|Year : 2014 | Volume
| Issue : 2 | Page : 87-90
An assessment of parental knowledge and practices related to pediatric liquid medications and its impact on oral health status of their children
Athimuthu Anantharaj, Praveen Prasanna, Prathibha Rani Shankarappa, Ananya Rai, Selabh Shivram Thakur, Rajeshkrishna Malge
Department of Pedodontics and Preventive Dentistry, D.A.P.M.R.V. Dental College and Hospital, Bengaluru, Karnataka, India
|Date of Web Publication||7-May-2014|
Department of Pedodontics and Preventive Dentistry, D.A.P.M.R.V. Dental College and Hospital, J.P. Nagar, 1st Phase, Bengaluru - 560 078, Karnataka
Background: Pediatric liquid medications (PLM) are the preferred form of medication for young children and contain 'hidden sugars' that increase their cariogenic potential especially in high risk patients. Aims: To assess the general practices followed by parents in the use of common Pediatric liquid medications (PLM), knowledge of dosages, frequency of consumption, side effects and impact on oral health.
Settings and Design: The sample comprised of the parents of children visiting the Department of Pediatric and Preventive Dentistry D.A. Pandu Memorial R.V. Dental College, Bangalore. The parents of children up to 8 years of age who preferred liquid medication were included in the study. Subjects and Methods: Questionnaire provided to the parents visiting the Department of Pedodontics and Preventive Dentistry, D.A.P.M.R.V. Dental College, Bangalore. Statistical analysis used: Results are presented in the form of n and % Results: The parental knowledge about PLM use is limited and the oral health of children on frequent use of PLM's is adversely affected especially in high risk patients. Conclusions: Inadvertent and injudicious use of PLM's should be avoided. The parents should be well informed about their usage, side effects and alternate options available.
Keywords: Cariogenic potential, hidden sugars, pediatric liquid medications, sucrose, syrups
|How to cite this article:|
Anantharaj A, Prasanna P, Shankarappa PR, Rai A, Thakur SS, Malge R. An assessment of parental knowledge and practices related to pediatric liquid medications and its impact on oral health status of their children. SRM J Res Dent Sci 2014;5:87-90
|How to cite this URL:|
Anantharaj A, Prasanna P, Shankarappa PR, Rai A, Thakur SS, Malge R. An assessment of parental knowledge and practices related to pediatric liquid medications and its impact on oral health status of their children. SRM J Res Dent Sci [serial online] 2014 [cited 2021 May 8];5:87-90. Available from: https://www.srmjrds.in/text.asp?2014/5/2/87/132077
| Introduction|| |
Pediatric liquid medications (PLM) are quite popular, widely prescribed by pediatricians and pedodontists, more palatable than tablets or capsules and easily available over the counter.
Liquid medications can be procured in the form of suspension, solutions, syrups, and mixtures.
Various advantages/benefits associated with this form of medication are:
- The wide acceptance by infants, toddlers, preschoolers, and even school age children. 
- Good absorption.
- Flexibility with dosage.
- Ease of availability and ease of administration.
However, there are certain disadvantages associated, which might be overlooked when these are administered for a short period, in case of long-term usage the risks are magnified. These include:
- Use of sweeteners that make them highly cariogenic. 
- Dangers of self-medication.
The hidden cariogenic component in these PLM's is sucrose, fructose, and glucose. These are added basically to increase palatability, patient compliance and bulk to the PLM.
The various factors that contribute to the cariogenic potential of these formulations include the low pH, the high sugar content, the duration and frequency and most importantly the time of administration (Night time administration reduces oral clearance due to reduced salivary flow).
Several in vitro studies have been previously carried out to assess the pH, viscosity, sugar content and cariogenic potential of PLM, but there is a paucity of studies to assess the knowledge, attitude, and practices of parents with regard to PLM.
This study aims to assess the general practices followed by parents in the use of PLM including, common medications used, knowledge of dosages, and side-effects and frequency of consumption.
| Subjects and methods|| |
This study sample consisted of the parents of children visiting our department. The sample size calculation was done by partial enumeration.
The parents of children up to 8 years and patients who only preferred liquid medicaments were included.
Data collection method was a questionnaire type consisting of 14 multiple choice questions with one or more suitable answers to be selected by the parent.
The questions were to test the knowledge of the parents about the liquid medicaments and the attitudes, and practices followed in their administration.
| Results|| |
The results of this study were calculated and are presented in the form of n and % (percentage).
