PAEDIATRICIANS COGNIZANCE ABOUT THE DELETERIOUS EFFECT OF ANTIBIOTICS AND DENTAL CARIES – A PRELIMINARY STUDY

PAEDIATRICIANS COGNIZANCE ABOUT THE DELETERIOUS EFFECT OF ANTIBIOTICS AND DENTAL CARIES - A PRELIMINARY STUDY

V. Anu^*, Saju Harshamol, Tomy Helena, Priya Dharshini Hannah, R. Gokila and Harinee Manomani

Department of Public Health Dentistry, Sathyabama University Dental College and Hospital, Jeppiar Nagar, OMR, Chennai - 600119, Tamil Nadu, India.

ABSTRACT: Aim: To evaluate pediatricians’ cognizance about the use of antibiotics and dental caries. Materials and Method: 200 Pediatricians’ who were willing to participate were selected randomly from public and private medical hospitals in South India. A pretested questionnaire was distributed to the Paediatricians’ and was personally contacted to receive the responses within a week’s time. Descriptive statistics was done using SPSS version 16 (SPSS Inc., Chicago, Illinois, USA). Results: The present study showed that 63% of pediatricians believed that paediatric medicines are not sweet. 72% of them believed antibiotics are not too sweet and 31% were unaware of what sweetens antibiotics. 35% of pediatricians frequently prescribed antibiotics and 95% of them chose oral way as their route of administration. 31% of pediatricians believed antibiotics can be related to dental effects and only 19% of them recommended children to brush after oral intake of antibiotics. 63% of   pediatricians revealed that children complain about the taste of antibiotics. Conclusion: The Paediatricians’ in the study did not perceive the correct relation between the presence of fermentable carbohydrates in antibiotics and dental caries. Many of them believed that these medicines promoted a defect in tooth structure favoring the development of dental caries. Clinical Significance: For the past few decades, there is an increasing rate of dental caries among children who is under consumption of paediatric medications. This study provides a channel to evaluate awareness among pediatricians’.

Pediatricians, Oral health, Antibiotics, Dental caries

INTRODUCTION: Dental caries is a major oral health problem affecting 50 to 65% of school going children in India ¹. Worldwide, Individuals are susceptible to this disease throughout their lifetime. Dental caries form through a complex interaction over time, between acid producing bacteria, fermentable carbohydrates and host factors, including teeth and saliva ^{2, 3, 4}.

Knowing the causative factor of the dental caries has not helped us to completely eradicate it from the scene ⁵. Sucrose is considered to be the arch criminal of dental caries ^{6, 7, 8}. The presence of sucrose in pediatric medications ^{6, 9}, lowers the pH of medicine formulation ^{5, 10, 11, 12} and viscosity of oral liquid medication ^{9, 13}.

This leads to cavity formation and tooth decay ¹⁴. Pediatricians are the first to enable contact with children and families. They are in an ideal position to influence the patient’s attitude towards oral health. Hence, Pediatricians should be aware about the deleterious relationship between antibiotics and dental caries. Pierro VVS, Barcelous R (2001) ¹⁵ in Brazil, Bawazir OA et al., (2014) ¹⁶ in Riyadh, Folayan MO et al.,  (2012) ¹⁷ in Nigeria conducted studies on Pediatrician’s perception about the use of antibiotics causing dental caries and reported that pediatricians did not perceive the correct relationship between the presence of fermentable carbohydrates in antibiotics and dental caries.

In India, there is scarcity of literature showing the pediatrician perceptions towards antibiotics and occurrence of dental caries, hence this study was undertaken.

MATERIALS AND METHOD: The study was conducted during November 2016 to January 2017 after obtaining ethical clearance from the Institutional Review Board of Sathyabama University. 200 pediatricians who were willing to participate were selected randomly from public and private medical hospitals in South India. A Pretested questionnaire comprising of 15 open and closed ended questions was used for the study ¹⁵. The questions focused on the knowledge and practices of the pediatricians with regard to prescribing antibiotics for pediatric use and their relationship with dental caries, pediatrician’s knowledge of the substances used to give these medicines their sweet flavor, as well as oral hygiene recommendations after oral antibiotic intake. The Pretested questionnaire was distributed to the pediatricians by the author's who were personally contacted to receive the responses within a week’s time.

The recorded data were gathered and entered into Microsoft Excel 2007 computer program and then exported to the data editor page of SPSS version 16 (SPSS Inc., Chicago, Illinois, USA). Descriptive statistics was done to report frequencies and percentage.

RESULTS: The pediatricians who participated in the study ranged in age from 23 to 75 years old. Out of 200 participants, 75% usually attended pediatric age group, 25% attended both adults and children in their daily practice.

Working Sector: Among 200 pediatricians, 30 (15) % worked only in the public service, 92 (46) % pediatricians had both public and private practice, 74 (37%) worked in other sectors and 4 (2%) did not answer.

