Factors which influence the prescribing of sugar-free medicines by 47 general medical practitioners were examined by means of questionnaire. The doctors all practise in the Newry and Mourne district of the Southern Health and Social Services Board, Northern Ireland. Twenty-six (55%) of the doctors stated that they support the principle of prescribing sugar-free medicines for children; the same number stated that they oblige parental requests and 14 (30%) stated that they frequently prescribe a common group of sugar-free medicines. However, only 14 (30%) of the doctors considered that their knowledge of sugar-free medicines was up-to-date. The main sources of information about sugar-free preparations were drug company travelling representatives and professional journals, but a few doctors learned of this issue from other professionals, including dental practitioners. The majority of doctors (especially those with a practice policy of prescribing sugar-free medicines) felt it was important to prescribe sugar-free preparations for all children, not only for those requiring long-term medication. The results show that there is a reasonable level of interest in this issue among the doctors in the area, but that there is an on-going need for further encouragement and provision of information for them, in order to increase as far as possible the use of sugar-free preparations for children.