الفهرس 
Review of Literature
Statistical AnalysisOnly 14 pages are availabe for public view
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Abstract
The enamel of primary teeth is less mineralized than that of
permanent teeth and the density of its outermost layer is lesser. So, it is
more susceptible to erosion than permanent teeth. When children were
exposed to different acidic challenges either dietary substances or medical
syrups, their teeth were severely affected.
Erosion in primary teeth may be associated with dental
hypersensitivity, loss of the occlusal vertical dimension, poor esthetics,
pulp exposure, pain and abscesses. These problems badly affect the eating
ability of children and harm their growth and development. In addition,
the chronic administration of the acidic drugs may increase the incidence
of caries and gingivitis in children and also may have negative effect on
the integrity of dental restoration.
Accordingly, the aim of this study was to evaluate the erosive
effect of the antibiotics that were commonly prescribed by Egyptian
pediatricians on primary teeth enamel and also to determine their effect on
the integrity of dental restoration.
This study was two parts, a questionnaire and an invitro part. The
questionnaire was conducted in two hospitals in Egypt (Qena public
hospital and Aldemrdash hospital) to determine the three most commonly
prescribed antibiotics by Egyptian Pediatricians. These antibiotics were
Suprax, E-moxclav and Duricef. For this questionnaire it was concluded
that there was unwise prescription of antibiotics in Egypt and many of the
pediatricians didn‘t follow the guidelines of prescription. Patient pressure
was also a major factor for prescription. That in fact will increase the
antibiotic resistance and lead to increase rather than decrease the infection The three antibiotics were subjected to laboratory tests for
measuring their pH and titratable acidity to evaluate their acidic challenge.
pH was measured using digital pH meter while titratable acidity was
measured using special equation in the chemistry labs. The results of this
measurement showed that Suprax has the highest acidity as it has the
lowest pH and highest titratable acidity while Duricef had the lowest
acidity as it had the highest pH and the lowest titratable acidity p<0.05.
The acidity of these antibiotics is due to some inactive ingredients
which are important for chemical stability and drug dispersion. Acetic
acid is used for Suprax. Citric acid is used for Duricef while succinic acid
is used for E-moxclav. These acids are the main cause of the erosive effect
of these drugs.
In our invitro study two tests were carried out: microhardness test
and microleakage test. Microhardness test was conducted for the first 40
extracted primary teeth using Vickers hardness test, while microleakage
test was conducted for the second 40 teeth after restoring them with resin
modified glass ionomer restoration.
For group I teeth, they were cleaned using pumice-water slurry using
polishing brush at low-speed handpiece to remove any debris or calculus
deposited on to the teeth surface. Teeth roots were cut using abrasive disc
mounted in low-speed handpiece with copious water irrigation.
Specimens were mounted in the middle of acrylic mold with
buccal surface facing upward. Separating medium was painted to the ring.
specimens were fixed in the middle of the acrylic mold and the buccal
surface was faced upwards.Each crown was fixed with plastic wax in the central orifice of an
acrylic mold. The buccal surface was faced upwards. Specimens were
stabilized with red wax. The buccal enamel surface was flattened using
abrasive papers. The test site was demarcated by attaching a piece of
insulating tape with a 2mm diameter central hole. The tooth/mold sets
were rendered acid-proof by coating them with 2 layers of acid resistant
nail polish while the flattest region of the buccal surface left uncoated.
Baseline microhardness was measured using Vickers testing
machine. After the assessment of baseline microhardness, the specimens
were demounted and randomly 10 teeth in each group were allocated into
the first four subgroups. There were four subgroups, Duricef group,
Suparx group, E-moxclav group and control group. Samples were
immersed for 7, 14 and 21 days. Microhardness was measured after each
period for three times and average was taken.
The results showed that Suprax group had the highest loss in
microhardness followed by E-moxclav. Duricef group showed the lowest
reduction in microhardness. In the Control group of artificial saliva, there
was increase in enamel microhardness.
The second group of forty teeth was allocated for microleakge test.
Class I cavity was prepared at first, then the forty teeth were restored with
resin modified glass ionomer restoration (Equia fil™). Teeth were
thermocycled between 5° and 55° water bath for 250cycles. The forty
teeth were divided randomly into four subgroups for drug immersion for
14 days, then methylene blue was applied for staining. Teeth were
sectioned for examination under stereomicroscope.According to khera and chanas scoring criteria Suprax group had
score 2 while E-moxclav and Duricef group recorded score 1. Control
group with artificial saliva had score 0 which meant no leakage was
recorded for this group.
Results of this study were tabulated and showed that the antibiotics
prescribed for children decreased enamel microhardness producing dental
erosion by the time and also affected the integrity of dental restoration
producing microleakage at tooth- restoration interface which led to failure.