According to Mary Poppins, a spoonful of sugar helps the medicine go down. However, sugar in liquid medicines is a factor in dental caries for many children. In fact, over half of the spoonful in some liquid medicines is sugar. There has been an increase in the availability of sugar-free medicines in recent years, but they need to be prescribed specifically, because most generic liquid medicines still contain sugar. Patients that could be on liquid medications include chronically ill children, frail elderly and adults with special needs. Children with chronic conditions such as epilepsy could require liquid medication for a long time. Frequent liquid medications could also be taken for a number of reasons including analgesia, infections and coughs and colds.
When checking the medical histories for patients and there is evidence of liquid medication then dental practitioners are encouraged to check in the British National Formulary if sugar-free alternatives are available and to write to the patient’s general practitioners to encourage them to prescribe sugar-free versions. Recent research shows that of all prescriptions for Amoxicillin Oral Suspension one third were not sugar-free specified. Where patients are on long-term or extended use of liquid medications dentists should monitor their oral health more frequently, and recall periods should be shortened accordingly. Higher risk groups of adults and children can be reviewed every three months and, where appropriate, fluoride varnish should be applied to the teeth. Fluoride mouthwash can also be prescribed for home use as can higher concentration fluoride toothpaste. Oral hygiene instructions should be reinforced and patients advised about avoiding food and drink one hour before bedtime and the importance of night-time brushing. Where medications do not specify that they should be taken on an empty stomach, patients should be encouraged to take them at mealtimes.