Erosive potential of medication on human enamel and posterior remineralization capacity

Abstract

Introduction: Changes in lifestyle have been reported as one of the greatest causes of dental erosion. Nevertheless the intake of potentially erosive medication might be other important factor contributing to the rise in prevalence of this condition [1]. The increased occurrence of some chronic respiratory diseases (such as asthma), allergic states and other recurrent common conditions (as cough, cold or flu) has led to frequent medicine prescription that might be potentially erosive to the teeth [2]. This study’s goals were to compare the erosive potential of two medicines commonly prescribed for chronic respiratory diseases, and to determine the enamel capacity for remineralization after their application.

Materials and methods: Ethical approval was obtained. Sixty-six human enamel samples were randomly assigned to 6 groups (n = 11): Ven (Ventilan^®), Ven-F (Ventilan^® with fluoride varnish), Cla (Claritine^®), Cla-F (Claritine^® with fluoride varnish), C (control) and C-F (control with fluoride varnish). The samples in groups Ven, Cla, and C were exposed to the respective medicines or distilled water (3x 1min/day during 5 days) followed by remineralization in artificial saliva. In groups Ven-F, Cla-F and C-F, fluoride varnish (Profluorid^®) was applied after the medicine exposure. Two 5-day cycles were performed. The enamel surface was analyzed by magnifying stereomicroscope (prevalence of erosive lesions), scanning electron microscopy (SEM) and surface hardness (SH). One-way ANOVA was used (α = 0.05) for the analysis.

Results: Groups Ven and Cla revealed 93 and 66% prevalence of erosive lesions, respectively, and significant lower SH than C (p < .001). Ven-F and Cla-F, with lesion prevalences of 30 and 23%, respectively, showed significant lower SH than C-F (p < .001) or even C (p < .001), but significantly higher than the non-fluorinated counterparts (p < .001). Cla showed the lowest SH, and even fluorinated couldn’t overcome the SH of Ven (p > .05) (Figure 1). The two medicines showed clear evidence of enamel surface damage on SEM micrographs, with cracks, craters and enamel prisms’ exposure, being the most common features encountered (Figures 2 and 3).

Figure 1. SH values in VHN (±sd).

Figure 2. Ven group (×3.000)

Figure 3. Cla group (×3.000).

Discussion and conclusions: Under the conditions of this study, Claritine^® treated samples showed lower prevalence of erosion lesions than Ventilan^®. Regarding the SH, Claritine^® seemed to have higher erosive potential, and to hold the lowest potential for remineralization.