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

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.

Nano-hydroxyapatite preparation for the remineralization of primary tooth enamel surface subjected to liquid medication: An observational study

Background and Aims

Acid-induced demineralization may be caused by the consumption of liquid medications routinely administered to children. Therefore, different remineralizing agents, such as fluorides and nano-hydroxyapatite, have been added to oral care products to remineralize erosive lesions. This study was conducted to compare the effectiveness of 1% nano-hydroxyapatite suspension and 2% sodium fluoride solution on the surface texture of primary teeth enamel previously exposed to liquid drugs.

Methods

Thirty posterior primary teeth were extracted and grouped depending on the remineralizing agent used: (A) nano-hydroxyapatite and (B) sodium fluoride. Groups A and B were subjected to liquid medication in two subgroups: cephalexin (cephalexin monohydrate) and ParAzar (acetaminophen), followed by remineralization with 1% nano-hydroxyapatite suspension and 2% sodium fluoride solution. An atomic force microscope was used to analyze the surface texture of the primary tooth enamel by measuring the roughness and waviness parameters of the tested surfaces. The examination was performed at baseline, 7 days after exposure to drugs, and after exposure to remineralizing agents.

Results

A significant difference in enamel surface roughness between nano-hydroxyapatite-treated surfaces and sodium fluoride-treated surfaces was observed. A significant change was observed in the surface waviness of the primary enamel surface of sodium-fluoride-treated teeth that were subjected to cephalexin.

Conclusion

Routine use of liquid medications could have a negative impact on primary enamel surface topography, because the primary tooth enamel is less mineralized than permanent tooth enamel. Our results show that compared with a 2% sodium fluoride solution, a 1% nano-hydroxyapatite suspension can be used for remineralizing and restoring defects of the enamel surface of primary teeth following exposure to liquid medication, thus reinforcing dental tissues with higher efficacy.

Acceptability of different oral dosage forms in paediatric patients in hospital setting

OBJECTIVE

The understanding of acceptability of existing dosage forms is limited in most of the world and hinders the development of acceptable, age-appropriate medicines. The attributes of paediatric medicine acceptability may differ from country to country based on culture, healthcare infrastructure and health policies. This study was designed to map the acceptability of oral medicines in paediatric patients treated in hospital in India.

METHODS

An observational, cross-sectional study was conducted in patients aged below 18 years and taking any form of oral medication. Acceptability scores were obtained using CAST-ClinSearch Acceptability Score Test tool.

FINDINGS

490 patients were recruited and 193 evaluations of different pharmaceutical products available in 20 dosage forms and 7 routes of administration were studied. Oral liquids (50%) and tablets (35%) were the most commonly prescribed and administered forms. Regardless of the therapeutic class and age, the oral liquids were 'positively accepted' in infants and toddlers. Acceptability of tablets improved with age and appeared to be generally good from the age of 6.

CONCLUSION

This study indicates the limited progress towards adoption of age-appropriate dosage forms in India and thus impact on the acceptability of existing oral dosage forms. The key challenges posed by the adoption of age-appropriate formulations in India are (1) awareness of importance of appropriate administration and acceptability of medicines to children in India, (2) availability of age-appropriate dosage forms and (3) lack of child-appropriate medicine policies.

Taste Perceptions of Common Pediatric Antibiotic Suspensions and Associated Prescribing Patterns in Medical Residents

OBJECTIVE

Palatability of medication is an important factor for adherence, especially in pediatric populations that tend to use oral suspensions for antibiotic therapy. Our study is the first to evaluate the impact of taste on prescribing patterns of antibiotic suspensions. The objective was to determine if taste testing common antibiotic suspensions altered prescribing patterns of medical residents, through data extracted from the electronic health record.

METHODS

After assessing 5 “primer” tastes (sweet, salty, bitter, sour, umami [savory]), residents were randomized to sample 6 antibiotic suspensions to rate their taste perception. A 12-month retrospective and prospective analysis of outpatient prescribing practices of the residents followed, and the results were compared to the resident cohort randomized to no taste test.

