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Table of Contents   
ORIGINAL RESEARCH  
Year : 2013  |  Volume : 24  |  Issue : 4  |  Page : 498-501
Evaluation of total soluble solids content (TSSC) and endogenous pH in antimicrobials of pediatric use


1 Department of Paediatric Dentistry, School of Dentistry, State University of Paraiba, Campina Grande, PB, Brazil
2 Department of Analytical Chemistry, School of Chemistry, State University of Paraiba, Campina Grande, PB, Brazil

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Date of Submission24-Jun-2007
Date of Decision09-Jan-2009
Date of Acceptance20-Feb-2009
Date of Web Publication19-Sep-2013
 

   Abstract 

Background: The use of liquid pharmaceutical preparations is a daily occurrence for some children. Evidences show a significant relation between the intake of oral sucrose based medicines and an increase incidence in dental caries.
Aim: This in vitro experimental study evaluated the Total Soluble Solids Content (TSSC) by means of Brix scale refractometry and the endogenous pH of antimicrobials of pediatric use presented as oral suspensions.
Materials and Methods: Nine medications (6 chemotherapics and 3 antibiotics) were evaluated by random experiment with 3 repetitions for each sample. The analysis of TSSC readings were performed by Brix refractometry using the Abbé refractometer, and the pH values were determined by potentiometry.
Results: The mean TSS contents ranged from 11.73 (Keflaxina) to 63.83 (Azitromed). The minimum and maximum mean pH values were 4.12 (Keflaxina) and 10.97 (Zitroneo), respectively.
Conclusions: The chemotherapic antimicrobials evaluated in this study presented the highest TSSC means, while the antibiotics showed pHs below the values considered as critical, which may contribute to the development of caries lesions in case of inadequate administration of these medications to children.

Keywords: Administration, oral, pediatrics, pharmaceutical preparations, total solids

How to cite this article:
Cavalcanti AL, de Oliveira KF, Xavier AF, Pinto DS, Vieira FF. Evaluation of total soluble solids content (TSSC) and endogenous pH in antimicrobials of pediatric use. Indian J Dent Res 2013;24:498-501

How to cite this URL:
Cavalcanti AL, de Oliveira KF, Xavier AF, Pinto DS, Vieira FF. Evaluation of total soluble solids content (TSSC) and endogenous pH in antimicrobials of pediatric use. Indian J Dent Res [serial online] 2013 [cited 2019 Nov 22];24:498-501. Available from: http://www.ijdr.in/text.asp?2013/24/4/498/118386
Most liquid medicines are for children and are usually coloured, flavoured, and sweetened with various additives. [1] The most common sweetener bases for medication include sucrose, sorbitol, and saccharin. [2] Sucrose acts as a preservative, an antioxidant, a demulcent and a bulking agent. It remains widely used because it is cheap, nonhygroscopic, and easy to process. [3]

Syrups sweetened with sucrose or fructose or with a combination of fructose and sorbitol produced a mark and long term drop in plaque pH. [4] These products are acidogenic like the foods and drinks sweetened with these sugars. The cariogenic potential of pediatric liquid medications is due to high concentration of fermentable carbohydrates and their acidogenicity. [5]

There is clear association between sugar containing oral medicines and dental caries [6],[7],[8] and the effect may be greater if they are taken at night or at bedtime when the protective buffering and cleansing effects of saliva are reduced as the salivary flow rate falls. [9]

In the chemistry laboratory, concentrations of solutions are expressed in a variety of common units. Given the importance of sugar concentrations in food and beverages, it may not be surprising to learn that there are several concentration scales that are commonly used to express the sugar content of solutions. [10]

Refractometry is used extensively in the food industry in the production of sugar, juices, wine, alcoholic drinks, beer, fats, oils, etc., and also in pharmacological plants, in medical establishments and pharmacies carrying out analyses and monitoring the quality of medicinal preparations. [11] Refractive index can be used to measure the concentration of particular materials or the percent dissolved solids of a substance. The Brix scale, which is numerically equal to the percent of sugar and other dissolved solids in the solution, is now referred to as degrees Brix (total soluble solids content - TSSC). In many cases, it is assumed that all of the dissolved solute is sugar. [10] A 25 °Bx solution is 25% (w/w), with 25 grams of sugar per 100 grams of solution.

The objective of this study was to evaluate the Total Soluble Solids Content (TSSC) by means of Brix scale refractometry and the endogenous pH of antimicrobials of pediatric use presented as oral suspensions.


