Erosive Effect of Analgesics on Primary Tooth Enamel - An in Vitro Study

Abstract Objective: To evaluate in vitro erosive effect of analgesics on primary tooth enamel. Material and Methods: The pH and the titratable acidity measurements of the medicines were performed in triplicate using a digital pH meter. Enamel slabs of primary teeth flat and polished were selected by initial surface microhardness analysis. Medications were selected and specimens were assigned into five groups (n=12): Dalsy; Magnopyrol; Paracetamol; Tylenol; and distilled water (negative control). Specimens were immersed in 5 ml of each group solution for 30 min, 4x/day for three days and stored in artificial saliva at 37 °C between immersions and at night. Final microhardness was determined. The data were submitted to Oneway ANOVA and Tukey's test. Scanning electron microscopy (SEM) analysis was performed in three specimens of each group. Results: Medicines showed acidic pH and mean values of titratable acidity ranged from 1.46 to 11.66 ml of 0.1N NaOH. The mineral loss of Magnopyrol was statistically significant in relation to the control group (p<0.01). Magnopyrol showed higher values when compared to Tylenol (p<0.05). SEM images displayed microstructure alterations in the Paracetamol group. Conclusion: Despite the low pH values, only Magnopyrol showed greater enamel softening. Paracetamol demonstrated morphological changes in primary tooth enamel (AU).

Quantification and gene expression of Lactobacillus casei group species associated with dentinal lesions in early childhood caries.

BACKGROUND: Considering that the Lactobacillus casei group is strongly associated with caries progression, the use of lactobacilli as probiotics must be balanced due to their possible involvement in dental caries. OBJECTIVE: This study aimed to detect and quantify L. paracasei, L. rhamnosus, and L. casei group species in the active and arrested dentinal lesions of preschoolers. It also aimed to determine the expression profiles of lactobacilli genes related to adhesion, extracellular polymeric substance regulation, and pyruvate oxidation. METHODS: Total ribonucleic acid (RNA) was extracted from dentinal lesion samples (25 active, 13 arrested) of children between 2 and 5 years of age. The samples were converted to complementary deoxyribonucleic acid (cDNA), and quantitative polymerase chain reaction (qPCR) analyses were performed to quantify and determine the relative abundance (measured by percentage of total bacteria) of L. paracasei, L. rhamnosus, and L. casei group species. The expression profiles of L. paracasei/casei genes (spaC and spxB) and L. rhamnosus genes (spaE and wzb) were assessed. The Student t-test and the Mann-Whitney U test were used for comparisons. RESULTS: The L. casei group species were found to be part of the viable microbial community in dentinal caries. L. paracasei (p = 0.001), L. rhamnosus (p = 0.022), and L. casei (p = 0.004) group species were abundant in the active dentinal lesions compared to the arrested dentinal lesions. Only the wzb gene (p = 0.006) exhibited a statistically significant difference between the active and arrested lesions in terms of its expression profile; it was expressed to a higher extent in the active dentinal lesions. CONCLUSIONS: The L. casei group species presented in large numbers in the active dentinal caries lesions, indicating that these microorganisms are related to caries activity, and the wzb gene may play an important role in caries progression.

Parents' Emotional and Social Experiences of Caring a Child with Cleft Lip and/or Palate

ABSTRACT Objective: To evaluate the emotional and social experiences of parents or caregivers of children with cleft lip and/or palate (CL/P) in a city in the Northeastern of Brazil. Material and Methods: A quantitative and cross-sectional study was conducted among parents or caregivers of children with CL/P by interviews based on a questionnaire. Interviews were conducted during the First Smile Project in Sobral, Ceará, Brazil. All participants (n=41) agreed to participate in the interview and signed an informed consent. The data was analyzed in SPSS software version 22.0. Results: The majority of participants were female (87.2%), with a mean age of 37 years, with a low level of education and low family income. The great majority (90.2%) of the parents were not prenatally diagnosed to have CL/P babies. Of those interviewed, 56.1% mentioned that the first diagnosis of cleft lip and palate was not presented by the professionals in a clarifying way to the family. Fear (36.6%) and sadness (19.5%) were the main feelings experienced when the child was diagnosed with fissure. Feeding (48.8%) was pointed out as the main concern in caring for a child with CL/P. Conclusion: The parents and caregivers interviewed faced important emotional and social problems that must be addressed by the professional team that assists the child with CL/P.

