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

BMC Oral Health

Alessandro L Cavalcanti⁴  Mauro HNG Abreu²  Fernando F Vieira¹  Waldeneide F Azevedo³  Eline FF Moura⁴  Alidianne Fábia C Xavier⁴ 

[1] Department of Sanitary and Environmental Engineering, State University of Paraiba, Avenida das Baraunas, S/N, Bodocongo, Campina Grande 58109-970, PB, Brazil;Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Belo Horizonte 31270.901, Brazil;Posgraduate Programa in Public Health, State University of Paraiba, Avenida das Baraunas, S/N, Bodocongo, Campina Grande, PB 58109-970, Brazil;Department of Preventive Dentistry, School of Dentistry, State University of Paraiba, Avenida das Baraunas, S/N, Bodocongo, Campina Grande, PB 58109-970, Brazil

关键词: Hydrogen-ion concentration;    Drug evaluation;    Dental caries;   

Others  :  1121523
DOI  :  10.1186/1472-6831-13-71

 received in 2013-05-17, accepted in 2013-12-05,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Xavier et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Standing J, Tuleu C: Paediatric formulations - getting to the heart of the problem. Int J Pharm 2005, 300:56-66.
• [2]Babu KL, Rai K, Hedge AM: Pediatric liquid medicaments - do they erode the teeth surface? An in vitro study: part I. J Clin Pediatr Dent 2008, 32:189-194.
• [3]Marquezan M, Marquezan M, Pozzobon RT, Oliveira MDM: Medicines used by pediatric dentistry patients and its cariogenic potential. Rev Pos-Grad 2007, 13:334-339.
• [4]Headley J, Northstone K: Medication administered to children from 0 to 7,5 years in the Avon Longitudinal Study of Parents and Children (ALSPAC). Eur J Clin Pharmacol 2007, 63:189-195.
• [5]Sturkenboom MC, Verhamme KM, Nicolosi A, Murray ML, Neubert A, Caudri D, et al.: Drug use in children: cohort study in three European countries. BMJ 2008, 24:1-13.
• [6]Cox ER, Halloran DR, Homan SM, Welliver S, Mager DE: Trends in the prevalence of chronic medication use in children: 2002–2005. Pediatrics 2008, 122:e1053-e1061.
• [7]Oliveira EA, Bertoldi AD, Domingues MR, Santos IS, Barros AJD: Uso de medicamentos do nascimento aos dois anos: coorte de nascimentos de pelotas, RS, 2004. Rev Saude Publica 2010, 44:591-600.
• [8]Taji S, Seow WK: A literature review of dental erosion in children. Aust Dent J 2010, 55:358-367.
• [9]Sahgal J, Sood PB, Raju OS: A comparison of oral hygiene status and dental caries in children on long term liquid oral medications to those not administered with such medications. J Indian Soc Pedod Prev Dent 2020, 20:144-151.
• [10]Al-Malik MI, Holt RD, Bedi R: The relationship between erosion, caries and rampant caries and dietary habits in preschool children in Saudi Arabia. Int J Paediatr Dent 2001, 11:430-439.
• [11]Nunn JH, Ng SK, Sharkey I, Coulthard M: The dental implications of chronic use of acidic medicines in medically compromised children. Pharm World Sci 2001, 23:118-119.
• [12]Pierro VSS, Abdelnur JP, Maia LC, Trugo LC: Free sugar concentration and pH of paediatric medicines in Brazil. Community Dent Health 2005, 22:180-183.
• [13]Maguire A, Baqir W, Nunn JH: 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. Int J Paediatr Dent 2007, 17:231-238.
• [14]Cavalcanti AL, Fernandes LV, Barbosa AS, Vieira FF: pH, titratable acidity and total soluble solid content of pediatric antitussive medicines. Acta Stomatol Croatica 2008, 42:164-170.
• [15]Passos IA, Sampaio FC, Martínez CR, Freitas CHM: Sucrose concentration and pH in liquid oral pediatric medicines of long-term use for children. Rev Panam Salud Public 2010, 27:132-137.
• [16]Neves BG, Farah A, Lucas E, Sousa VP, Maia LC: Are paediatric medicines risk factors for dental caries and dental erosion? Community Dent Health 2010, 27:46-51.
• [17]Cavalcanti AL, Sousa RIM, Clementino MA, Vieira FF, Cavalcanti CL, Xavier AFC: In vitro analysis of the cariogenic and erosive potential of paediatric antitussive liquid oral medications. Tanz J Health Res 2012, 14:1-8.
• [18]Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária: Lista de medicamentos de referência. Disponível em: http://www.anvisa.gov.br/medicamentos/referencia/index.htm webcite
• [19]Instituto Adolfo Lutz: Métodos físico-químicos para análise de alimentos. Açúcares e produtos correlatos. São Paulo: Digital; 2008.
• [20]Méndez Esteban ME, Antequera Rodríguez-Rabadán J, Puebla García V, Pardo de Torres J, Gallego Lago V, Herreros de Tejada A: Formulaciones orales acuosas: uma administración más segura para pediatría. Rev OFIL 2006, 16:15-28.
• [21]West NX, Hughes JA, Addy M: The effect of pH on the erosion of dentine and enamel by dietary acids in vitro. J Oral Rehabil 2001, 28:860-864.
• [22]Longhini R, Raksa SM, Oliveira ACP, Svidzinski TIE, Franco SL: Antifungal activity evaluation of different propolis extracts. Rev Bras Farmacogn 2007, 17:388-395.
• [23]Gil ES: Controle físico-químico de qualidade de medicamentos. 3rd edition. São Paulo: Pharmabooks; 2010.
• [24]Knappmann AL, Melo EB: Qualidade de medicamentos isentos de prescrição: um estudo com marcas de dipirona comercializadas em uma drogaria de Cascavel (PR, Brasil). Ciênc Saúde Coletiva 2010, 15:3467-3476.
• [25]Lussi A, Jaeggi T: Occupation and sports. Monogr Oral Sci 2006, 20:106-111.
• [26]Nogueira LC, Silva F, Ferreira IM, Trugo LC: Separation and quantification of beer carbohydrates by high-performance liquid chromatography with evaporative light scattering detection. J Chromatogr A 2005, 1065:207-210.
• [27]Linnet V, Seow WK: Dental erosion in children: a literature review. Pediatr Dent 2001, 23:37-43.
• [28]Boots I, Sukhai RN, Klein RH, Holl RA, Wit JM, Cohen AF, et al.: Stimulation programs for pediatric drug research - do children really benefit? Eur J Pediatr 2007, 166:849-855.