In vitro analysis of the cariogenic and erosive potential of paediatric antitussive liquid oral medications

Abstract

We evaluated in vitro the cariogenic and erosive potential of antitussive liquid oral medications for paediatric use. Fifteen paediatric liquid antitussives were sampled. The endogenous pH was evaluated by potentiometry, titratable acidity was measured according to the method adopted by the Association of Official Analytical Chemists, total soluble solids content (TSSC) readings were performed by Brix refractometry using the Abbé refractometer, and the total sugar content was determined according to the Fehling methodology. The experiments were performed in triplicate and the obtained data were entered in the Excel software, analyzed and presented by descriptive statistics (means and standard deviations). Endogenous pH values ranged from 2.49 ± 0.09 (Iodetox^®) to 6.75 ± 0.005 (Carbocysteine^®) and twelve medications showed pHs below the critical value of 5.5 for enamel demineralization. Iodetox^® (0.021 ± 0.01) presented the lowest titratable acidity and Aerofrin^® (1.171 ± 0.01) presented the highest titratable acidity. Celergin^® presented the highest TSSC (62.26 ±0.40) and Acetylcysteine^® (100 mg granules bags) presented the lowest TSSC (3.25 ± 0.43). Only 5 medications contained sugar, with total sugar content ranging from 35.93% ± 6.65 (Iodetox^®) to 59.60% DP ± 6.66 (Celergin^®). The paediatric antitussive medications showed low endogenous pH, some of them even below the critical value for enamel dissolution (pH<5.5). These antitussives are potentially cariogenic and erosive to dental structures if used frequently because of the high titratable acidity and high sugar concentration, especially when adequate oral clearance is not performed after administration of each dose.