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

Effects of Different Anti-Epileptic Drug Groups and Brushing on the Color Stability of Restorative Materials Used in Pedodontics: An In Vitro Evaluation

OBJECTIVES

This study will evaluate the effects of anti-epileptic drugs and brushing used in children on the color change of three restorative materials by creating an in vitro study model.

METHODS

Forty samples of polyacid-modified composite resin (compomer), glass ionomer cement (GIC), and composite resin (CR) were prepared. Samples were split into four groups (n = 10) and soaked in three anti-epileptic drugs (Tegretol, Depakine, Keppra) and distilled water. For each group (n = 5), two subgroups (brushing and non-brushing) were created. Discolorations [CIEDE2000 (ΔE00)] were determined initially and on days 7 and 14. The data were analyzed with a four-factor repeated measures ANOVA analysis, and a post hoc analysis Bonferroni test was used.

RESULTS

After the second week, the highest ΔE00 value was seen in the non-brushed compomer material in the Tegretol drug group (8.59 ± 0.43). In contrast, the lowest value was seen in GIC filling material-brushing-Depakine drug (3.45 ± 2.14). ΔE00 values in the brushing groups were statistically significantly lower than those in the no brushing groups (p < 0.05).

CONCLUSIONS

It has been determined that the color stability of aesthetic restorative dental materials used in pediatric dentistry is affected by antiepileptic drugs. In addition, it has been determined that tooth brushing positively affects the color stability of restorative materials. Therefore, pediatric dentists should advise their patients and their relatives about this issue and take precautions.

Effect of Low pH Dietary Supplements on Discoloration of Resin Composites

AIM

This study aimed to evaluate the impact of the consumption of low pH dietary supplements on the color stability of different resin composites.

MATERIALS AND METHODS

Three different restorative materials were used for this in vitro study: Filtek One Bulk-Fill (FOB), Filtek Z550 (Z550), and Fill-Up (FUP). Samples fabricated from each composite group were divided into four subgroups, and color measurements were performed at baseline. The control subgroup was stored in distilled water, and the other three subgroups were immersed in acidic dietary supplement solutions (Redoxon, Supradyn, and Voonka Collagen Shake) for 2 minutes daily for 28 days. Color measurements were obtained using a digital spectrophotometer. Color change values (ΔE1) were calculated after each color measurement. Next, all samples were immersed in a coffee solution for 7 days and repeat color measurements were taken to determine ΔE2 values. The study groups were compared using the Kruskal-Wallis test (α =0.05).

RESULTS

ΔE1 values were significantly different among the groups (P < 0.05). While Voonka Collagen Shake produced the greatest discoloration in FOB (1.67 ± 1.08) and Filtek Z550 (3.59 ± 1.90) materials, Fill-Up showed the highest discoloration (3.14 ± 0.37) with Supradyn. Analysis of ΔE2 values demonstrated a significant difference only for the Filtek Z550-Redoxon group versus the control group (P < 0.05).

CONCLUSION

Acidic dietary supplements not only produce color alterations in resin composites but also reduce the staining resistance of the composite further, depending on the type of composite and dietary supplement. Consumption of staining food after taking Redoxon effervescent tablets produces greater discoloration in Filtek Z550 restorations compared with other restorative materials.

Comparative Evaluation on the Effects of Three Pediatric Syrups on Microhardness, Roughness and Staining of the Primary Teeth Enamel: An In-Vitro Study

​​​​​Introduction One of the most prevalent oral diseases is dental caries. Syrups are commonly used by children who have difficulty swallowing tablets and capsules. Some medications can make dental caries worse and cause the enamel to erode. Most of the time, parents are unaware that a number of foods, drinks, and syrup-formulated pediatric drugs include sugar, which can cause erosion of primary teeth, resulting in plaque accumulation and dental caries. Henceforth, the aim of this study is to assess the effects of pediatric syrups on the microhardness, roughness, and staining ability of primary tooth enamel as a result of daily intake of syrup. Methods Eighty primary teeth, including both anterior and posterior, that required extraction due to pre-shedding mobility were randomly divided into four groups of twenty samples each. Samples were exposed to multivitamin syrup (Rudimin), iron syrup (C Pink), and diuretic syrup (Furosemide). The samples were submerged in 10 mL of the respective medication once daily for five minutes for 21 days. On days 0 and 21, enamel surfaces were assessed for changes in microhardness, roughness, and staining. The microhardness was assessed using a Micro Vickers microhardness tester machine; the roughness was assessed using a Mitutoyo surface roughness tester; and the staining ability was assessed using a spectrophotometer, and data processing was done using the analysis of variance (ANOVA) test and Tukey's post hoc analysis. Results The changes in enamel surface for microhardness, roughness, and staining were assessed twice, at days 0 and 21. Group 4 (Furoped) showed a significant difference in surface microhardness and staining ability of enamel surfaces with a statistically significant p-value (<0.05). When roughness was compared, all three interventions had a significant difference from the control group, whereas there was no statistically significant difference between the intervention groups. Conclusion This study concludes that pediatric syrups can significantly weaken the enamel of primary teeth, resulting in loss of enamel surface microhardness and roughness making them vulnerable to caries. Since frequent consumption of these syrups is correlated with tooth decay, certain precautions like oral hygiene maintenance and rinsing with water after taking the syrup should be done to prevent dental caries, as consumption of medicinal syrups by children cannot be avoided.