Consideration while Prescribing Antibiotics: 70 (35%) of pediatricians frequently prescribed antibiotics for children, 120 (60%) rarely prescribed antibiotics, 6 (2%) never prescribed antibiotics and 4 (2%) did not answer. A majority, 190 (95%) of them chooses oral way as their route of administration. Based on their daily practice, 38 (19%) of the pediatricians consider medication features (spectrum of action, side effects, flavor and way of administration), 12 (6%) consider child characteristics (age, medicine’s acceptability and immune deficiency), 138 (69%) consider disease characteristics (severity of the case and type of microorganism involved) and 6 (3%) consider socioeconomic factors (patient’s financial status and the availability of the antibiotics in the public health services) as most important, relevant factor when choosing a pediatric antibiotic at the time of writing prescriptions. 63% of pediatricians revealed that children complain about the taste of antibiotics.

Knowledge about antibiotics: The present study showed that 126 (63%) of pediatricians believe that pediatric medicines are not sweet (Fig. 1). 144 (72%) of them believe antibiotics are not too sweet, 30 (15%) do not know whether antibiotics are sweet, 20 (10%) knew antibiotics are sweet and 6(3%) did not answer. 31% were unaware of what sweeten antibiotics (Fig. 2).

FIG. 1: PERCENTAGE OF PEDIATRICIANS WHO BELIEVE PEDIATRIC ANTIBIOTICS ARE SWEET

FIG. 2: PERCENTAGE OF PEDIATRICIANS KNOWLEDGE ABOUT WHAT SWEETENS ANTIBIOTICS

Cognizance about Antibiotics and Dental Caries: 46 (23%) of pediatricians believe that antibiotics can cause defects to tooth structure. 31% of pediatricians believed antibiotics can be related to dental effects and only 19% of them recommended children to brush after oral intake of antibiotics.

DISCUSSION: In the current scenario, age group of 71 months or younger children’s are affected by Early Childhood Caries. The deep rooted etiology is the heedless attitude of parents   towards oral hygiene practices ¹⁸. These  factors  can  be  abrogated  by  providing  a  clear guide to  the caretakers  of  the  child to  practice  an  ideal  oral  hygiene measures  with  the support  of pediatrician’s  and  Pedodontist’s ¹⁹.  Although  this study  was  carried out  among  200  pediatricians, it  described  a gross  picture  of  their  awareness  and  knowledge  about  the  factors  that  causing  dental  caries  due  to  the use  of  pediatric  medications. 80% of  the  pediatricians  never  recommended  to  practice  oral  hygiene after  the intake of  liquid  medicine. Considering the  economic  background  of  our country, most  of  the  drug  manufactures’ ideally choose  sucrose  and  similar carbohydrates  to  sweeten  medications  as  they  are  cheaper  compared  to the  other  sugar  substitutes. Many of the studies recognized sucrose causes dental defects ⁵. Similar studies conducted in Brazil ¹⁸ and India ^{4, 19}.

In a Brazilian study, 56.7% and in Indian 51.1% of pediatricians believed that sucrose concentrated medications are the known cause of dental defects. This fact is of  concern  because  of  the  known  relationship  between  carbohydrate  consumption and  dental  caries,  it becomes  more alarming if  the  pediatricians  neglect  the importance  of oral  hygiene  after  medicine  intake.

The result  of  this  study  supported   the  insistence  for  the  pediatricians  to  be  instructed  about  dental  caries and its  relationship with fermentable  carbohydrates  as these  people  are  the first  to influence  Children and  parents’  attitude  towards oral  health by informing them about  the bombarding  effect  of  sucrose  and other  hidden  sugars present  in  liquid  medications  and   the  necessity to  practice oral  hygiene after  medicine  intake.

CONCLUSION: Pediatricians in this study did not perceive the correct relation between the presence of fermentable carbohydrates in antibiotics and dental caries. Many of them believed these medicines promoted a defect in tooth structure favoring the development of dental caries.

CLINICAL SIGNIFICANCE: For the past few decades, there is an increasing rate of dental caries among children who is under consumption of pediatric medications. This study provides a channel to evaluate awareness among pediatricians about the pediatric antibiotics causing dental caries.

ACKNOWLEDGEMENT: We would like to acknowledge Dr. A. G. Manimegalai MDS, Dean, Sathyabama University Dental College and Hospital for her constant support and all the Paediatricians’ for their active participation.

CONFLICT OF INTEREST:  Nil

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    How to cite this article:

    Anu V, Harshamol S, Helena T, Hannah PD, Gokila R and Manomani H: Paediatricians cognizance about the deleterious effect of antibiotics and dental caries - a preliminary study. Int J Pharm Sci Res 2018; 9(2): 708-11.doi: 10.13040/IJPSR.0975-8232.9(2).708-11.

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