Parents and caregivers' knowledge and attitudes toward children's toothbrushing

Introduction: Fluoride prevents tooth decay, but especially in young children, it is important to balance the anticaries effect of fluoride toothpastes versus the risk of dental fluorosis. Objective: The aim of this study was to analyze parents' and caregivers' knowledge and attitudes toward their children's toothbrushing habits from 12 to 71 months of age, as well as to verify their knowledge about fluoride and toothpastes' dispensed amount. Methods: A semi-structured interview script was applied to a convenience sample of parents and caregivers (n = 63) at the Pediatric Dentistry Clinic of a public university. Respondents were asked to simulate the amount of toothpaste used in their children's brushing. Results were presented with absolute and relative frequencies. Results: Regarding their children's toothbrushing, 49.2% performed oral hygiene of their children; 31.7% mentioned that their children brushed under adult supervision; and 19.1% said their children brushed alone. When asked if they had already received guidance regarding the adequate amount of toothpaste to be dispensed, 54% stated they were never oriented. In 74.6% of cases, the amount dispensed exceeded the recommended dose for preschoolers. In addition, 57.1% reported that the toothpaste is within the reach of the child. Of the respondents, 66.7% pointed out the role of fluoride in caries prevention, and 73% were unaware of its toxicity. Conclusion: In general, parents had good oral hygiene practices with their children. However, most respondents did not use the appropriate amount of toothpaste for their children's age and were unaware of fluoride toxicity, although they could identify its purpose.

Introdução: O flúor pode prevenir a cárie dentária, porém, especialmente em crianças menores, é importante equilibrar o efeito anticárie dos dentifrícios fluoretados versus o risco de fluorose dentária. Objetivo: O objetivo deste estudo foi analisar o conhecimento e atitudes de pais e cuidadores sobre os hábitos de escovação de seus filhos de 12 a 71 meses de idade, bem como verificar seu conhecimento sobre flúor e quantidade utilizada de creme dental. Métodos: Um roteiro de entrevista semi-estruturado foi aplicado a uma amostra de conveniência de pais e cuidadores (n=63) na Clínica de Odontopediatria de uma universidade pública. Solicitou-se que os entrevistados simulassem a quantidade de creme dental utilizada na escovação de seus filhos. Os resultados foram apresentados de forma descritiva com frequências absolutas e relativas. Resultados: Quanto à supervisão da escovação, 49,2% realizavam a higienização de seus filhos; 31,7% mencionaram que as próprias crianças escovavam sob supervisão de um adulto, e 19,1% responderam que seus filhos escovavam sozinhos. Quando perguntados como aprenderam a dispensar dentifrício na escova, 54% afirmaram que nunca foram orientados. Em 74,6% dos casos, a quantidade dispensada superou a dose recomendada para pré-escolares. Ademais, 57,1% relataram que o dentifrício fica ao alcance da criança. Dos entrevistados, 66,7% apontaram o papel do flúor na prevenção da cárie e 73% desconheciam sua toxicidade. Conclusão: Em geral, os entrevistados praticavam bons hábitos de escovação em seus filhos. Entretanto, a maioria da amostra estudada não utilizou a quantidade apropriada de dentifrício para a idade e desconhecia a toxicidade do flúor, apesar de identificar sua finalidade.

Extraction and purification of RNA from human carious dentine: an approach to enable bacterial gene expression studies / Extração e purificação de RNA proveniente de dentina humana cariada: uma abordagem para viabilizar estudos de expressão gênica

Background: RNA isolation from bacteria within dentine caries lesions could be difficult due to reduced amount of collectable biomass and high mRNA instability. Attempting to overcome this challenge we describe one protocol developed to extract and purify total RNA from dentine lesions. Objective: customize a bacterial RNA extraction and purification method from human carious dentine. Methods: quantity and purity of extracted RNA were measured with a microvolume UV-VIS spectrophotometer, RNA integrity was assessed by standard denaturing agarose gel electrophoresis and images were captured under ultraviolet light with camera and analyzed. DNase treatment removed genomic DNA and an additional step of purification was carried out in silica spin column. Results: final yield (ng/µl) was 67.01 ± 22.33, absorbance ratio A260/A280 = 2.0 ± 0.07 and RNA integrity were obtained. The purified samples were reversely transcribed and the expression of atpD and fabM gene from Streptococcus mutans analyzed by quantitative real-time PCR. Conclusion: the extraction methodology developed produced high-quality RNA from dentine microbiota for transcriptional analysis.

