- Mark Donaldson, BSP, RPH, PharmD, FASHP, FACHE
- Jason H. Goodchild, DMD
- Joel B. Epstein, DMD, MSD, FRCD(C), FDS, RCS(Edin)
Courtesy of the American Dental Association, you can access the full-text article for the next 3 months here (PDF)
Context
- Oral adverse events such as cariogenicity are often overlooked as drug-associated effects because the sugar content of many medications may be negligible compared with the patients’ overall dietary intake of sugar.
- There are, however, several liquid formulations of medications with significantly high sugar content that are commonly used in patients with swallowing difficulties.
- These medications may be associated with negative oral health sequelae and should be considered part of the oral health care providers’ differential diagnosis of oral pathologies.
Purpose of the Review
The authors:
- Review the sugar content of oral liquid medications commonly prescribed by oral health care providers (OHCPs) with consideration to their caries potential.
- Focus specifically on some of the most common sugar-containing oral liquid medications patients may be exposed to;
- Review their oral health implications; and
- Provide guidance for contemporary dental practice.
Key Findings
- Over 50 commonly used oral liquid medications prescribed for patients with swallowing difficulties were reviewed and found to contain sugar in varying amounts up to 4 grams per dose (usually 1 teaspoon or 5 milliliters).
- Patients who are required to take multiple doses per day of these sugar-containing oral liquid medications may be at increased risk for caries and associated oral health consequences.
Practical Clinical Implications
- Recognition and avoidance of sugar-containing oral liquid medications can help clinicians optimize patient treatment, decreasing the risk for potential drug-induced caries while emphasizing patient safety and improved oral health.
The cariogenic potential of medications containing “sugar” (sucrose, fructose, glucose) may be particularly high in patients with increased factors (xerostomia; poor oral hygiene; etc.) Yet, the formulation of medication that contains sugar may be intended to provide particular benefit:
1. To camouflage the unpleasant taste of a medication (frequently unnecessary in xerostomic patients who have altered taste sensibility).
2. To provide a syrupy lubricant that facilitates the distribution of the medication causing it to adhere to tissues, or to promote the ease with which the material can be swallowed.
Given that there are few tested replacements for sugar in these medications, has consideration been given to the partial substitution of the “sugar” with xylitol, as suggested in the Turku sugar studies (Scheinin and Makinen, 1974)?
This topic has been in the literature before. Research and review articles by Dr David Kenney at SickKids in the late 70’s and early 80’s covered the subject quite well with similar conclusions.
This is a nice list of sugar content of the medications, but it does NOT answer the question posed in the paper or in this post. There is no evidence that such low levels of sugar content by themselves and in isolation from other factors actually cause dental caries. The simple act of a quick drink or rinse of water after taking such medications should help mitigate any cariogenic potential of such medications.