Wednesday, March 15, 2023

Non-steroidal anti-inflammatory drugs and risk of dental hypomineralization

Paracetamol and changes in tooth enamel:

These nonsteroidal anti-inflammatory drugs (NSAIDs) classified, like paracetamol by the World Health Organization (WHO) as first-line analgesics, can cause, children can cause alterations in the dental enamel, even a fracture of the tooth, when taken too frequently. These effects, revealed by a team from the São Paulo Research Foundation (FAPESP) and documented in Scientific Reports, call for limiting the use of certain NSAIDs in young children.

Effects on children of using analgesics:

It is precisely the use of the NSAIDs celecoxib and indomethacin that appears to be associated with dental enamel defects, effects observed in as many as 20% of children worldwide. In recent years, the dentists of the dental clinic attached to the Ribeirão Preto Dental School (FORP-USP) had observed a sharp increase in the number of children needing treatment for pain and presenting with white spots or yellow on the teeth, sensitivity and dental fragility. In some cases, simple chewing could trigger a fracture of the tooth. These observations led the team to look at the effects, in children, of the use of these analgesics.

NSAIDs and hypomineralization of tooth enamel:

Hypomineralization promotes the development of dental caries, in the form of carious lesions that are particularly difficult to restore. Studies have in fact shown that these lesions require 10 times restorations during life than “classic” caries.

The very young age of the patients has drawn the attention of researchers:

these carious lesions which form during the first years of life are generally frequent in affected children and are often accompanied by high fever. "These cavities are usually treated with NSAIDs, which inhibit cyclooxygenase (COX, a key inflammatory enzyme) activity and reduce prostaglandin production, which also promotes inflammation," says lead author Dr. Francisco de Paula-Silva, Professor of Pediatrics: "However, COX and prostaglandin are known to be involved in the formation of tooth enamel, and we therefore wondered if these drugs could interfere with normal tooth formation".

The study conducted on mice, models that have continuously growing incisors, treated with celecoxib and indomethacin for 28 days, reveals:

  • the absence of difference on the teeth visible to the naked eye,
  • but a very increased fragility on analysis after extraction: these teeth fracture more easily;
  • observation by imaging and analysis of their chemical composition suggests that dental mineralization has been affected;
  • the levels of calcium and phosphate, 2 important minerals for the formation of tooth enamel, and the mineral density are much lower than average.

What process is involved?

The researchers identify alterations in the proteins necessary for mineralization and cell differentiation and confirm that NSAIDs have indeed affected the composition of dental enamel.

A new factor in dental caries in children:

this discovery will lead to a study on the medical history of children with these carious lesions. If the relationship were confirmed, new recommendations for the use of NSAIDs could emerge, or at least new treatment protocols in children.

A result similar to that of tetracycline, an antibiotic not recommended for children because it causes tooth discoloration.