Abstract
BackgroundIron in the form of oral supplements is routinely prescribed to children to help fight anemia, however tooth staining is a commonly reported complication. This study tests in vitro, the staining potential of two different forms of iron syrup on primary teeth.MethodsForty caries free primary central incisors were divided into four groups of ten teeth each. The control group comprised of ten teeth immersed in artificial saliva, while the test solutions were comprised of different forms of iron mixed with vitamins such that the iron content of each solution was approximately 100 mg (from 100 to 101.1 mg). The test solutions used iron syrup (Ferrose®, SPIMACO, Jeddah, Saudi Arabia) with iron in the form of ferric oxide polymaltose (FOP), slow release formula (Ferroglobin®, Vitabiotics ltd., London, UK) containing ferrous fumarate (FF and a combination of the two (FOP + FF). All the teeth were then immersed for 72 h and subjected to a protocol developed by Lee et al. to test staining. Color changes were measured using a wave dispersion spectro-photometer (Color-Eye 7000A, X-Rite Gmbh, Regensdorf, Switzerland) on the exposed labial surface at 4, 8, 24, 48 and 72 h. Two-way ANOVA with Scheffe’s post hoc test was used to determine significance of difference in shade, while the Kurskull-Wallis test used to determine the significance of difference in clinical staining (∆E > 3).ResultsWhile all three iron groups showed some amount of staining, the combination of the two forms of iron (FOP+FF) showed significantly lower incidence of clinical staining than the other two groups at the end of 72 h. At the end of 72 h the (FOP) had significantly higher ∆E than ferrrous fumarate (FF ) while the combination (FOP+ FF) had a significantly lower ∆E than either group.ConclusionIn an in vitro model, combining different forms of iron seems to elicit a lower intensity of staining than equivalent doses of a single form of iron.Electronic supplementary materialThe online version of this article (doi:10.1186/s12903-015-0072-0) contains supplementary material, which is available to authorized users.
Highlights
Iron in the form of oral supplements is routinely prescribed to children to help fight anemia, tooth staining is a commonly reported complication
While it has been shown that low dose iron in the form of ferrous fumarate produces less tooth staining than syrups [5], there is concern that these low dose formulas do not provide adequate iron to prevent anemia [11]
There was no significant difference between the mean baseline L*,a*,b* values of the teeth assigned to the different groups (Table 1)
Summary
Iron in the form of oral supplements is routinely prescribed to children to help fight anemia, tooth staining is a commonly reported complication. While it has been shown that low dose iron in the form of ferrous fumarate produces less tooth staining than syrups [5], there is concern that these low dose formulas do not provide adequate iron to prevent anemia [11]. This has meant that physicians often prescribe high dose iron syrups, with iron in the form of ferrous sulfate, or more recently ferric hydroxide polymaltose complex to help combat anemia [12]. There is little evidence to highlight the staining potential of either the low dose ferrous fumarate preparations or the newer ferric hydroxide polymaltose complex on primary teeth
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