Sugar content and erosive potential of commonly prescribed Orodispersible tablets- An in vitro study

Background: Dental caries is a major non-communicable disease of public health concern caused due to freely available dietary sugars. We aimed to compare the sugar content and erosive potential with duration of use and drug classes of orodispersible tablets (ODTs).  Methods: We conducted an in vitro evaluation of the total sugar content (TSC), Potential of Hydrogen (pH), solubility, and Titratable Acidity (TA) of commonly prescribed 62 ODTs. TA was measured by titrating the samples with known amount of. 0.1N sodium hydroxide (NaOH) with phenolphthalein indicator and pH was determined by digital pH meter. TSC was evaluated by phenol sulphuric acid. Solubility was assessed by filtration.  Results: Out of the 62 ODTs, majority were Antimicrobials (n=30). One-quarter of the ODTs (26%) had a mean pH below ≤5.5. No significant difference was seen in the mean pH with respect to different drug classes (p=0.082) and duration of use of ODTs. A significant difference was seen in the mean percentage solubility with respect to drug classes (p<0.001). Antimicrobials had the least percentage of solubility as compared to other drug classes. Antiemetics and proton pump inhibitors (24.33 ± 17.34) had significantly higher mean percentage sugar content than Antimicrobials (23.25 ± 17.16). No significant difference was seen in the mean TSC with respect to various drug classes (p=0.718) and between the duration of use of drugs (P=0.568) respectively. No significant difference was seen in the mean percentage TA with respect to drug class (p=0.123) and duration of use of drugs (p=0.424).  Conclusion: Overall, we can conclude that one in four ODT formulations had a pH below 5.5 (critical pH).  Only one ODT formulation did not have a sugar content. No difference was seen in the mean pH, sugar content, and TA with respect to duration of use of drugs and drug classes.

Sugar content and erosive potential of commonly prescribed Orodispersible tablets- An in vitro study

Background: Dental caries is a major non-communicable disease of public health concern caused due to freely available dietary sugars. We aimed to compare the sugar content and erosive potential with duration of use and drug classes of orodispersible tablets (ODTs).  Methods: We conducted an  in vitro evaluation of the total sugar content (TSC), Potential of Hydrogen (pH), solubility, and Titratable Acidity (TA) of commonly prescribed 62 ODTs. TA was measured by titrating the samples with known amount of. 0.1N sodium hydroxide (NaOH) with phenolphthalein indicator and pH was determined by digital pH meter. TSC was evaluated by phenol sulphuric acid. Solubility was assessed by filtration.  Results: Out of the 62 ODTs, majority were Antimicrobials (n=30). One-quarter of the ODTs (26%) had a mean pH below ≤5.5. No significant difference was seen in the mean pH with respect to different drug classes (p=0.082) and duration of use of ODTs. A significant difference was seen in the mean percentage solubility with respect to drug classes (p<0.001). Antimicrobials had the least percentage of solubility as compared to other drug classes. Antiemetics and proton pump inhibitors (24.33 ± 17.34) had significantly higher mean percentage sugar content than Antimicrobials (23.25 ± 17.16). No significant difference was seen in the mean TSC with respect to various drug classes (p=0.718) and between the duration of use of drugs (P=0.568) respectively. No significant difference was seen in the mean percentage TA with respect to drug class (p=0.123) and duration of use of drugs (p=0.424).   Conclusion: Overall, we can conclude that one in four ODT formulations had a pH below 5.5 (critical pH).  Only one ODT formulation did not have a sugar content. No difference was seen in the mean pH, sugar content, and TA with respect to duration of use of drugs and drug classes.

The Effects of Different Pediatric Drugs and Brushing on the Color Stability of Esthetic Restorative Materials Used in Pediatric Dentistry: An In Vitro Study

The aim of the current study is to observe how different pediatric drugs and tooth brushing affect the color stability of different esthetic restorative materials. Three restorative materials (composite, compomer, and glass ionomer cement (GIC)) were each used to produce 72 specimens (10 mm × 2 mm). The specimens were divided into six groups and immersed in distilled water and five different pediatric drugs (amoxicillin, ibuprofen, ventolin, paracetamol, and multivitamins). Each group was divided into two subgroups (brushed and non-brushed). Over the course of two weeks, the specimens were agitated for one minute every eight hours. Color changes in all the specimens were evaluated using a spectrophotometer at 1 and 2 weeks. GIC showed a change in color that was significantly greater than that in all the other materials in each solution, except for those in amoxicillin. After a period of 1 to 2 weeks, the most noticeable change in color was detected in the amoxicillin composite and amoxicillin GIC unbrushed groups, and after 2 weeks, a significant difference was found in the ventolin GIC unbrushed group. The color stability of the restorative materials used in pediatric dentistry can be influenced by using popular liquid pediatric medications. GIC was the least color-stable material when subjected to liquid medications.

Effects of fluoridated tooth paste on medically erosive enamel in bonded primary teeth during maxillary arch expansion in cleft palate patient: An in vitro study

AIMS

This study searched the effects of fluoridated toothpaste on the enamel surface of deciduous molars eroded by different pediatric liquid medicaments which were encircled by orthodontic bands by gravimetric analysis method.