   Materials and Methods Top


The determination of Total Soluble Solids Content (TSSC) and pH levels was carried out in the nine most prescribe commercial and generic medicines (6 chemotherapics and 3 antibiotics) in the city of Campina Grande, PB, Brazil. They were randomly selected according to their availability in the market [Table 1]. They were evaluated by a random experiment with 3 repetitions for each sample, and the mean of the three values was recorded. Data were collected by a single calibrated examiner (Kappa = 0.83) and were recorded in study-specific charts.
Table 1: Commercial name, classification and manufacturer of pediatric medicines used in this study

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Degrees Brix ( o Bx)

The analysis of TSSC readings were performed by refractometry using the Abbé refractometer (PZO-RL1, Warszawa, Poland). As the refractive index of a sugar-containing solution is also temperature-dependent, refractometers are typically calibrated at 20 o C. The equipment was calibrated with deionized water (refraction index = 1.3330 and 0° Brix at 20°C) and the readings of the samples were performed. [12],[13]

pH measurement

The endogenous pH of each medicine was determined at room temperature (20°C) using a pH meter (TEC-2 pH meter; Tecnal, Sion Paulo, SP, Brazil) placed directly into each solution. [12] The pH meter accurate to 0.1 was first calibrated according to the manufacturer's instructions, using buffer standards of pH 7 and pH 4. As much as 20 mL of each antitussive medicine was placed in a beaker, the pH meter was immersed into the syrup and the value was recorded.


   Results Top


The nine medications tested varied considerably with regard to two measured variables. Total soluble solid content (°Brix) varied between 11.73% (Keflaxina ® ) to 63.83% (Azitromed ® ) [Table 2]. The median value of antibiotics' TSCC was 30.26 while the median value of chemotherapics' was 32.89.
Table 2: Total Soluble Solids Content (Mean and Standard Deviation) for each pediatric medicine

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With regard to pH, values ranged from 4.12 (Keflaxina ® ) to 10.97 (Zitroneo ® ) [Table 3]. Five medicines showed pH value lower than the critical of 5.5. The median value of antibiotics' pH was 5.34 while the median value of chemotherapics' pH was 6.48.
Table 3: pH (Mean and Standard Deviation) for each pediatric medicine

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   Discussion Top


The small sample of this study was due to the fact that its intent was just to alert health professionals to the potential contribution of these medicines to dental caries and enamel erosion in children. [12]

Sugar is frequently part of liquid medications, cough drops, vitamins, antacid tablets and antifungal agents. [14] Some studies have showed that the sugar proportion was 12.0% to 80.0%. [2],[4],[12],[15],[16],[17] In this study, total soluble solid content varied between 11.73% to 63.83%. The amount of TSSC present in Ampicilina, Azitromed and Zitroneo, as determined by the Brix scale was above 40%.

People who receive long-term medication may be at greater risk of developing tooth decay when they are using sweetened medications. [14],[18] Taken at night they can be an aggravating condition, because during this period salivary flow rate is reduced and the time of elimination from the oral cavity rises. [19] Children, too, should be encouraged to rinse their mouths with water after taking the medication. [14]

Pharmaceutical companies are able to manufacture sugar free medicines that are just as effective, stable, and acceptable as sugared medicines. Sugar-free medicines are defined as oral liquid preparations that do not contain fructose, glucose, or sucrose. Prescription of sugar-free medication is particularly important if treatment is long term (defined as daily or alternate days for more than three months). [9]

Sorbitol may be an appropriate substitutive sweetener for children whose sucrose intake needs to be restricted, such as children with diabetes or a high dental caries rate. [2],[6]

Low endogenous pH of liquid medicines could markedly contribute to the erosive potential of these solutions. In the present study, with regard to hydrogenionic potential (pH), five medications showed endogenous pH value lower than the critical of 5.5. The median value of antibiotics' pH was 5.34 while the median value of chemotherapics' was 6.48. Brazilian studies verified that the median value of paediatric syrups' pH was 4.90 [17] and antibiotics' pH was 5.5. [12],[20] Two Amoxicillina preparations were used and the results of the measurements were similar. This can be explained by the fact the both have the same pharmaceutical excipients.

Decreasing the cariogenic potential of children's medications should be of concern to all professionals interested in the total health of their patients. The first step in decreasing dental caries caused by medication would be to educate consumers regarding the need to clean the teeth after each dose. Careful instructions for oral hygiene given whenever prescriptions are written would help reduce future problems. Additional education by dental professionals whenever a chronically medicated patient is encountered is essential. Most effective prevention would be possible if the nonactive ingredients of children's medicines did not contain readily fermentable carbohydrates. [4]


   Conclusion Top


It is concluded that health practitioners should be aware of the sucrose content of pediatric medications. The chemotherapic antimicrobials evaluated in this study presented the highest TSSC means, while the antibiotics showed pHs below the values considered as critical, which may contribute to the development of caries lesions in case of inadequate administration of these medications to children.