Introdução: o isolamento de RNA de bactérias dentro de lesões de dentina cariada pode ser difícil devido à quantidade reduzida de biomassa e alta instabilidade de mRNA. Na tentativa de superar esse desafio, descrevemos um protocolo desenvolvido para extrair e purificar o RNA total das lesões dentinárias. Objetivo: personalizar um método de extração e purificação de RNA bacteriano a partir da dentina cariada humana. Métodos: a quantidade e a pureza do RNA extraído foram medidas com um espectrofotômetro UV-VIS de microvolume, a integridade do RNA foi avaliada por eletroforese em gel de agarose desnaturante padrão e as imagens foram capturadas sob luz ultravioleta e analisadas. O tratamento com DNase removeu o DNA genômico e uma etapa adicional de purificação foi realizada em coluna de spin de sílica. Resultados: o rendimento final (ng / µl) foi de 67,01 ± 22,33, a razão de absorbância A260 / A280 = 2,0 ± 0,07 e a integridade do RNA foram obtidas. As amostras purificadas foram transcritas reversamente e a expressão do gene atpD e fabM de Streptococcus mutans analisadas por PCR quantitativo em tempo real (RT-qPCR). Conclusão: a metodologia de extração desenvolvida produziu RNA de alta qualidade da microbiota dentinária para análises transcricionais.

Quantitative analysis of biofilm bacteria according to different stages of early childhood caries.

OBJECTIVE: Monitoring selected key species related to health or disease may facilitate caries risk assessment and discovery of novel ecological preventive and therapeutic approaches. This study aimed at quantifying Actinomyces naeslundii, Bifidobacterium spp., Lactobacillus acidophilus, Lactobacillus casei group, Streptococcus gordonii, Mitis group and Streptococcus mutans by quantitative polymerase chain reaction (qPCR) in dental biofilm from Brazilian children with different stages of early childhood caries (ECC). DESIGN: Seventy-five preschool children were clinically evaluated by ICDAS criteria and divided into groups: caries-free (CF; n = 20), enamel caries lesions (ECL; n = 17) and dentine caries lesions (DCL; n = 38). Plaque samples from all children were collected for detection and quantification of the selected bacteria. RESULTS: L. acidophilus and L. casei group were absent in almost all plaque samples. No differences in relative proportions of A. naeslundii, Mitis group and S. gordonii were observed in any stage of caries. However, S. mutans and Bifidobacterium spp. were present at higher concentrations in the biofilm of children with DCL (p < 0.001). Multivariate analysis showed that S. mutans and Bifidobacterium spp. were strongly associated with biofilm in children with DCL. CONCLUSION: Differences were observed in the proportion of acidogenic and aciduric bacteria with dental caries progression. The data indicate that S. mutans and Bifidobacterium spp. in dental biofilm may be involved in some progression processes for ECC.

Proliferative Periostitis in a Pediatric Patient.

Proliferative periostitis is a rare condition that can affect children and adolescents. It is characterized by the successive deposition of layers of bone caused by low-virulence infection or chronic inflammatory stimulation. The purpose of this paper is to report a case of proliferative periostitis in a pediatric patient, emphasizing the clinical and radiographic aspects as well as the therapeutic management.

Bruxismo infantil e sua associação com fatores psicológicos ­ revisão sistemática da literatura / Bruxism in children and its association with psychological factors - a systematic review of literature

O bruxismo compreende uma atividade parafuncional caracterizado pelo ato de ranger ou apertar os dentes de forma voluntária e/ou involuntariamente, ocorrendo durante o período diurno e/ou noturno, podendo acarretar vários prejuízos ao sistema estomatognático. Diversos são os fatores etiológicos que podem estar associados a esta desordem, como fatores locais, sistêmicos, hereditários, psicossociais e comportamentais. Pesquisadores têm sugerido que fatores comportamentais, como estresse, ansiedade e traços de personalidade se sobressaem a fatores locais. Portanto, o objetivo deste estudo foi realizar uma revisão sistemática da literatura a fim de avaliar se há relação entre bruxismo e fatores psicológicos em crianças. Foram realizados levantamentos nas bases de dados: PubMed, BVS Biblioteca Virtual em Saúde e SciELO no período de fevereiro de 2007 a setembro de 2017. Os descritores utilizados foram "bruxism", "children", "stress", "anxiety", "pshychological factors". Sendo assim, 97 publicações foram identificadas na busca inicial. Após aplicação dos critérios de inclusão e exclusão, a amostra final foi composta por sete estudos. Houve evidência significativa de uma associação entre estresse, ansiedade e fatores psicológicos com o bruxismo infantil. Porém, ainda existe uma enorme necessidade de estudos bem delineados e com metodologias padronizadas a fim de verificar a associação entre o bruxismo e fatores psicológicos.