A total of 45 parents took part in the study. Thirty-four (75.5%) parents said that their child preferred PLM's over tablets, 5 (11.11%) parents said that their child preferred tablets, while 6 (13.33%) parents said that their child was compliant with either form of medication [Graph 1].
Two out of 34 (5%) of the parents said their child was on long-term medication like multivitamins [Graph 2].
Thirty-four out of 34 (100%) of the parents administered medication only on the doctor's prescription [Graph 2].
However, the frequency of administration was not very consistent among the parents. Nine out of 34 (26.4%) parents administered the syrups as and when the child demanded, 12 (35.2%) parents said they administered the medication twice a day, 5 (14.7%) said they administered it once or twice a day and 8 (23.5%) parents said they administered it twice or thrice a day. Most of the parents did not have a clear idea about the dosage of medication to be administered as the results depict inconsistent and variable administration [Graph 3].
Three out of 34 (8.8%) parents noticed side-effects to the medication like stomach pain and pruritus. No major side-effects of concern were generally noticed by the parents [Graph 2].
Thirty-two out of 34 (94.1%) parents were aware that the PLM's contained flavoring agents, but only 11 out of 34 (32.3%) were aware of sugar being the major constituent [Graph 2]. The others thought that PLM contained fruit flavors and other additives for a pleasant taste.
Bed time consumption was reported by 23 (67.6%) of the parents [Graph 2].
Twenty-one (61.7%) of the parents encouraged the children to drink water and 6 (17.6%) encouraged them to rinse after the administration of PLM's and the others did not give any instructions to the child after administration [Graph 2].
The most commonly used medications were antipyretics such as paracetamol and ibuprofen syrups used in cases of febrile episodes or instances of night pain.
| Discussion|| |
Pediatric liquid medications are commonly available over the counter and are actively prescribed by pediatricians and pedodontists. They are administered quite frequently to very young children and to children with low compliance of tablets and capsules. They are preferred due to their palatability and ease of administration. However, these medicaments comprise of a hidden component apart from the active drug.
A study carried out to assess the sweetener content of common pediatric oral liquid medications from different manufacturers concluded that the common antibiotics had a wide range of sucrose concentration (18-80%).  A study mentioned that 50% of the PLM contained sucrose, glucose, and sorbitol. ,
Parents are unaware of the hidden sugars in liquid medicaments and their implication on the oral and dental health of their child.
Liquid medications are a major etiologic factor leading to rampant dental decay.  Increased incidence of dental caries and gingivitis has been noted in children receiving sweetened liquid medications. ,, These medications have low endogenous pH, which is responsible for their erosive and cariogenic potential as mentioned by many studies. ,,,,,,,
A high frequency of ingestion of these PLM's can be attributed to the repetitive administration, chronic ailments, and in cases of self-medication. The frequency of sugar consumption is proportional to the caries experience.  These PLM's add on to the number of sugar exposures in the child's normal diet thereby increasing the caries risk.
There is also increased usage of nonprescription and over the counter liquid medicaments for cough and cold in children. A review of literature has shown many adverse effects associated with nonprescription drug administration. 
The PLM are mostly consumed at night time by children. It has been shown that there is reduced salivary flow at night, which reduces the clearance of these medications, thus further increasing the caries risk.
The parents should therefore be made aware of the potential risks of inadvertent and injudicious use of these medications. The pediatrician and pedodontist should inform the parent about the sugar content of these medications well in advance, recommend limited use whenever possible, use of tablets be encouraged, advise brushing after administration, to be given at meal times rather than between meals and avoid administration at bedtime. 
In order to reduce the cariogenic potential, the sweetener in these medications can be substituted from sucrose to certain available nonacidogenic sweeteners like polyalcohols (sorbitol, and xylitol). The advantage with these sweeteners being that these produce minimal oral pH drop as they are not readily fermented by plaque bacteria. Further studies have confirmed that the pH drop associated with the sugar substitutes is lesser than that with sucrose. 
The parents should be informed about the availability of medicaments with these substitutes and should be encouraged to use the same for their children.  The pedodontist and pediatrician should prescribe nonsucrose medicaments.  It is their responsibility to advise adequate preventive and oral hygiene measures for children on the long-term use of PLM. 
