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Children who are taking long-term sugar-containing liquid medicines have an increased risk of developing dental caries. A recent survey of paediatric liquid medicines in New Zealand revealed that over half of the prescribed and over-the-counter (OTC) medicines for children contain sugar. Only one-third of the sugar-free medicines were labelled as such, and only one-quarter were stated to be sugar-free in the New Ethicals Catalogue. Recommendations for limiting caries in these children include: where possible, taking the medicine in tablet form; brushing with toothpaste or chewing sugar-free gum after taking the medicine; home and dental-office fluoride applications; where possible, taking medicines at meal-times rather than between meals; avoiding ingestion of the medicine before bed; and seeking regular preventive dental care. Awareness of the danger posed by these medications should be promoted among prescribers, pharmacists, manufacturers, regulatory authorities, and the public in order to bring about increased availability and use of sugar-free liquid medicines.

An investigation into the acidogenic potential of six of the most commonly used sugar-containing and sugar-free paediatric medicines was carried out on 10 adult volunteers. The guidelines of the Food, Nutrition and Dental Health Committee of the American Dental Association were followed. Subjects refrained from brushing their teeth for 48 hours and did not eat or drink for at least 2 1/2 hours prior to each appointment. pH measurements were taken at baseline to determine 'resting' plaque pH and at time intervals of 5, 10, 15, 20, 25 and 30 minutes following a 1-minute rinse with each medication. A pooled sample of plaque was removed from the buccal surfaces of posterior teeth, thoroughly mixed with 20 microliters of distilled water and plaque pH was determined using a glass combination electrode. Data were compared with plaque pH changes after rinsing with control solutions of 10% sucrose and 10% sorbitol. An ANOVA test indicated all sucrose-containing preparations produced a significantly greater drop in plaque pH than their sucrose-free counterparts (P < 0.001). The study provided evidence in support of prescribing sugar-free preparations for children on long-term medication.

The long-term use of sugar-containing medicines has long been considered a cause of dental caries in children. Several studies have examined the role of prescription medicines in dental decay, but what about those that can be bought over the counter and that are used infrequently? In this paper practitioners are advised on how to encourage parents to use sugar-free medicines for the sake of their children's teeth.

The aim of the study was to assess the prevalence of frequent administration of liquid oral medicines, long-term, in children aged 1-16 years in a number of districts within the Northern Region in 1989-91. This was achieved through two surveys, one conducted amongst consultant paediatricians in five districts, and the other in four general medical practices in two districts within the region. The consultant survey identified 243 children aged 1-16 years currently taking long-term liquid oral medicines frequently, under consultant paediatric care. This represented a prevalence of 1:916 children (0.11 per cent) in the five districts studied. The general medical practice survey showed that the prescribing of liquid oral medicines for prolonged periods was not confined to those children who had been referred to and were under the care of consultant paediatricians. It indicated that the prevalence of long-term medication with prescription-based liquid oral medicines in children under the care of consultant paediatricians or general medical practitioners or both, was approximately 1:361 (0.28 per cent). Of the 67 different liquid oral medicine preparations which were used long-term, 39 per cent were sugar-based, 33 per cent sugar-free, and the rest 'variable'; either sugar-based or sugar-free depending on how specifically they were prescribed.

Cariogenicity of seven commonly prescribed liquid medications was studied. Sucrose content of the medications ranged from 0 to 70 gm/100 ml. Initial pH and buffering capacity were measured and found to vary widely among the medications. Intraoral microbial plaque pH changes were determined at intervals for 30 minutes following an oral rinse with each medication. These data were compared with plaque pH changes caused by rinsing with an established cariogenic challenge, 10% sucrose solution. Decreased plaque pH was caused by each medication tested. The extent and duration of the pH drop varied among the medications. Patterns of the pH curves are discussed in relation to sucrose content, endogenous pH, and buffering capacity of the medications. Intraoral pH response to several medications equaled or exceeded that seen when sucrose rinses alone were given. The findings are discussed in relation to dental caries-producing potential of long-term therapy with liquid medications, and two cases are presented that implicate liquid medications as a major etiologic factor leading to rampant dental decay. It is concluded that health practitioners should be aware of the sucrose content of pediatric medications. Patient education to ensure adequate oral clearance following each dose of medication is an essential first step in minimizing the risk of dental decay posed by long-term therapy with liquid medications.

Children with congenital disorders or chronic illnesses receive additional sugar from oral liquid medications. The purpose of this study was to determine the history of oral liquid medication usage and the incidence of dental caries from birth until about 36 months of age in a population of 20 such children. A pattern appeared in the frequency and dispensing characteristics of the 44 different drugs used for these children. Parents gave daily doses of syrupy medications and elixirs 3-4 times a day and at least two of these doses were given just before or during a designated nap or bedtime. Parental concerns for the more serious medical condition naturally overrode the consideration of sound dental hygiene practices. In this study, diseased, extracted and filled primary teeth def(t) were recorded and the medicinal sugar load at the time of examination was calculated as well as the cumulative medicinal sugar load from birth. Average age on examination was 31 months and the median number of def(t) was eight. The mean total amount of additional sugar from oral liquid medications was 8,696 g and the maximum sugar consumed by one child was over 20 kg. Physicians currently have no choice but to prescribe certain medications that contain 30 to 70 per cent sugar for patients who are already at higher than usual risk for dental caries due to chronic illness.