Common anti-inflammatory drugs may be ruining kids' teeth

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Enamel hypomineralisation: Study points to anti‑inflammatory drugs commonly used in children

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As many as 20% of children worldwide are estimated to suffer from dental enamel defects, a poorly understood condition that researchers in Brazil think may be linked to anti-inflammatory drugs. (Image: BeautifulPicture/Shutterstock)

SÃO PAULO, Brazil: Dental enamel defects (DEDs) are estimated to affect around 20% of children worldwide, and instances such as the fracturing of children’s teeth as a result of mastication are of great concern to clinicians. A recent study conducted by researchers at the University of São Paulo has found that anti-inflammatory drugs commonly prescribed to children may be associated with the poorly understood condition.

Researchers from the Ribeirão Preto Dental School and School of Pharmaceutical Sciences at the university studied the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on the biomineralisation of enamel in male mice. Extracted teeth that had been treated with the NSAIDs celecoxib and indomethacin for a period of 28 days were found to have decreased levels of calcium and phosphate and lower mineral density, and they fractured more easily. Crucially, the researchers found in the teeth alterations in the proteins that are important for enamel biomineralisation and cellular differentiation. The findings, the researchers wrote, alluded to the possibility that NSAIDs may have a causal effect in the development of DEDs.

“Hitherto we’ve been totally in the dark” – Dr Francisco Paula-Silva, University of São Paulo

An article by the São Paulo Research Foundation about the research noted that the researchers’ curiosity had been piqued by the fact that DEDs occur within the first years of life, when sickness and high fever are frequent. “These diseases are typically treated with NSAIDs, which inhibit the activity of cyclooxygenase [COX] and reduce production of prostaglandin,” corresponding author Dr Francisco Paula-Silva, an associate professor of paediatric dentistry at the university, told the foundation. “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,” he added.

“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,” Dr Paula-Silva said.

The researchers now plan to conduct a clinical study in order to confirm the results. “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,” Dr Paula-Silva told the foundation.

The study, titled “Enamel biomineralization under the effects of indomethacin and celecoxib non-steroidal anti-inflammatory drugs”, was published online in Scientific Reports on 22 September 2022, ahead of inclusion in an issue.

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