 
   References Top

1.Kulkarni ML, Sureshkumar C, Venkataramana V. Colourings, flavourings, and sugars in children's medicines in India. BMJ 1993;25:773.  Back to cited text no. 1
    
2.Hill EM, Flaitz CM, Frost GR. Sweetener content of common pediatric oral liquid medications. Am J Hosp Pharm 1988;45:135-42.  Back to cited text no. 2
[PUBMED]    
3.Bigeard L. The role of medication and sugars in pediatric dental patients. Dent Clin North Am 2000;44:443-56.  Back to cited text no. 3
[PUBMED]    
4.Feigal RJ, Jensen ME, Mensing CA. Dental caries potential of liquid medications. Pediatrics 1981;68:416-9.  Back to cited text no. 4
[PUBMED]    
5.Sahgal J, Sood PB, Raju OS. A comparison of oral hygiene status and dental caries in children on long term liquid oral medications to those not administered with such medications. J India Soc Pedo Prev Dent 2002;20:144-51.  Back to cited text no. 5
    
6.Roberts IF, Roberts GJ. Relation between medicines sweetened with sucrose and dental caries. Br Med J 1979;7:14-6.  Back to cited text no. 6
    
7.Roberts GJ, Roberts IF. Dental disease in chronically sick children. ASDC J Dent Child 1981;48:346-51.  Back to cited text no. 7
[PUBMED]    
8.Durward C, Thou T. Dental caries and sugar-containing liquid medicines for children in New Zeland. N Z Dent J 1997;93:124-9.  Back to cited text no. 8
[PUBMED]    
9.Foster H, Fitzgerald J. Dental disease in children with chronic illness. Arch Dis Child 2005;90:703-8.  Back to cited text no. 9
[PUBMED]    
10.Ball DW. Concentration scales for sugar solutions. J Chem Educ 2006;83:1489-91.  Back to cited text no. 10
    
11.Vishnyakov GN, Kornysheva SV. Provision of measurement uniformity in refractometry of solids, liquids, and gases. Measurement Techniques 2005;48:1099-1102.  Back to cited text no. 11
    
12.Cavalcanti AL, Fernandes LV, Barbosa AS, Vieira FF. pH, titratable acidity and total soluble solid content of pediatric antitussive medicines. Acta Stomatol Croat 2008;42:164-70.  Back to cited text no. 12
    
13.Cavalcanti AL, Oliveira KF, Paiva PS, Rabelo MVD, Costa SKP, Vieira FF. Determination of total soluble solids ( o Brix) and pH in milk drinks and industrialized fruit juices. Pesq Bras Odontoped Clin Integr 2006;6:57-64.  Back to cited text no. 13
    
14.American Dental Association (ADA). JADA 2005;136:831.  Back to cited text no. 14
    
15.Peres KG, Oliveira CT, Peres MA, Raymundo MS, Fett R. Sugar content in liquid oral medicines for children. Rev Saúde Pública 2005;39:486-9.  Back to cited text no. 15
    
16.Lima KT, Almeida IC, Senna ET. Medicamentos pediátricos: Agentes edulcorantes e pH. J Bras Odontoped Odonto Bebê 2000;3:457-63.  Back to cited text no. 16
    
17.Pierro VS, Abdelnur JP, Maia LC, Trugo LC. Free sugar concentration and pH pf paediatric medicines in Brazil. Community Dent Health 2005;22:180-3.  Back to cited text no. 17
    
18.Mackie, IC. Chidren's dental health and medicines that contain sugar. Br Dent J 1995;15:141-2.  Back to cited text no. 18
    
19.Fraiz FC. Diet and dental caries in early infancy. In: Walter LRF, Ferelle A, Issao M (eds). Dentistry for infants. Sao Paulo: Artes Medicas; 1997, pp. 107-122.  Back to cited text no. 19
    
20.Neiva A, Silva VS, Maia LC, Soares EL, Trugo LC. In vitro analysis of sucrose concentration and pH of pediatric antibiotics. Pesq Bras Odontoped Clin Integr 2001;1:9-16.  Back to cited text no. 20
    

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Correspondence Address:
Alessandro Leite Cavalcanti
Department of Paediatric Dentistry, School of Dentistry, State University of Paraiba, Campina Grande, PB
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.118386

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    Tables

  [Table 1], [Table 2], [Table 3]

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