Limits...
Experimental study of iron and multivitamin drops on enamel microhardness of primary tooth.

Pasdar N, Alaghehmand H, Mottaghi F, Tavassoli M - J Int Soc Prev Community Dent (2015 Nov-Dec)

Bottom Line: In all groups, microhardness was decreased, but it was not significant in Eurovit multivitamin group (P = 0.088).The reduction rate in Kharazmi iron group was significant compared to that in other groups (P < 0.005).Hardness reduction percent for Kharazmi iron drop was 28/12 ± 47/43.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Dentistry, Babol University of Medical Sciences, Babol, Iran.

ABSTRACT

Objectives: Iron and multivitamin drops are being frequently prescribed in children less than 2 years of age. Due to their low pH levels, these drops may lead to the softening of enamel and accelerate the destructive process. The aim of the present study was to investigate the enamel microhardness of primary teeth after exposing them to iron and multivitamin drops.

Materials and methods: Forty healthy anterior teeth were randomly divided into four groups of 10 samples each. Samples were exposed to two iron drops of Kharazmi (Iran) and Ironorm (UK) and two multivitamin drops of Shahdarou (Iran) and Eurovit (Germany) for 5 min. The surface microhardness was measured before and after exposure and data processing was done using statistical paired t-test and analysis of variance (ANOVA) test. The surface structure of the teeth was examined by scanning electron microscope (SEM).

Results: In all groups, microhardness was decreased, but it was not significant in Eurovit multivitamin group (P = 0.088). The reduction rate in Kharazmi iron group was significant compared to that in other groups (P < 0.005). Hardness reduction percent for Kharazmi iron drop was 28/12 ± 47/43. In SEM analysis, irregular granular appearance was observed in the enamel exposed to Kharazmi iron drop.

Conclusion: The results showed that all the studied drugs have the potential to cause erosion; this potential is the most in Kharazmi iron drop and the least in Eurovit multivitamin drops. Therefore, after using these kinds of drops, preventive measures should be used in children.

No MeSH data available.


Related in: MedlinePlus

SEM image of the polished enamel which was exposed to Ironorm iron drop for 5 min: (a) 1000×; (b) 2000×
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4697239&req=5

Figure 5: SEM image of the polished enamel which was exposed to Ironorm iron drop for 5 min: (a) 1000×; (b) 2000×

Mentions: However, in the meantime, TA is more important[15] because the total amount of acid (TA) represents the actual amount of available H+ to react with the dental surfaces.[18] Acids are usually used as a buffering agent to maintain the chemical stability, for the control of consistency, or for physiological adaptations. Furthermore, acidic compounds are mostly required for the solubility of drugs. Acidic ingredients have better taste and improve patient compliance.[1119] However, the amount of citrate was significant in Kharazmi and Shahdarou drops (498 and 102 ppm, respectively). It seems that parameters like pH, exposure time, temperature, and type of acid could affect the strength of acidic materials to cause erosion.[20] The pH of drops used in this study was in the range of 2.1–3.3, which is below the critical pH range of enamel. Meanwhile, Kharazmi iron drop had the lowest pH and highest TA (2.37). As can be seen in the SEM photographs, this may cause the demineralization of enamel surfaces. In the SEM images of the Kharazmi iron drops, enamel erosion and porosity, cracks, and fractures were observed [Figure 5]. Although we do not know exactly what caused the pores and cracks, they may be due to the exposure to low pH or the pharmaceutical combinations or dehydration. The increase of surface roughness, however, can cause more retention of the plaque and increased susceptibility to tooth decay. Endogenous erosive potential effects of some common drugs used for children, such as salbutamol (pH = 6.05), paracetamol (pH = 6.77), and theophylline (pH = 7.71), were studied by Babu et al. using SEM; in all the samples, irregular erosion cavities were observed in teeth enamel surfaces.[21] Tupalli et al. evaluated the erosive potential of various pediatric liquid medicaments with SEM in primary teeth. All drugs used in their study (analgesics, antibiotics, anti-epileptics, multivitamins, and anti-tussives) showed an erosive effect on primary enamel surfaces. The majority of the medications, especially multivitamins, caused etched prism pattern followed by crater formation and sporadic rod ends. The content of calcium, phosphate, and fluoride of drugs has a protective effect.[22] In comparison to Kharazmi iron drop, Ironorm iron drop caused lower reduction in microhardness of samples due to high levels of calcium and phosphate. Among the studied drugs, the Eurovit drop was safer than others, and this can be related to the higher pH, higher amount of calcium, and lower citrate than the other drops. There was no significant difference in the amount of fluoride in the studied drops and the low levels do not seem to have a protective role. This was an in vitro study, so the role of protective factors such as saliva has not been evaluated. Perhaps in the future in vitro studies, this shortcoming can be compensated by performing pH cycling partially.[23] Eskandarian et al. studied the effect of three iron drops on the surface hardness of primary tooth in artificial decay plants; the results have shown that iron supplements have no effect on the demineralization of the teeth structure. The difference between the results of their study and the present study could be due to the different concentrations of iron drops (1 ml iron in 25 ml medium) and the difference in the procedures; for example, in their study, after immersing in solutions, the samples were polished and then microhardness was measured, which may remove the most superficial layer influenced by the drugs.[24]


Experimental study of iron and multivitamin drops on enamel microhardness of primary tooth.