MATERIALS AND METHODS

A suitable orthodontic band was used to band each of the 110 non-carious exfoliated deciduous molars, and stored in artificial saliva. These teeth were divided randomly into fluoridated and non-fluoridated groups (50 teeth each), and 10 teeth were used as negative controls. The enamel surface of the fluoridated group was swabbed with fluoridated toothpaste for 5 minutes twice daily. Each group was subdivided into five clusters of 10 teeth each according to the type of medication used which included paracetamol, Adol, amoxicillin, Medazole (ME), and Viton (VI) according to a specific immersion cycle. The erosion induced in the enamel for all the teeth was evaluated by gravimetric analysis for different intervals.

RESULTS

The results showed that the weight loss increased with increasing exposure to liquid medication for all groups, but this increase was smaller in the fluoridated group. The highest mean weight loss after 28 days was in VI, and the lowest was in ME (0.145 [0.005] mg; 0.08 [0.008] mg), respectively.

CONCLUSION

The fluoridated toothpaste significantly reduced medically eroded enamel by oral medical syrups. The gravimetric method is valid for the detection of erosion on banded deciduous molars.

Clinical Study of the Change of pH Level in the Supragingival Plaque in Children after Taking Homeopathic Remedies

Objective: There are numerous publications on the parameters of conventional medications, which contribute to their cariogenic and erosive potential. Little is known about the homeopathic remedies (HR) and the changes in the oral cavity they lead to, especially during childhood.

Material and methods: The study involved 25 children (5-9 years of age). It monitored the change in plaque pH level after intake of three frequently used homeopathic remedies in five consecutive weeks. The pH level values were measured after the administration of the remedies, without HR intake, and after rinsing with 10% sucrose solution. Five groups were formed – two controls and three groups with results from the tested HR.

Results: A drop in the plaque pH level was observed after intake of all HR and in all tested individuals. The biggest decrease was observed at the 15th minute for all HR. At the 30th minute the greatest decrease was observed with the second remedy, and at 60th minute – with the first and second.

Conclusions: A dramatic decrease in the plaque pH level was observed after intake of each studied remedy. In many cases the drop was below the critical value of pH = 5.5. The low plaque pH values were maintained even at the 60th minute after the start of the study.

Effect of antihistamine-containing syrup on salivary metabolites: an in vitro and in vivo study

This study tested the null hypothesis that antihistamine-containing syrup does not change salivary metabolites in vitro and in vivo. For the in vitro experiments, saliva from 10 volunteers was mixed with a syrup or pill suspension of loratadine (1 mg/ml Claritin®, Schering-Plough, Rio de Janeiro, Brazil). For the in vivo experiment, 10 volunteers performed a mouth rinse with 10 mL of antihistamine syrup (Claritin®; Schering-Plough, Rio de Janeiro, Brazil) for 20 seconds and then discarded the rinse water. After 20 seconds, 5 mL of unstimulated whole saliva was spit into a plastic tube kept on ice. The protein profile of in vitro and in vivo experiments was analyzed using 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The samples were also analyzed by nuclear magnetic resonance (NMR) spectroscopy, followed by Principal Component Analysis and Wilcoxon test (p < 0.05). There were differences in salivary metabolites after syrup interaction. The salivary concentrations of acetate, n-caproate, arginine, glutamate, and lysine among other metabolites were reduced with the syrup in both in vivo and in vitro experiments (p < 0.05), but no differences were observed when the pill suspension was used (p > 0.05). Similar changes in metabolite profiles were observed in both in vitro and in vivo experiments. Electrophoresis revealed no difference in the salivary protein pattern. The null hypothesis was rejected because the intake of syrup medicine changes the salivary composition and influences oral homeostasis and susceptibility to oral diseases.

The effect of various asthma medications on surface roughness of pediatric dental restorative materials: An atomic force microscopy and scanning electron microscopy study

The aim of the study is to examine and compare the effects of various inhaled asthma medications (IAMs) on the surface roughness of dental restorative materials (DRMs). In total, 192 samples were prepared including 32 samples for the each material group from six different DRMs [Nanohybrid composite (Filtek Z550), Nanofilled flowable composite (Filtek Ultimate), Compomer (Dyract XP), Conventional glass ionomer (Fuji IX Fast), Resin-modified glass ionomer (Fuji II LC), Self-adhering flowable composite (Fusio Liquid Dentin)]. Each group, were divided into four subgroups (n = 8) according to four different IAMs. Surface roughness values (Ra) were obtained by atomic force microscopy (AFM). After the initial roughness of DRMs was analyzed by using AFM and scanning electron microscopy (SEM), each samples were exposed to the same IAMs for 21 days and all analysis were repeated on the 7th and 21st day. Ras increased in all DRMs and higher Ras were recorded through the long-term IAMs administrations. For all IAMs, Fuji II LC had the highest Ra and Filtek Z550 had the lowest Ra. The combined IAM created the highest roughness change on the 7th and 21st day compared to other IAMs. As a result, in in vitro conditions IAMs significantly increased the surface roughness of DRMs.

Effect of pediatric multivitamin syrups and effervescent tablets on the surface microhardness and roughness of restorative materials: An in vitro study

Background/purpose

Multivitamin syrups and effervescent tablets are commonly used for dietary support in children; however, these preparations may have detrimental effects on the surface of restorative materials. The aim of this study was to evaluate the effect of two multivitamin syrups and two effervescent tablets taken daily on the surface microhardness and roughness of two different restorative materials.

