A study from the University of São Paulo in Brazil suggests that children who regularly take anti-inflammatory medications may be at risk for dental enamel defects (DEDs), which are currently present in 20% of children worldwide.
The effects of celecoxib and indomethacin, non-steroidal anti-inflammatory drugs (NSAIDs) categorized by the World Health Organization (WHO) as the first step on the analgesic ladder along with paracetamol, were examined by the authors of the study, who are associated with the Ribeiro Preto Dental School (FORP-USP) and School of Pharmaceutical Sciences (FCFRP-USP).
Recent years have seen a substantial increase in the number of children seeking treatment for pain, white or yellow tooth spots, dental sensitivity, and fragility, according to dentists at FORP-Dental USP's Enamel Clinic, who study and deal with these issues on a daily basis. Simple chewing may occasionally cause children's teeth to chip off or fracture. All of them are typical signs of enamel hypomineralization-related DEDs, whose etiology is not yet fully understood.
These patients' restorations are less adhesive and more prone to failure as a result of this condition which also makes the teeth more prone to caries. According to studies, they can require replacement of restorations ten times more frequently in their lifetime than individuals with healthy teeth.
The patients' ages were a coincidence that intrigued the researchers' interest the most. Illness is frequent throughout the early years of life when DEDs occur and is frequently accompanied by a high temperature.
According to Francisco de Paula-Silva, professor in the pediatric department at FORP-USP and the article's final author, "These diseases are typically treated with NSAIDs, which inhibit the activity of cyclooxygenase [COX, a key inflammatory enzyme] and reduce the production of prostaglandin [which also promotes inflammation]. However, COX and prostaglandin are known to be physiological for dental enamel, and we, therefore, wondered whether these drugs interfered in the normal formation of this structure."
Rats were chosen as the experimental animal because of their continuously growing incisors, which makes analysis easier. After 28 days of celecoxib and indomethacin therapy, there were almost no alterations in the rats' teeth that could be seen with the naked eye. However, the researchers discovered that the teeth cracked more easily when they started removing them.
Imaging and chemical analysis indicated that enamel mineralization had been impacted. Low mineral density and below-normal calcium and phosphate levels were seen in the teeth, both of which are crucial for the development of dental enamel.
The cause for this was later determined to be a change in proteins needed for the mineralization and cellular differentiation, which demonstrated that the medications had really changed the makeup of dental enamel.
“Right now, the study at least offers us a clue to the identity of a new player that may be involved in the development of DEDs. Hitherto we've been totally in the dark. We only achieved these important findings thanks to the efforts of FORP-USP's Dental Enamel Clinic and collaboration with Lúcia Helena Faccioli, a professor at FCFRP-USP. She made a crucial contribution to our understanding of the role played by lipidic mediators related to inflammatory diseases that affect teeth." says Francisco de Paula-Silva, Professor, FORP-USP's Pediatric Department.
"We're going to analyze the medical history of the children with DEDs and their use of these drugs, and we'll set up a clinical study that will correlate the two datasets to see if the same thing happens to humans. If so, we can make recommendations on which drugs shouldn't be used for which patients. We can also help work out an appropriate treatment protocol in the future," said Paula-Silva.
A further issue that has to be addressed is the indiscriminate use of over-the-counter medications. Although specific data on this is not yet available, it appears that this issue has gotten worse as pediatric care has become more widespread.
Source: Scientific Reports