Pasdar N, Alaghehmand H, Mottaghi F, Tavassoli M - J Int Soc Prev Community Dent (2015 Nov-Dec)

SEM image of the polished enamel which was exposed to Ironorm iron drop for 5 min: (a) 1000×; (b) 2000×
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697239&req=5

Figure 5: SEM image of the polished enamel which was exposed to Ironorm iron drop for 5 min: (a) 1000×; (b) 2000×
Mentions: However, in the meantime, TA is more important[15] because the total amount of acid (TA) represents the actual amount of available H+ to react with the dental surfaces.[18] Acids are usually used as a buffering agent to maintain the chemical stability, for the control of consistency, or for physiological adaptations. Furthermore, acidic compounds are mostly required for the solubility of drugs. Acidic ingredients have better taste and improve patient compliance.[1119] However, the amount of citrate was significant in Kharazmi and Shahdarou drops (498 and 102 ppm, respectively). It seems that parameters like pH, exposure time, temperature, and type of acid could affect the strength of acidic materials to cause erosion.[20] The pH of drops used in this study was in the range of 2.1–3.3, which is below the critical pH range of enamel. Meanwhile, Kharazmi iron drop had the lowest pH and highest TA (2.37). As can be seen in the SEM photographs, this may cause the demineralization of enamel surfaces. In the SEM images of the Kharazmi iron drops, enamel erosion and porosity, cracks, and fractures were observed [Figure 5]. Although we do not know exactly what caused the pores and cracks, they may be due to the exposure to low pH or the pharmaceutical combinations or dehydration. The increase of surface roughness, however, can cause more retention of the plaque and increased susceptibility to tooth decay. Endogenous erosive potential effects of some common drugs used for children, such as salbutamol (pH = 6.05), paracetamol (pH = 6.77), and theophylline (pH = 7.71), were studied by Babu et al. using SEM; in all the samples, irregular erosion cavities were observed in teeth enamel surfaces.[21] Tupalli et al. evaluated the erosive potential of various pediatric liquid medicaments with SEM in primary teeth. All drugs used in their study (analgesics, antibiotics, anti-epileptics, multivitamins, and anti-tussives) showed an erosive effect on primary enamel surfaces. The majority of the medications, especially multivitamins, caused etched prism pattern followed by crater formation and sporadic rod ends. The content of calcium, phosphate, and fluoride of drugs has a protective effect.[22] In comparison to Kharazmi iron drop, Ironorm iron drop caused lower reduction in microhardness of samples due to high levels of calcium and phosphate. Among the studied drugs, the Eurovit drop was safer than others, and this can be related to the higher pH, higher amount of calcium, and lower citrate than the other drops. There was no significant difference in the amount of fluoride in the studied drops and the low levels do not seem to have a protective role. This was an in vitro study, so the role of protective factors such as saliva has not been evaluated. Perhaps in the future in vitro studies, this shortcoming can be compensated by performing pH cycling partially.[23] Eskandarian et al. studied the effect of three iron drops on the surface hardness of primary tooth in artificial decay plants; the results have shown that iron supplements have no effect on the demineralization of the teeth structure. The difference between the results of their study and the present study could be due to the different concentrations of iron drops (1 ml iron in 25 ml medium) and the difference in the procedures; for example, in their study, after immersing in solutions, the samples were polished and then microhardness was measured, which may remove the most superficial layer influenced by the drugs.[24]

Bottom Line: In all groups, microhardness was decreased, but it was not significant in Eurovit multivitamin group (P = 0.088).The reduction rate in Kharazmi iron group was significant compared to that in other groups (P < 0.005).Hardness reduction percent for Kharazmi iron drop was 28/12 ± 47/43.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Dentistry, Babol University of Medical Sciences, Babol, Iran.

ABSTRACT

Objectives: Iron and multivitamin drops are being frequently prescribed in children less than 2 years of age. Due to their low pH levels, these drops may lead to the softening of enamel and accelerate the destructive process. The aim of the present study was to investigate the enamel microhardness of primary teeth after exposing them to iron and multivitamin drops.

Materials and methods: Forty healthy anterior teeth were randomly divided into four groups of 10 samples each. Samples were exposed to two iron drops of Kharazmi (Iran) and Ironorm (UK) and two multivitamin drops of Shahdarou (Iran) and Eurovit (Germany) for 5 min. The surface microhardness was measured before and after exposure and data processing was done using statistical paired t-test and analysis of variance (ANOVA) test. The surface structure of the teeth was examined by scanning electron microscope (SEM).

Results: In all groups, microhardness was decreased, but it was not significant in Eurovit multivitamin group (P = 0.088). The reduction rate in Kharazmi iron group was significant compared to that in other groups (P < 0.005). Hardness reduction percent for Kharazmi iron drop was 28/12 ± 47/43. In SEM analysis, irregular granular appearance was observed in the enamel exposed to Kharazmi iron drop.

Conclusion: The results showed that all the studied drugs have the potential to cause erosion; this potential is the most in Kharazmi iron drop and the least in Eurovit multivitamin drops. Therefore, after using these kinds of drops, preventive measures should be used in children.

No MeSH data available.


Related in: MedlinePlus