Materials and methods

The study groups were comprised of a conventional glass ionomer cement, Ketac Molar, and a giomer, Beautifil II. A total of 140 disc-shaped specimens were prepared and randomly assigned to 5 subgroups. The samples were immersed in 4 multivitamins (Supradyne syrup, Supradyne effervescent, Sambucol syrup, Sambucol effervescent) and deionized water (control group) for 2 min once a day for 28 days. Surface microhardness and roughness measurements were recorded at baseline and on the 7th, 14th, 21st and 28th days. Surface microhardness was measured using a Vickers hardness tester and surface roughness was determined using a profilometer.

Results

For all subgroups; the surface microhardness values of the Ketac Molar and Beautifil II demonstrated a statistically significant decrease from the baseline to the 28th day measurements (p < 0.05), while the surface roughness displayed increased values that were found to be statistically significant (p < 0.05). The Ketac Molar surface roughness values were significantly higher than Beautifil II in all subgroups for all measurement days (p = 0.0001).

Conclusion

The prolonged use of multivitamin syrups and effervescent tablets may have negative effects on the physical properties of restorative materials.

Acidogenic evaluation of pediatric medications in Saudi Arabia

Background:

To gain patient compliance, pediatric medication preparations are made palatable by adding sugars such as sucrose, glucose, or fructose. These readily fermentable carbohydrates can significantly increase dental caries potential in the young and chronically sick children.

Objectives:

To evaluate acidogenic potential of commonly used pediatric liquid medicaments (PLMs).

Materials and Methods:

The acidogenic potential is assessed by estimating the endogenous pH of PLM.

Results:

The mean endogenous pH was higher in Azomycin (9.16 ± 0.25) and lowest in Lorinase (3.16 ± 0.15).

Conclusion:

Of nine, eight PLMs were acidic in nature.

Stability of extemporaneous sulfadiazine oral suspensions from commercially available tablets for treatment of congenital toxoplasmosis

OBJECTIVES

To determine the physicochemical and microbiological stability of sulfadiazine suspensions (100 mg/mL) in simple syrup (A) and sorbitol (B) formulations prepared from commercially available tablets.

METHODS

An ultra-performance liquid chromatographic assay was developed and validated to determine the chemical stability of sulfadiazine. Three samples were prepared and stored at 5 and 25 °C and assayed at 0, 7, 14 and 30 days. Physical parameters (appearance, pH, particle size and viscosity) were also monitored. Microbiological examination was performed through the suitable counting method.

RESULTS

The formulations presented a sulfadiazine concentration of around 95% at the beginning at both temperatures. There was some variation in pH, viscosity and particle size distribution over time. The samples met the pharmacopoeia criteria of microbiological quality over 30 days, but only sulfadiazine formulated in syrup stored at 25 °C was suitable for use after one week.

CONCLUSION

The sulfadiazine suspension in simple syrup was chosen as the most suitable formulation because it demonstrated stability for 14 days at room temperature, providing an alternative liquid dosage form of sulfadiazine for congenital toxoplasmosis treatment.

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

Abstract The present study evaluated the effect of NaF and CPP-ACP/NaF varnishes to reduce erosion produced by soft drink (SD) combined or not with pediatric liquid medicine. Enamel specimens were pre-treated with fluoride varnish, according to the following groups: NaF varnish (Duraphat®) or CPP-ACP/NaF varnish (MI varnishTM). Two types of erosive cycles were made: by soft drink erosion (SDE) or by pediatric liquid medicine plus soft drink erosion (PLM/SDE). Bovine enamel specimens were randomly assigned in six groups (n=10): G1=NaF + SDE; G2=CPP-ACP/NaF + SDE; G3=Distilled and deionized (DD) water + SDE; G4=NaF + PLM/SDE; G5=CPP-ACP/NaF + PLM/SDE and G6=DD water + PLM/SDE. Before treatments, the sample surface was divided in two areas (unexposed area-UA and exposed area-EA). The specimens were evaluated by 3D non-contact profilometry technique to determinate tooth structure loss (TSL) and surface roughness (Sa). Scanning electron microscopy (SEM) analysis was also performed. After SDE, G2 presented the lowest TSL values compared to G3 (p=0.008). G1 and G2 did not differ between them (p=0.203) and no groups differed among them despite Sa. Regarding TSL and Sa, G4 and G5 differed from G6 (p=0.0001), but not between them (p=1.00). Examining 3D and SEM images, the greatest differences between UA and EA were observed for G3 and G6. CPP-ACP/NaF varnish seems to be a promising treatment to reduce enamel loss from the erosion produced by a soft drink. Both varnishes also showed capacity to reduce TSL and Sa after erosion by soft drink combined to pediatric liquid medicine.

