Hidden Sugar

Now that we are deep into the middle of winter, we are spending more time inside with a lot of sick people.  Flu season is an all-encompassing term to mean that we are probably going to get sick.  We take all the necessary precautions: flu shot, hand washing, and cloistering ourselves away from  the visibly ill.  However, the sickness gets us and take us down.  For adults, we tough it out. Down the magic pills to stop the runny noses, coughs, sore throats, sneezing, and anything else the sickness decides to give us.  There is medicine available for every imaginable symptom.

Children have the same available options in liquid form with flavors like bubble gum, grape, cherry, berry, and even cotton candy.  Anything to get the medicine in their little bodies to help fight the illness and make them better faster.  And while the medicine does work, there is a hidden factor that makes children susceptible to tooth decay.  SUGAR!  "A spoonful of sugar helps the medicine go down."

And what a spoonful it is.  Take liquid Children's Acetaminophen (aka Tylenol), for every 5ml, there is 2.5 grams of sugar.  And the dose for a 8 year old contains 5 grams of sugar, over 1 teaspoon.  If you following the dosing instructions, a child would receive almost 25 grams of sugar throughout the course of a day, in addition to food consumption.

Fortunately, colds and flus are temporary and so is the medicine children take for them.  But it's not just acetaminophen or ibuprofen.  What about those who require medication on a daily basis in liquid form? Liquid Antibiotics, Steroids, and most other liquid medications have sugar, commonly in the form of high fructose corn syrup. When these are taken daily and several times a day, a person is at higher risk to develop cavities.  Mainly because people don't think about the medicine they take as candy and take appropriate action. 

According to the latest JADA article: Sugar content, cariogenicity, and dental concerns with commonly used medications by Mark Donaldson BSP, RPH, PharmD, FASHP, FACHE
Some physicians may not be aware that frequently used medications with high sugar content can have a high cariogenic risk. We found over 50 commonly used oral liquid medications to contain varying amounts of sugar, up to 4 g per dose (usually 1 teaspoon or 5 mL). Patients who are required to take multiple doses per day of these sugar-containing oral liquid medications because of swallowing issues may be at the highest risk for drug-induced cariogenicity and associated oral health consequences. Although alternative sweeteners such as sorbitol and xylitol are increasingly common in medicinal preparations in lieu of sucrose,⁵x5Rudenko, A.W. Prevention of hygiene-related oral disorders. in: D. Krinsky, R. Berardi, S. Ferreri, (Eds.) Handbook of Nonprescription Drugs. 17th ed. American Pharmacists Association, Washington, DC; 2012See all References5 some of these noncariogenic sweeteners, such as saccharin, aspartame, and cyclamate, have a bitter or metallic taste.⁶x6Riera, C.E., Vogel, H., Simon, S.A., and Ie Coutre, J. Artificial sweeteners and salts producing a metallic taste sensation activate TRPV1 receptors. Am Physiol Regul lntegr Comp Physiol. 2007; 293: R626–R634CrossRef | PubMed | Scopus (50)See all References6 Regardless, OHCPs (oral health care providers) may want to consider suggesting sugarless or alternative-sweetener–containing oral liquid preparations if they are available for patients who present with these iatrogenic findings. In lieu of commercially available alternatives, compounding pharmacies are an excellent resource for creating nonsugar-containing oral liquid medications. Patients should also be counseled to rinse their mouths with water or brush their teeth after each dose of these medications to help mitigate cariogenic risk.


Be conscience of the medicine consumed and treat liquid medication like candy.