The manufacturing companies should clearly label the sugar content present and also PLM with sugar substitutes should be manufactured.
| Conclusion|| |
The study showed a limited knowledge pertaining to the harmful effects of PLM on the oral health status of their children. Further studies are required to assess the impact of parental education on the knowledge and practices regarding PLM. This study can be replicated with a larger group.
| References|| |
|1.||Nunn T, Williams J. Formulation of medicines for children. Br J Clin Pharmacol 2005;59:674-6. |
|2.||Roberts IF, Roberts GJ. Relation between medicines sweetened with sucrose and dental disease. Br Med J 1979;2:14-6. |
|3.||Hill EM, Flaitz CM, Frost GR. Sweetener content of common pediatric oral liquid medications. Am J Hosp Pharm 1988;45:135-42. |
|4.||Subramaniam P, Nandan N. Cariogenic potential of pediatric liquid medicaments - An in vitro study. J Clin Pediatr Dent 2012;36:357-62. |
|5.||Pierro VS, Abdelnur JP, Maia LC, Trugo LC. Free sugar concentration and pH of paediatric medicines in Brazil. Community Dent Health 2005;22:180-3. |
|6.||Feigal RJ, Jensen ME, Mensing CA. Dental caries potential of liquid medications. Pediatrics 1981;68:416-9. |
|7.||Bigeard L. The role of medication and sugars in pediatric dental patients. Dent Clin North Am 2000;44:443-56. |
|8.||Shaw L, Glenwright HD. The role of medications in dental caries formation: Need for sugar-free medication for children. Pediatrician 1989;16:153-5. |
|9.||Passos IA, Sampaio FC, Martínez CR, Freitas CH. Sucrose concentration and pH in liquid oral pediatric medicines of long-term use for children. Rev Panam Salud Publica 2010;27:132-7. |
|10.||Sunitha S, Prashanth GM, Shanmukhappa, Chandu GN, Subba Reddy VV. An analysis of concentration of sucrose, endogenous pH, and alteration in the plaque pH on consumption of commonly used liquid pediatric medicines. J Indian Soc Pedod Prev Dent 2009;27:44-8. |
|11.||Arora R, Mukherjee U, Arora V. Erosive potential of sugar free and sugar containing pediatric medicines given regularly and long term to children. Indian J Pediatr 2012;79:759-63. |
|12.||Xavier AF, Moura EF, Azevedo WF, Vieira FF, Abreu MH, Cavalcanti AL. Erosive and cariogenicity potential of pediatric drugs: Study of physicochemical parameters. BMC Oral Health 2013;13:71. |
|13.||Tupalli AR, Satish B, Shetty BR, Battu S, Kumar JP, Nagaraju B. Evaluation of the erosive potential of various pediatric liquid medicaments: an in-vitro study. J Int Oral Health 2014;6:59-65. |
|14.||Babu KL, Rai K, Hedge AM. Pediatric liquid medicaments - Do they erode the teeth surface? An in vitro study: Part I. J Clin Pediatr Dent 2008;32:189-94. |
|15.||Babu KL, Rai K, Hegde AM. PH of medicated syrups - Does it really matter? - An in-vitro study: Part-II. J Clin Pediatr Dent 2008;33:137-42. |
|16.||Lökken P, Birkeland JM, Sannes E. pH changes in dental plaque caused by sweetened, iron-containing liquid medicine. Scand J Dent Res 1975;83:279-83. |
|17.||Touger-Decker R, van Loveren C. Sugars and dental caries. Am J Clin Nutr 2003;78:881S-92S. |
|18.||Yang M, So TY. Revisiting the safety of over-the-counter cough and cold medications in the pediatric population. Clin Pediatr (Phila) 2014;53:326-30. |
|19.||Durward C, Thou T. Dental caries and sugar-containing liquid medicines for children in New Zealand. N Z Dent J 1997;93:124-9. |
|20.||Mentes A. pH changes in dental plaque after using sugar-free pediatric medicine. J Clin Pediatr Dent 2001;25:307-12. |
|21.||Bradley M, Kinirons MJ. Provision of sugar-free medicines for young children: The views of a sample of parents in Northern Ireland. J Ir Dent Assoc 1998;44:70-3. |
|22.||Bradley MB, Kinirons MJ. Choice of sugar-free medicines by a sample of dentists, doctors and pharmacists in Northern Ireland: The views of parents and health professionals. Community Dent Health 1998;15:105-8. |
|23.||Neves BG, Pierro VS, Maia LC. Pediatricians' perceptions of the use of sweetened medications related to oral health. J Clin Pediatr Dent 2008;32:133-7. |