Citric Acid Suppresses the Bitter Taste of Olopatadine Hydrochloride Orally Disintegrating Tablets

Orally disintegrating tablets (ODTs) are formulated to disintegrate upon contact with saliva, allowing administration without water. Olopatadine hydrochloride, a second-generation antihistamine, is widely used for treating allergic rhinitis. However, it has a bitter taste; therefore, the development of taste-masked olopatadine ODTs is essential. Some studies have suggested that citric acid could suppress the bitterness of drugs. However, these experiments were performed using solutions, and the taste-masking effect of citric acid on ODTs has not been evaluated using human gustatory sensation tests. Thus, this study evaluated citric acid's taste-masking effect on olopatadine ODTs. Six types of olopatadine ODTs containing 0-10% citric acid were prepared and subjected to gustatory sensation tests that were scored using the visual analog scale. The bitterness and overall palatability of olopatadine ODTs during disintegration in the mouth and after spitting out were evaluated in 11 healthy volunteers (age: 22.8±2.2 years). The hardness of the ODTs was >50 N. Disintegration time and dissolution did not differ among the different ODTs. The results of the gustatory sensation tests suggest that citric acid could suppress the bitterness of olopatadine ODTs in a dose-dependent manner. Olopatadine ODTs with a high content of citric acid (5-10%) showed poorer overall palatability than that of those without citric acid despite the bitterness suppression. ODTs containing 2.5% citric acid, yogurt flavoring, and aspartame were the most suitable formulations since they showed low bitterness and good overall palatability. Thus, citric acid is an effective bitterness-masking option for ODTs.

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

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.

Cariogenic Potential of the commonly Prescribed Pediatric Liquid Medicaments in Kingdom of Saudi Arabia: An in vitro Study

AIM

The aim of this study was to assess the cariogenic potential of the commonly prescribed pediatric liquid medicaments (PLMs) for dental disease in Jazan region, Kingdom of Saudi Arabia.

MATERIALS AND METHODS

Seven most commonly prescribed PLMs were selected by prior questioning the pediatric dentists as well as general dentists in Jazan region. The endogenous pH and sucrose concentrations of the liquid medicaments were assessed. The endogenous pH was assessed by Hanna pH meter instrument. The sucrose concentration was assessed by anthrone reagent method.

RESULTS

All the PLM were acidic. The pH of the PLM ranged from 4.22 to 6.10. All the PLM contained sucrose and its concentration ranged from 5.38 to 11.41 gm% in the samples.

CONCLUSION

In this study, all the PLM were acidic and contained sucrose. Hence, they have cariogenic potential.

CLINICAL SIGNIFICANCE

Parents and dentists are unaware of the hidden sugars and cariogenicity of these medications. Strict oral hygiene instructions are mandatory for the children taking these medications. The use of PLM should also be minimized and parents should seek early dental treatment to restore child's oral health.

Effects of Different Pediatric Drugs on the Color Stability of Various Restorative Materials Applicable in Pediatric Dentistry

Background. The chronic recommendation of pediatric drugs could exhibit erosive and cariogenic problems. Objective. To evaluate the effects of different pediatric drugs on the color stability of various restorative materials. Methods. Five specimens (1 mm × 3 mm) were prepared and immersed in ten different pediatric drugs and agitated every 8 hours daily for 2 min up to 1 week. Between immersion periods, the samples were stored in artificial saliva. After 1-week period, ΔE^⁎ values were calculated. Two-way ANOVA and Fisher's LSD test were used for statistical analysis at a level of p < 0.05. Results. ΔE^⁎ values were only significantly influenced by restorative material factor (p < 0.001) and varied in the range of 2.08 and 6.55 units for all drugs/restorative materials. The highest ΔE^⁎ was found in Ferrosanol B-composite (6.55 ± 1.38) and the lowest one was found in Dolven-glass ionomer (2.08 ± 0.40) pairwise. The most prominent ΔE^⁎ value elevations were obtained in composite material compared to the compomer and/or glass ionomers in Macrol, Ferrosanol B, and Ventolin (p < 0.001; for all) and also for other drugs (p < 0.05). Dolven exhibited significantly higher values compared to Augmentin (p = 0.021), Macrol (p = 0.018), and Ventolin (p = 0.013) in compomer group. Conclusion. The clinically perceptible color changes for tested composite/pediatric drug pairwise can be more problematic than compomer and glass ionomers in pediatric dentistry.

Erosive effects of pediatric liquid medicinal syrups on primary enamel: An in vitro comparative study

Context:

The use of liquid medicinal syrups in childhood is high owing to the reasons that children suffer from illness quite often. The acidic component in the formulations may cause erosion to the dental tissues.

Aims:

The aim of this study is to evaluate the erosive potential of pediatric liquid medicinal syrups on the deciduous teeth.

Subjects and Methods:

A total of sixty extracted/exfoliated noncarious deciduous molars were used. Four medical syrups were used (viz., 1 – artificial saliva [control], 2 – Ferium XT, 3 – Crocin syrup, 4 – Ambrolite-D) and the teeth were equally divided into the four groups (n = 15) for the immersion cycle, following which the teeth were examined for surface microhardness at 7, 14, 21, and 28 days.

Statistical Analysis Used:

ANOVA and post hoc analysis were applied.

Results:

The time and immersion media interaction demonstrated that antitussives produced a significant and gradual loss of surface microhardness on all days (viz., 7, 14, 21, and 28 days), but a statistically significant difference was seen only between 7^th and 28^th day (P < 0.05).

Conclusions:

The knowledge of the erosive potential of commonly used syrups is mandatory as erosion in children teeth may be associated with dental hypersensitivity, loss of the occlusal vertical dimension, eating difficulties, poor esthetics, pulp exposure, and abscesses. Mouth rinsing with water after taking the medication; addition of calcium, fluoride, or phosphate to formulations; and consumption of the medication at meal times have been recommended to avoid tooth damage that is caused by the regular use of medication.

