According to research from University of Sao Paulo, anti-inflammatory medications commonly taken by children could contribute to dental enamel defects (DEDs).
The team specifically investigated the side effects of celecoxib and indomethacin, non-steroidal anti-inflammatory drugs (NSAIDs). The World Health Organization (WHO) categorises them alongside paracetamol as “the first step on the analgesic ladder”.
The authors, who are affiliated with Ribeirão Preto Dental School (FORP-USP) and School of Pharmaceutical Sciences (FCFRP-USP), had noticed a sharp rise in children seeking treatment at their Dental Enamel Clinic. They observed increases in treatment for pain, white or yellow tooth spots, and dental sensitivity and fragility, all classic symptoms of DEDs.
Reflecting on the rise, clinicians noticed that the patients had one thing in common – their age.
In childhood, sicknesses and fevers are frequent. Francisco de Paula-Silva, a professor in FORP-USP’s Pediatric Department explains, “These diseases are typically treated with NSAIDs, which inhibit the activity of cyclooxygenase [COX, a key inflammatory enzyme] and reduce 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.”
To test their hypothesis the researchers treated rats with celecoxib and indomethacin for 28 days. Although there were no differences to the naked eye, upon extraction they found that the teeth fractured more easily.
Further imaging revealed that dental mineralisation had been affected. Below-normal levels of calcium and phosphate were noted, and mineral density was low.
“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,” said Francisco. “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.”
Francisco commented, “We’re going to analyse 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 future.”