244 zyxwvutsrqponm Journal of Public Health Dentistry z Pediatricians’ Percetltion about the Use of Antibiotics and Dental Caries-a Pielirninary Study zyx Vivlane Santos da Silva Pierro, DDS; Roberta Barcelos, DDS, MSD; Lucianne Cople Maia, DDS, MSD, PhD; Andrea Neiva da Silva, DDS Abstract zyxwvutsrq Objectives: zyxwvutsrqp This study aimed to evaluate pediatricians’ perception about the use of antibiotics and dental caries. Methods: One hundred pretested question- naires containing open and closed questions were distributed to pediatricians from public hospitals in Rio de Janeiro, Brazil. Results: The response rate was 60 percent. Considering the respondents, 73.3 percent frequently prescribed antibiotics, oral administration being the chosen mode (93.3%). Antibiotics were pointed out as being very sweet substances by 53.3 percent of the pediatricians. However, the samepercentage did not know what sweetener was responsiblefor the sweet flavor, and just 40.6 percent recommended oral hygiene after the medicine’s intake. Among the pediatricians, 56.7 percent related the use of antibiotics to the occurrence of dental effects, and 40 percent thought that antibiotics could cause a defect of tooth structure. Only one pediatrician (3.2%) associated thepresence of fermentable carbohydrates in the composition of these medicines with dental caries. Conclusions: Pediatricians in this study did not perceive the correct relationship between the presence of fermentable carbohy- drates in antibiotics and dental caries. Many of them believed these medicines promoted a defect of tooth structure favoring the development of dental caries. Further studies with a larger sample are necessary. [J Public Health Dent 2004;64(4):244-48] Key Words:pediatrics, antibiotics, sweetening agents, dental caries, oral health. Dental caries is a localized disease resulting from localized bacterial ac- tivity of the indigenous oral micro- biota (1). Part of this microbiota is ca- pable of adhering to tooth surface, leading to dental biofilm formation. In the presence of fermentable carbohy- drates such as sucrose and glucose, the bacteria present in the biofilm produce acids as products of their metabolism, which cause a drop in pH to levels at which there is dissolution of the min- eral componentsof the tooth, a process called demineralization (2). With an increase in pH, the inverse process zyxwvut oc- curs-remineralization, in which there is a reprecipitation of mineral in the damaged area. Thus, the carious process is the dynamic de- and remin- eralizing process, which over time may result in a net loss of mineral and subsequently may possibly, but not always, lead to cavitation (3,4). Therefore, as the dental biofilm is the determinant etiologic factor of dental caries, a decreased intake of norunilk extrinsic sugars (5) and ade- quate and systematic cleaning of the teeth are effectivemethods for control- zyxw ling zyxwvut this disease (1). However, it seems to be part of human culture to accept that, at some point in life, losing one’s teeth is a natural process; in zyxw this con- text, dental caries is not seen as a pre- ventable or controllable disease (6). In Brazil, one observes that many parents and guardians associate the developmentof carious lesions in their children’s teeth with the excessive consumption of certain antibiotic medications, which they believe pro- mote “defects of the tooth structure” (7). In fact, the presence of sucrose in these medicines has been related to an increase in the prevalence of dental caries among children (8-17), although some studies have demonstrated that the use of antibiotics promoted a de- cline in caries experience (18,19). The relationship between antibiot- ics and dental caries involves various factors. Among the most widely de- scribed factors in literature are the presence of sucrose in these medi- cines’formulations (15,ZO); the low pH of some formulations (21-23);high vis- cosity of liquid medications for oral intake (15,24); lack of oral hygiene af- ter medication’s intake (24); and fre- quency of intake of these liquid pedi- atric formulations (22,23,25)-empha- sizing the regular use by children with chronic diseases such as cardiopa- thies, asthma, recurring otitis media, and infection of the upper respiratory tract (15,2026). On the other hand, studies that reported reductions in dental caries with antibiotic therapy jushfy this observation based on the anticariogenicpotential of antistrepto- cocci antibiotics (18J9). Although pharmacists are in an ideal position to influence the supply of medicines (27), parents have an in- nate reluctance to “interfere” in what they see as a medical decision (28). Considering that pediatricians are those mainly responsible for pediatric prescriptions and also for the supply of information to parents, this study evaluated the perception of these pro- fessionals about the use of antibiotics and the occurrence of dental caries in order to provide an overview of their influence on children’s consumption of sugared antibiotics. Methodology This study was carried out in the pediatric services of public hospitalsin the state of Rio de Janeiro, Brazil, Send correspondenceand reprint requests to Dr. Pierro, R PresidenteJolo Pessoa, 263/904, Icarai, Niterbi, Rio de Janeiro,Brazil 24.220-330. E-mail: vivigus@hol.conbr. Drs. Pierro and Maia are with the School of Dentisfry, Federal University of Rio de Janeiro. Dr. Barcelos is with the Salgado de Oliveira University, Rio de Janeiro. Dr. Neiva is with the Federal Fluminense University, Rio de Janeiro. This paper was presented to the SBPqO (IADR Brazilian Division), Sept 2001, in So Paulo, Brazil. Manuscript received: 8/22/03; returned to authors for revision:10/17/03; final version accepted for publication: 3/23/04.