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.

Efeito sobre a morfologia do esmalte dental e análise físico-química de medicamentos utilizados por pacientes pediátricos com paralisia cerebral

Resumo Introdução Muitos medicamentos pediátricos líquidos são considerados fatores de risco para a estrutura dentária. Esse potencial pode aumentar quando ingeridos de forma crônica, como é o caso do tratamento de algumas condições, tal como a paralisia cerebral. Objetivo Avaliar o efeito sobre a morfologia do esmalte dental e as propriedades físico-químicas de medicamentos de uso contínuo indicados a pacientes infantis com Paralisia Cerebral. Material e método A amostra foi constituída por quatro medicamentos: Fenobarbital (M1), Carbamazepina (M2), Oxcarbazepina (M3) e Domperidona (M4), todos em suspensão oral. Analisaram-se o pH, o teor de Sólidos Solúveis Totais (SST) e a viscosidade dos medicamentos. Todos os testes foram realizados em duplicata. Para análise em microscopia eletrônica de varredura (MEV), 15 blocos de esmalte bovino foram distribuídos aleatoriamente e imersos em oxcarbamazepina (n=5), carbamazepina (n=5) e saliva artificial (n=5). Os ciclos de imersão foram feitos por seis dias, durante cinco minutos, duas vezes ao dia, com intervalos de 12 horas, quando ficavam mantidos em saliva artificial. O grupo controle permaneceu em saliva artificial. Os dados foram analisados descritivamente. Resultado Em relação ao pH endógeno, os valores variaram de 2,82 (M3) a 9,60(M1). Para o SST, as médias de maior e menor valor foram, respectivamente, de 20,5% (M3) e 46% (M1). A viscosidade variou de 6,89 mm2/s (M1) a 58 mm2/s (M3). Em MEV, observaram-se alterações sugestivas de perda de estrutura no esmalte dental em oxcarbamazepina e carbamazepina, proveniente da ação dos medicamentos analisados. Conclusão Concluiu-se que os medicamentos líquidos pediátricos analisados, indicados a pacientes com paralisia cerebral, apresentam potencial cariogênico e erosivo, destacando-se a Oxcarbazepina.

Experimental study of iron and multivitamin drops on enamel microhardness of primary tooth

OBJECTIVES

Iron and multivitamin drops are being frequently prescribed in children less than 2 years of age. Due to their low pH levels, these drops may lead to the softening of enamel and accelerate the destructive process. The aim of the present study was to investigate the enamel microhardness of primary teeth after exposing them to iron and multivitamin drops.

MATERIALS AND METHODS

Forty healthy anterior teeth were randomly divided into four groups of 10 samples each. Samples were exposed to two iron drops of Kharazmi (Iran) and Ironorm (UK) and two multivitamin drops of Shahdarou (Iran) and Eurovit (Germany) for 5 min. The surface microhardness was measured before and after exposure and data processing was done using statistical paired t-test and analysis of variance (ANOVA) test. The surface structure of the teeth was examined by scanning electron microscope (SEM).

RESULTS

In all groups, microhardness was decreased, but it was not significant in Eurovit multivitamin group (P = 0.088). The reduction rate in Kharazmi iron group was significant compared to that in other groups (P < 0.005). Hardness reduction percent for Kharazmi iron drop was 28/12 ± 47/43. In SEM analysis, irregular granular appearance was observed in the enamel exposed to Kharazmi iron drop.

CONCLUSION

The results showed that all the studied drugs have the potential to cause erosion; this potential is the most in Kharazmi iron drop and the least in Eurovit multivitamin drops. Therefore, after using these kinds of drops, preventive measures should be used in children.

Patient-centred pharmaceutical design to improve acceptability of medicines: similarities and differences in paediatric and geriatric populations

Patient acceptability of a medicinal product is a key aspect in the development and prescribing of medicines. Children and older adults differ in many aspects from the other age subsets of population and require particular considerations in medication acceptability. This review highlights the similarities and differences in these two age groups in relation to factors affecting acceptability of medicines. New and conventional formulations of medicines are considered regarding their appropriateness for use in children and older people. Aspects of a formulation that impact acceptability in these patient groups are discussed, including, for example, taste/smell/viscosity of a liquid and size/shape of a tablet. A better understanding of the acceptability of existing formulations highlights opportunities for the development of new and more acceptable medicines and facilitates safe and effective prescribing for the young and older populations.

In Vitro Erosive Effect of Pediatric Medicines on Deciduous Tooth Enamel

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.

Comparative evaluation of cariogenic and erosive potential of commonly prescribed pediatric liquid medicaments: an in vitro study

INTRODUCTION

Liquid oral medicines being the most accepted form of medication in children are frequently prescribed. The harmful effects of these liquid medicaments on a child's dental health are not known to many. The present study aimed to evaluate and compare the cariogenic and erosive potential of 5 most commonly prescribed pediatric liquid medicaments (PLM) in Pimpri Chinchwad and Pune city, Pune district.

MATERIALS AND METHODS

Most commonly prescribed PLM in Pune district were selected as opined by 50 pediatricians. The selected medicaments were Syr. Augmentin® Duo, Syr. Valparin®, Syr. Combiflam®, Syr. Visyneral and Syr. Orofer®. An estimation of pH, percentage of sucrose concentration and calcium dissolving capacity of these preparations was carried out. The results as obtained were subjected to statistical analysis using SPSS v 17.0 for windows. The statistical test as undertaken was Pearson's correlation coeffcient(r).

