title: 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.
abstract: OBJECTIVE
  The reduced use of sugars-containing (SC) liquid medicines has increased the use of other dose forms, potentially resulting in more widespread dental effects, including tooth wear. The aim of this study was to assess the erosive potential of 97 paediatric medicines in vitro.
  
  
  METHODS
  The study took the form of in vitro measurement of endogenous pH and titratable acidity (mmol). Endogenous pH was measured using a pH meter, followed by titration to pH 7.0 with 0.1-M NaOH.
  
  
  RESULTS
  Overall, 55 (57%) formulations had an endogenous pH of < 5.5. The mean (+/- SD) endogenous pH and titratable acidity for 41 SC formulations were 5.26 +/- 1.30 and 0.139 +/- 0.133 mmol, respectively; for 56 sugars-free (SF) formulations, these figures were 5.73 +/- 1.53 and 0.413 +/- 1.50 mmol (P > 0.05). Compared with their SC bioequivalents, eight SF medicines showed no significant differences for pH or titratable acidity, while 15 higher-strength medicines showed lower pH (P = 0.035) and greater titratable acidity (P = 0.016) than their lower-strength equivalents. Chewable and dispersible tablets (P < 0.001), gastrointestinal medicines (P = 0.002) and antibiotics (P = 0.007) were significant predictors of higher pH. In contrast, effervescent tablets (P < 0.001), and nutrition and blood preparations (P = 0.021) were significant predictors of higher titratable acidity.
  
  
  CONCLUSIONS
  Paediatric SF medicines were not more erosive than SC medicines in vitro; a more significant predictor of their erosive potential was dose form.
authors.affiliation: School of Dental Sciences, University of Newcastle, Newcastle upon Tyne, UK. A.Maguire@ncl.ac.uk
authors.forename: Anne
authors.initials: A
authors.lastname: Maguire
authors.forename: Wasim
authors.initials: W
authors.lastname: Baqir
authors.forename: June Heather
authors.initials: JH
authors.lastname: Nunn
mesh_terms: D002648:Child; D002675:Child, Preschool; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008657:Metabolic Clearance Rate; D009055:Mouth / Q000378:metabolism; D004364:Pharmaceutical Preparations / Q000737:chemistry*; D014677:Pharmaceutical Vehicles / Q000009:adverse effects; D013395:Sucrose / Q000009:adverse effects; D013549:Sweetening Agents / Q000009:adverse effects*; D017186:Titrimetry; D014077:Tooth Erosion / Q000139:chemically induced*
chemical_list: D004364:Pharmaceutical Preparations; D014677:Pharmaceutical Vehicles; D013549:Sweetening Agents; D013395:Sucrose