Abstract
Objective: To assess the total sugar content, endogenous pH, total soluble solids content (TSSC) and titratable acidity of the commonly prescribed long-term and short-term liquid oral medicines (LOM) for children and to compare the erosive potential with the total sugar content and total soluble solids of the LOM. Material and Methods: Twenty-three most commonly prescribed pediatric LOM were evaluated in-vitro for the cariogenic and erosive potential. Manufacturers' information on labels, endogenous pH, titratable acidity, TSSC, and the total sugar content was determined. Descriptive statistics and the Mann-Whitney U test were applied. Results: Overall, 22 LOM contained sugar. Only 3 LOM revealed the sugar content of the formulation but did not disclose the quantity (Cheston, Ventorlin and Eptoin). None of the samples revealed the sugar content as well as endogenous pH in their labels. The overall mean total sugar content was 6.92 ± 3.49 g/100ml, ranging from 3.40 ± 0.00 (corticosteroids) to 9.67 ± 0.61 (antitussive/expectorant). The mean endogenous pH for the total sample of medicines was 5.91 ± 1.51 (range of 3.5 to 10.3). Eptoin (0.013%) presented the lowest titratable acidity and Imol (1.171%) presented the highest titratable acidity with an overall mean of 0.40 ± 0.73. Omnacortil and Epilex presented the highest TSS content (19.3%), and Ventorlin presented the lowest TSS content (18.7%) with an overall mean of 18.97 ± 0.19. Over twelve medicines were identified to have the potential to cause dental erosion. No significant differences were seen in the total sugar content, total soluble solids, titratable acidity, and the endogenous pH between the short-term and long-term LOMs (p=0.145, p=0.263, p=0.067 and p=0.107), respectively. Conclusion: The pediatric LOMs showed the presence of the sugar, low endogenous pH, high titratable acidity and high total soluble solids.
Highlights
Dental caries is the common oral disease and the most prevalent infectious disease in the oral cavity.Among the theories that explain caries onset, the action of acids produced by bacterial fermentation of carbohydrates from the diet is universally accepted [1]
No significant differences were seen in the total sugar content, total soluble solids, titratable acidity, and the endogenous pH between the short-term and long-term liquid oral medicines (LOM) (p=0.145, p=0.263, p=0.067 and p=0.107), respectively
The pediatric LOMs showed the presence of the sugar, low endogenous pH, high titratable acidity and high total soluble solids
Summary
Among the theories that explain caries onset, the action of acids produced by bacterial fermentation of carbohydrates (sugars) from the diet is universally accepted [1]. Various studies have pointed out the possible relationship between dental caries and frequent intake of liquid oral medicines (LOM) [2,3,4,5]. Sugar has been widely added to pediatric liquid oral medicines to improve their palatability. Dental erosion is defined as the “irreversible loss of tooth structure due to chemical dissolution by acids without the involvement of bacteria” [7], besides mechanical activities such as abrasion and attrition [8]. Low endogenous pH and high titratable acidity of liquid oral medicines may favor dental erosion [10], especially when the contact of the medicine with the tooth surface remains for a very long time [11]
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