Evaluation of cariogenic and erosive potentials of drugs in syrup form commonly used in children

Introduction and Aim: In recent years, the frequency of oral drug use in children with acute or chronic diseases has been increasing. For this reason, the aim of our study is to evaluate the cariogenic and erosive effects of frequently prescribed pediatric liquid form drugs on primary tooth enamel. Materials and Methods: Five long-term and widely used pediatric drugs were selected in our study. Augmentin, Zimaks, Calpol, Vitabiol and Ferro Sanol B are among these drugs that are frequently prescribed by pediatricians in Hatay to pediatric patients with acute or chronic diseases. In order to evaluate the erosive and cariogenic potential of drugs in syrup form, sucrose concentrations, pH values, and calcium concentrations dissolved from enamel tissue were determined in pediatric liquid drugs. Lane-Eynon copper reduction method was used for endogenous sucrose measurement. This method measures the sucrose concentration by percent glucose concentration based on the fact that sucrose is composed of glucose and fructose units. For the estimation of endogenous pH, the samples taken from the syrups were diluted 10% and measured with the help of a digital pH meter in Hatay Mustafa Kemal University Technology and R&D Application and Research Center. For endogenous erosive potential measurement, previously extracted primary teeth were used in Hatay Mustafa Kemal University Oral and Dental Health Hospital Pediatric Dentistry clinic. The teeth were divided mesiodistally with a diamond disc, and the dentin was removed with the help of a diamond bur. Using an agate mortar, the remaining enamel fragments were ground and a fine powder was obtained. The particle size of the obtained powder was standardized with the help of 120 mesh sieve. Enamel powder weighing 250 mg was added one by one to 5 mL individual pediatric syrup solutions and mixed with a vortex device. It was maintained at three time intervals: 1 minute, 10 minutes and 8 hours. All syrup solutions were centrifuged at 6,000 rpm for 20 minutes with a Weightlab WN CMV6000 Microcentrifuge device and the pellet and supernatant were separated from each other. The samples were subjected to acid incineration with MARS XPress (CEM Brand) Microwave oven. Calcium concentrations were then measured by Inductively Coupled Plasma-Mass Specteroscopy (ICP MS). Analyzes were carried out using the Analytik Jena XIII AG brand PlasmaQuant model ICP MS system installed in HMKU MARGEM Spectroscopy Laboratory-1. Results: Most of the pediatric liquid drugs (80%) have a pH less than 5.5. It is therefore critical for enamel to be affected. The syrup with the highest acidity value was Ferro sanol B (average pH 2.96 ± 0.01) and the lowest acidity value was Calpol (average pH 6.42 ± 0.03). All of the pediatric syrup samples we used in our study contain sucrose. Total sucrose ratio; the highest Vitabiol (35.34%) and the lowest Ferro Sanol B (16.22%) were measured in the syrup sample. It has been determined that all of the pediatric liquid drugs have a certain amount of calcium element in their content. Calcium element transition from enamel to all sample solutions was observed for all pediatric liquid drugs at all three time intervals. In general, the amount of dissolution increased as the holding time increased. The lowest Calcium dissolution rate was found in the Augmentin syrup sample (15.87 mg/L) in the first minute. The highest Calcium dissolution rate was determined in the Zimaks syrup sample (609.69 mg/L) at the eighth hour. There is no correlation between the pH values of the syrups and the amount of calcium dissolved from the enamel. Conclusion: As a result, it has been observed seen that syrups used for various reasons in early childhood may cause erosion on tooth surfaces at different pH and acidity values. Contents of all syrups examined have cariogenic effects as they contain sucrose. In this study, in which we stated that drugs in syrup form, which are constantly prescribed and used, are cariogenic and have a high risk factor for dental erosion, dental preventive measures can be recommended to dentists, parents and pediatricians.