Bruxism comprises a parafunctional activity characterized by the act of grinding or clenching the teeth voluntarily and/or involuntarily, occurring during the day and / or night, and may cause several damages to the stomatognathic system. Several etiological factors may be associated with this disorder, such as local, systemic, hereditary, psychosocial and behavioral factors. Researchers have suggested that behavioral factors such as stress, anxiety, and personality traits stand out from local factors. Therefore, the aim of this study was to perform a systematic review of the literature in order to evaluate if there is a relation between bruxism and psychological factors in children. Data were collected in the databases: PubMed, BVS Virtual Health Library and SciELO from February 2007 to September 2017. The descriptors used were "bruxism", "children", "stress", "anxiety" and "pshychological factors". Thus, 97 publications were identified in the initial search. After applying the inclusion and exclusion criteria, the final sample consisted of seven studies. There was significant evidence of an association between stress, anxiety, and psychological factors with infant bruxism. However, there is still a great need for well-designed studies with standardized methodologies in order to verify the association between bruxism and psychological factors.

Molecular detection of bacteria associated to caries activity in dentinal lesions.

OBJECTIVES: This study aimed at identifying and quantifying Actinomyces naeslundii, Bifidobacterium spp., Streptococcus mitis group, Lactobacillus acidophilus, Lactobacillus casei group, Streptococcus gordonii, and Streptococcus mutans in active and inactive carious dentine lesions of children with early childhood caries by using quantitative polymerase chain reaction. MATERIAL AND METHODS: Fifty-six dentin lesion samples, classified as active (n = 39) or inactive (n = 17), were collected from children aged from 2 to 5 years old. Dentinal-cavitated lesions were evaluated by Nyvad criteria for the assessment of caries lesion activity. RESULTS: Relative quantification revealed that Bifidobacterium spp. and the L. casei group were significantly more abundant in active dentin lesions (p < 0.05). Concentrations of A. naeslundii, S. mitis group, and S. gordonii were not significantly different when comparing dentin lesion activity. The relative proportion of S. mutans was significantly greater in inactive than in active lesions (p < 0.05). Bifidobacterium spp. and L. casei group demonstrated a positive correlation (p = 0.001) in active lesions. The positive detection of L. acidophilus (odds ratio = 15.1) and S. gordonii (odds ratio = 7.7) was significantly associated to the active lesions. CONCLUSIONS: The data indicate that higher detection levels of Bifidobacterium spp. and the L. casei group may be linked to dentin lesion activity. Additionally, the presence of L. acidophilus and S. gordonii was associated with lesion activity. CLINICAL RELEVANCE: Considering that information about the oral microbiota related to dentin caries activity status is relevant, this study provides insights to better understand the differences in the microbiotas between active and arrested dentin cavities.

Long-term clinical performance of aesthetic restorations in primary molars: a case report.

There is a great diversity of restorative materials and techniques for deciduous molars with significant coronal destruction, including resin composite restorations and biologic restorations (portions of natural teeth). By using 4 evaluation methods, this study aimed at longitudinally evaluating the effectiveness of restorations in the deciduous molars of a patient having high caries activity, using adhesive techniques. The evaluation methods consisted of the fibre-optic transillumination method, clinical evaluation based on the United States Public Health Service criteria, radiographs, and an indirect method, scanning electron microscopy. Despite the patient's poor biofilm control, the restorative techniques were shown to be efficacious, particularly the biologic restorative technique.

Traumatic lesions from congenital insensitivity to pain with anhidrosis in a pediatric patient: dental management.