RESULTS

The 43 residents prescribed 207 liquid antibiotic prescriptions for 176 patients, with no difference in patient characteristics between residents in the taste test versus non–taste test group. Although amoxicillin was most preferable and amoxicillin-clavulanate least, the only significant finding was a greater prescribing rate of cefdinir among those who had tasted it and an inverse relationship between cephalexin taste preference and percentage prescribing amoxicillin in the taste group. Residents who tasted were poor in identifying primer tastes, but this did not impact prescribing patterns.

CONCLUSIONS

Among 6 commonly prescribed antibiotic suspensions, amoxicillin remains a highly preferred taste among prescribers. Interestingly, after the taste test there was a significantly greater prescribing rate of cefdinir among those who had tasted it and somewhat lower prescribing rate for amoxicillin-clavulanate.

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.

Relationship of pH and the viscosity of five different iron supplements with the absorption of iron ions and enamel discoloration in the anterior primary teeth (an in vitro study)

BACKGROUND

Various iron drops are prescribed to children to prevent iron-deficiency anemia. The current study aimed to evaluate and compare the physicochemical profile of iron drops and the effect of these medicines on the color of primary teeth.

MATERIALS AND METHODS

On the commencement of this experimental study, the pH and viscosity of five types of iron drops were measured. For the purpose of the current study, sixty healthy anterior deciduous teeth were provided; thereafter, they were assigned to five groups and then exposed to iron drops. The color and color difference of each specimen were measured by VİTA Easyshade Compact after 2 weeks. The amount of absorbed iron was determined by atomic absorption. The data were analyzed using two-way ANOVA and Tukey's test (P < 0.05).

RESULTS

As evidenced by the obtained results, all medications demonstrated acidic pH and discoloration. The viscosity values of iron drops were reported to be within the range of 2.07-33.58 cP. Based on the results of Pearson's correlation coefficient test, discoloration showed a correlation with pH and atomic absorption (P < 0.05).

CONCLUSION

Analyzed iron drops displayed low pH and discoloration higher than 3.3 which can be easily distinguished with naked eyes. Medicine labels should include warning statements on the feasibility of dental discoloration and erosion.

Oral Aspects Identified in Atopic Dermatitis Patients: A Literature Review

Introduction:

Atopic dermatitis is a chronic inflammatory skin condition that is more prevalent in children (10-20% of the world's population) than in adults. As its etiology is multifactorial, it is important to know the most frequent oral manifestations in atopic dermatitis patients.

Methodology:

In the last decades, the correlation between atopic dermatitis and conditions and/or changes in the oral cavity has been demonstrated by several studies. The objective of this paper was to describe, through a review of the literature, the oral health conditions and/or oral aspects identified in patients with atopic dermatitis.

Search Strategy:

A descriptive literature review was carried out through a bibliographical survey based on the last 10 years, in order to answer the study questions.

Results:

As a result, we found six studies with different sample sizes, ranging from 43 to 468 patients, and the majority of them were of cross-sectional study design.

Discussion:

Two studies performed their analysis through dental exams and reported that patients with atopic dermatitis tend to have a greater frequency of carious lesions, and two studies correlated Candida with atopic dermatitis through mycological analyzes.

Conclusion:

There are a few studies in the literature that identify the oral aspects of atopic dermatitis. More investigations are needed in order to contribute to the knowledge of such oral aspects and the approach to treat these patients regarding oral health.

Sweetener content and cariogenic potential of pediatric oral medications: A literature

Sweetened oral medications are widely used for children to facilitate compliance. A variety of natural and artificial sweeteners are used in these drug formulations to augment the sweetness and thereby palatability of the product. There is growing concern among dentists about the increased consumption of sugars in these medications by children, especially those who are chronically ill as it may contribute to diabetes mellitus, dental erosion, and dental caries. This literature review provides information about the sweetener content and cariogenic potential of commonly prescribed pediatric oral medications that are used for managing acute and chronic conditions in children and measures for oral health prevention.