RESULTS

Sucrose was seen to be present in Syr. Combiflam® (35.75% ± 0.25%) and Syr. Visyneral (18.48% ± 0.43%). Acidic pH was observed for Syr. Visyneral (mean pH 3.63 ± 0.04), Syr. Combiflam®(mean pH 5.03 ± 0.02) and Syr. Augmentin® (mean pH 6.22 ± 0.02). Highest calcium dissolution was seen with Syr. Combiflam®(295.86 mg/ml) and the least with Syr. Orofer® (25.51 mg/ml). No statistical significant correlation was observed with calcium dissolution potential of PLM in comparison with their respective pH.

CONCLUSION

Syr. Combiflam® can be regarded as the highest cariogenic and erosive potential medicament among the compared and tested PLM.

CLINICAL SIGNIFICANCE

Considering syrups with high cariogenic and erosive potential should always follow with proper oral hygiene practices or search for an alternative drugs void of such detrimental effects.

Erosive and cariogenicity potential of pediatric drugs: study of physicochemical parameters

Background

Pediatric medications may possess a high erosive potential to dental tissues due to the existence of acid components in their formulations. The purpose was to determine the erosive and cariogenic potential of pediatric oral liquid medications through the analysis of their physicochemical properties in vitro.

Methods

A total of 59 substances were selected from the drug reference list of the National Health Surveillance Agency (ANVISA), which belong to 11 therapeutic classes, as follows: analgesics, non-steroidal anti-inflammatory, corticosteroids, antihistamines, antitussives, bronchodilators, antibacterials, antiparasitics, antiemetics, anticonvulsants and antipsychotics. Measurement of pH was performed by potentiometry, using a digital pH meter. For the Total Titratable Acidity (TTA) chemical assay, a 0.1 N NaOH standard solution was used, which was titrated until drug pH was neutralized. The Total Soluble Solids Contents (TSSC) quantification was carried out by refractometry using Brix scale and the analysis of Total Sugar Content was performed according to Fehling’s method. In addition, it was analyzed the information contained in the drug inserts with regard to the presence of sucrose and type of acid and sweetener added to the formulations.

Results

All drug classes showed acidic pH, and the lowest mean was found for antipsychotics (2.61 ± 0.08). There was a large variation in the TTA (0.1% - 1.18%) and SST (10.44% - 57.08%) values. High total sugar contents were identified in the antitussives (53.25%) and anticonvulsants (51.75%). As described in the drug inserts, sucrose was added in 47.5% of the formulations, as well as citric acid (39.0%), sodium saccharin (36.4%) and sorbitol (34.8%).

Conclusion

The drugs analyzed herein showed physicochemical characteristics indicative of a cariogenic and erosive potential on dental tissues. Competent bodies’ strategies should be implemented in order to broaden the knowledge of health professionals, drug manufacturers and general consuming public about the risks from the consumption of medicines potentially harmful to dental tissues.

The bad taste of medicines: overview of basic research on bitter taste

BACKGROUND

Many active pharmaceutical ingredients taste bitter and thus are aversive to children as well as many adults. Encapsulation of the medicine in pill or tablet form, an effective method for adults to avoid the unpleasant taste, is problematic for children. Many children cannot or will not swallow solid dose forms.

OBJECTIVE

This review highlights basic principles of gustatory function, with a special focus on the science of bitter taste, derived from studies of animal models and human psychophysics. We focus on the set of genes that encode the proteins that function as bitter receptors as well as the cascade of events that leads to multidimensional aspects of taste function, highlighting the role that animal models played in these discoveries. We also summarize psychophysical approaches to studying bitter taste in adult and pediatric populations, highlighting evidence of the similarities and differences in bitter taste perception and acceptance between adults and children and drawing on useful strategies from animal models.

RESULTS

Medicine often tastes bitter, and because children are more bitter-sensitive than are adults, this creates problems with compliance. Bitter arises from stimulating receptors in taste receptor cells, with signals processed in the taste bud and relayed to the brain. However, there are many gaps in our understanding of how best to measure bitterness and how to ameliorate it, including whether it is more efficiently addressed at the level of receptor and sensory signaling, at the level of central processing, or by masking techniques. All methods of measuring responsiveness to bitter ligands-in animal models through human psychophysics or with "electronic tongues"-have limitations.

CONCLUSIONS

Better-tasting medications may enhance pediatric adherence to drug therapy. Sugars, acids, salt, and other substances reduce perceived bitterness of several pharmaceuticals, and although pleasant flavorings may help children consume some medicines, they often are not effective in suppressing bitter tastes. Further development of psychophysical tools for children will help us better understand their sensory worlds. Multiple testing strategies will help us refine methods to assess acceptance and compliance by various pediatric populations. Research involving animal models, in which the gustatory system can be more invasively manipulated, can elucidate mechanisms, ultimately providing potential targets. These approaches, combined with new technologies and guided by findings from clinical studies, will potentially lead to effective ways to enhance drug acceptance and compliance in pediatric populations.