Congenital insensitivity to pain with anhidrosis is a rare autosomal-recessive disorder characterized by unexplained fever episodes, anhidrosis, pain insensitivity, self-mutilating behavior, and mental retardation. The lack of sensitivity to pain results in traumatic lesions, such as ulcers, fractures, burns, bites, scars, and digital amputations. Several methods have been suggested to treat these patients; however, appropriate management is difficult, especially when the mutilation is particularly severe. This report describes the case of a 2-year-old female patient who had severe self-mutilating injuries to her tongue, hands, lips, and oral mucosa caused by biting. The patient presented digital amputation and also a premature loss of a permanent tooth germ during the treatment. The dental management is described and discussed. It is important to include the dentist on the multidisciplinary team to reduce the frequency and severity of the self-inflicted lesions in these patients, also to prevent complications.

Surface degradation of composite resins by acidic medicines and pH-cycling.

This study evaluated the effects of acidic medicines (Dimetapp and Claritin), under pH-cycling conditions, on the surface degradation of four composite resins (microhybrid: TPH, Concept, Opallis and Nanofilled: Supreme). Thirty disc-shaped specimens ([symbol: see text] = 5.0 mm/thickness = 2.0 mm) of each composite were randomly assigned to 3 groups (n = 10): a control and two experimental groups, according to the acidic medicines evaluated. The specimens were finished and polished with aluminum oxide discs, and the surface roughness was measured by using a profilometer. After the specimens were submitted to a pH-cycling regimen and immersion in acidic medicines for 12 days, the surface roughness was measured again. Two specimens for each material and group were analyzed by scanning electron microscopy (SEM) before and after pH-cycling. Data were analyzed by the Student's-t test, ANOVA, Duncan's multiple range test and paired t-test (alpha=0.05). Significant increase in roughness was found only for TPH in the control group and TPH and Supreme immersed in Claritin (p<0.05). SEM analyses showed that the 4 composite resins underwent erosion and surface degradation after being subjected to the experimental conditions. In conclusion, although the roughness was slightly affected, the pH-cycling and acidic medicines caused surface degradation of the composite resins evaluated. Titratable acidity seemed to play a more crucial role on surface degradation of composite resins than pH.

Surface degradation of composite resins by acidic medicines and ph-cycling

This study evaluated the effects of acidic medicines (Dimetapp® and Claritin®), under pH-cycling conditions, on the surface degradation of four composite resins (microhybrid: TPH, Concept, Opallis and Nanofilled: Supreme). Thirty disc-shaped specimens (Ø = 5.0 mm / thickness = 2.0 mm) of each composite were randomly assigned to 3 groups (n = 10): a control and two experimental groups, according to the acidic medicines evaluated. The specimens were finished and polished with aluminum oxide discs, and the surface roughness was measured by using a profilometer. After the specimens were submitted to a pH-cycling regimen and immersion in acidic medicines for 12 days, the surface roughness was measured again. Two specimens for each material and group were analyzed by scanning electron microscopy (SEM) before and after pH-cycling. Data were analyzed by the Student's-t test, ANOVA, Duncan's multiple range test and paired t-test (α=0.05). Significant increase in roughness was found only for TPH in the control group and TPH and Supreme immersed in Claritin® (p<0.05). SEM analyses showed that the 4 composite resins underwent erosion and surface degradation after being subjected to the experimental conditions. In conclusion, although the roughness was slightly affected, the pH-cycling and acidic medicines caused surface degradation of the composite resins evaluated. Titratable acidity seemed to play a more crucial role on surface degradation of composite resins than pH.

Pediatricians' perceptions of the use of sweetened medications related to oral health.

OBJECTIVE: To evaluate pediatricians' perceptions and attitudes about the use of liquid pediatric medicines and their relationship with dental caries and dental erosion. STUDY DESIGN: A cross sectional study was conducted. Data was collected by questionnaires handed out in hospitals, medical clinics and offices. A convenience sample of 104 pediatricians was obtained. RESULTS: Most respondents (80.8%) stated that pediatric medicines could be related with dental disorders. Dental caries (64.70%) and tooth discoloration (43.7%) were the most frequent mentioned alterations, while only 3 (4.2%) respondents pointed out dental erosion. A considerable number of respondents (62.50%) recognized the presence of fermentable carbohydrates as a contributing factor to tooth decay, however not all of them recommended oral hygiene after their consumption (50.80%). Besides, 48 respondents (46.20) also believed that pediatric medicines could cause dental wear. CONCLUSIONS: Pediatricians in this study did not perceive the correct relationship between the presence of acidity in medicines and dental erosion; however, most of them presented a reasonable awareness about the relationship between sugared pediatric medicines and dental caries. Besides, they were unaware about the need of recommending oral hygiene after medicines' use.

Percepções e atitudes de responsáveis por crianças frente ao uso de medicamentos infantis e sua relação com cárie e erosão dentária / Perceptions and attitudes among parents and guardians on the use of pediatric medicines and their cariogenic and erosive potential

Este estudo avaliou as percepções e atitudes de responsáveis por crianças sobre os potenciais cariogênico e erosivo de medicamentos infantis. Foram realizadas entrevistas sobre a associação do uso de medicamentos infantis com cárie e erosão dentária, bem como os cuidados com a higiene bucal após sua ingestão. Do total de responsáveis com entrevista completa (n=86), 24 (27,9 por cento) consideraram os medicamentos infantis ácidos, 51 (59,3 por cento) amargos e 56 (65,1 por cento) doces; porém, apenas 16 (28,6 por cento) destes últimos realizavam higiene bucal das crianças após utilização (Exato de Fisher; p>0,05). Além disso, apenas 18 (20,9 por cento) responsáveis realizavam esta prática, dos quais 8 (44,4 por cento) haviam recebido orientação prévia sobre higiene bucal (Exato de Fisher; p<0,05). A associação entre uso de medicamentos e cárie dental ou defeitos na estrutura dos dentes foi apontada por 61 (70,9 por cento) entrevistados, dos quais 24 (39,3 por cento) justificaram tal associação em função da presença de açúcar nas formulações. Apesar dos responsáveis considerarem os medicamentos doces e relacionarem seu uso à presença de cárie e defeitos na estrutura dental, grande parte destes não realiza higiene bucal em seus filhos após o uso desses fármacos e não consegue estabelecer claramente a relação de causa e efeito existente em tal associação.

The study assesses the perceptions of parents/guardians on the use of pediatric medicines and their cariogenic/erosive potential, interviewing them on the relationship between the use of pediatric medicines and cavities/dental erosion, as well as oral hygiene procedures after the medication. Among the interviewed parents/guardians (n=86), 24 (27.9 percent) mentioned the sour taste of pediatric medication, 51 (59.3 percent) the bitter taste, and 56 (65.1 percent) considered them sweet, although only 16 (28.6 percent) of these parents/guardians brushed their children's teeth after the medication (Fisher's Exact; p>0.05). Moreover, only 18 (20.9 percent) of the parents/guardians performed oral hygiene practices after the medication, of whom 8 (44.4 percent) received previous instructions (Fisher's Exact; p<0.05). The association between taking medications and dental caries or structural dental defects was mentioned by 61 (70.9 percent) of the parents/guardians, with 24 (39.3 percent) of them justifying this association through the presence of sugar in the formulations. Although parents/guardians consider medicines to be sweet substances and relate their use to dental caries and tooth structure flaws, most of them do not brush their children's teeth after taking medications and are unable to establish a clear cause/effect relationship for this association.

[Perceptions and attitudes among parents and guardians on the use of pediatric medicines and their cariogenic and erosive potential]. / Percepções e atitudes de responsáveis por crianças frente ao uso de medicamentos infantis e sua relação com cárie e erosão dentária.

The study assesses the perceptions of parents/guardians on the use of pediatric medicines and their cariogenic/erosive potential, interviewing them on the relationship between the use of pediatric medicines and cavities/dental erosion, as well as oral hygiene procedures after the medication. Among the interviewed parents/guardians (n=86), 24 (27.9%) mentioned the sour taste of pediatric medication, 51 (59.3%) the bitter taste, and 56 (65.1%) considered them sweet, although only 16 (28.6%) of these parents/guardians brushed their children's teeth after the medication (Fisher's Exact; p>0.05). Moreover, only 18 (20.9%) of the parents/guardians performed oral hygiene practices after the medication, of whom 8 (44.4%) received previous instructions (Fisher's Exact; p<0.05). The association between taking medications and dental caries or structural dental defects was mentioned by 61 (70.9%) of the parents/guardians, with 24 (39.3%) of them justifying this association through the presence of sugar in the formulations. Although parents/guardians consider medicines to be sweet substances and relate their use to dental caries and tooth structure flaws, most of them do not brush their children's teeth after taking medications and are unable to establish a clear cause/effect relationship for this association.