Cariogenic potential of medications used in treatment of children with HIV infection

In children infected with human immunodeficiency virus (HIV), initiation of antiretroviral therapy (ART) commences at a very young age. These drugs are administered over a prolonged period and could be a possible risk factor for dental caries in these children.

OBJECTIVES

To assess endogenous pH, titratable acidity and type and concentration of sugars present in drugs used in treatment of HIV-infected children.

STUDY DESIGN

Eleven drugs that are regularly prescribed to treat HIV infection in children (antiretrovirals, antibacterial, antifungal) were selected. The endogenous pH and titratable acidity of each drug was assessed. Type and concentration of sugars present in these medications was estimated using thin layer chromatography.

RESULTS

Medications were mostly in syrup form and their pH ranged from 2.27 to 7.98. Titratable acidity varied between 0.01 to 0.37 mmol. Sucrose was present in all medications, and more than 60 g% of sucrose was present in anti-acterial and antifungal preparations.

CONCLUSION

The physical properties and sugar content of medications used in ART pose a risk to dental health of children.

In vitro alterations in dental enamel exposed to acidic medicines

OBJECTIVE

To evaluate the effect of acidic medicines (Klaricid(®), Claritin(®), and Dimetapp(®)) on surface enamel in vitro.

METHODS

Enamel blocks (n=104) were randomly distributed into two groups: G1 (pH-cycling simulating physiological oral conditions) and G2 (erosive conditions). Each group was divided into four subgroups, three to be immersed in the medicines and the control in deionized water. Specimen surfaces were evaluated for roughness and hardness at baseline and again after the in vitro experimental phase, which included 30 min immersions in the medicines twice daily for 12 days. Scanning electron microscopy (SEM) was also performed after the in vitro experimental phase.

RESULTS

All medicines produced a significant reduction in hardness in G1 after 12 days (P<0.05). The three medicines promoted greater roughness after both pH-regimens - G1 and G2 (P<0.01), except for Claritin in G1. Scanning electron microscopy analysis showed erosive patterns in all subgroups. Dimetapp(®) showed the most erosion and Klaricid(®) the least, in both groups.

CONCLUSION

Dimetapp(®) (lowest pH and viscosity) and deionized water (control) showed the most pronounced erosive patterns. Klaricid(®) (highest pH and viscosity) presented an in vitro protective effect against acid attacks perhaps due to its mineral content and viscosity.

Oral health in Autoimmune Polyendocrinopathy Candidiasis Ectodermal Dystrophy (APECED)

BACKGROUND

APECED (Autoimmune Polyendocrinopathy Candidiasis Ectodermal Dystrophy) is a rare autosomal recessive disease characterised primarily by sequential immune-mediated destruction of endocrine tissues, chronic oral or mucocutaneous candidiasis and ectodermal disorders, including hypoplasia of dental enamel.

AIM

This was to investigate the oral health and presence of enamel defects in a cohort of patients with APECED.

METHODS

16 patients with APECED (mean age of 13.9 years) were matched for age and gender with healthy controls. A comprehensive medical, dental and drug history was recorded, followed by a clinical assessment of oral health which was determined by assessing periodontal treatment needs, prevalence of dental caries, erosion, fluorosis and enamel defects. The estimated time of the development of the enamel defects and the contemporaneous medical diagnosis were recorded.

RESULTS

Oral health of patients with APECED was poor compared with controls, with a higher prevalence of periodontal disease, caries and erosion. There was a significantly (P < 0.05) higher prevalence of enamel defects in the study group. The enamel defects were mostly hypoplastic in the form of pits, missing enamel and grooves. The enamel defects occurred in a chronological pattern. There was a strong association between the estimated time of defective enamel formation and a history of hypoparathyroidism. Gastrointestinal dysfunction and a history of chronic mucocutaneous candidiasis were also associated with the presence of enamel defects.

CONCLUSION

The oral health of individuals with APECED was poor compared with controls with a higher prevalence of periodontal disease, caries, erosion and enamel defects. The enamel defects in the study population occurred in a chronological pattern and some were associated with a history of systemic disease during the period of tooth development.

Intraoral condition in children with juvenile idiopathic arthritis compared to controls

AIMS

The aims of this study were to compare the periodontal conditions in children and adolescents with juvenile idiopathic arthritis (JIA) in comparison to age-matched healthy individuals, and to describe intraoral health in relation to medical assessments.

DESIGN

Forty-one JIA patients, 10-19 years old, were compared to 41 controls. Plaque, calculus, probing depth, bleeding on probing, clinical attachment loss, as well as mucosal lesions were registered. Marginal bone level was recorded on radiographs. A questionnaire was included. Data were analysed with chi-squared test, Fisher's exact test, and Mann-Whitney U-test (P < 0.05).

RESULTS

The JIA patients reported pain from jaws (P = 0.001), hands (P = 0.001), and oral ulcers (P = 0.015) more often than controls. They avoided certain types of food because of oral ulcers (P = 0.037). The frequencies of sites with plaque (32% vs. 19%, P = 0.013), calculus (11% vs. 5%, 5 = 0.034), bleeding on probing (26% vs. 14%, P < 0.01), and probing depth 2 mm (32% vs. 2%, P < 0.001) were higher among JIA patients. No sites with attachment loss or reduced marginal bone level were observed.

CONCLUSIONS

These obtained results are probably because of joint pain, making it difficult to perform oral hygiene as well as the use of medication and general disease activity.