Antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs) may interfere with enamel formation, leading to thinner, weaker teeth, according to a review recently published in the International Dental Journal.
Furthermore, exposure to antibiotics and NSAIDs may be linked to changes in enamel-forming cells and disruptions in enamel mineralization, the authors wrote.
“This review demonstrates that antibiotics and anti-inflammatory medications can influence enamel development in animal models,” wrote the authors, led by Nadia Zamri of the South West Hospital and Health Service in Australia (Int Dent J, March 12, 2026, Vol. 76:3, 109478).
The review sought to evaluate how commonly prescribed antibiotics and NSAIDs taken by children under age 5 affect enamel development. A literature search of electronic databases was conducted for relevant studies published between 1995 and 2024, the authors wrote.
Both in vitro and in vivo experimental studies examining these medications during tooth development were included. Quantitative meta-analysis focused on in vivo animal studies with comparable data on enamel thickness or mineral content, while in vitro studies were used to explore underlying mechanisms. Ultimately, 12 studies were reviewed, analyzing the effects of NSAIDs, acetaminophen, and various antibiotics on enamel formation and mineralization.
Several studies examined how amoxicillin affects enamel formation during the secretory and early mineralization stages of amelogenesis, with early studies showing that higher doses led to more pronounced enamel matrix alterations in rats. Also, experimental exposure to antibiotics and NSAIDs was linked to changes in ameloblast morphology and function, including altered protein expression, reduced cell height, disrupted polarization, and the formation of abnormal multicellular layers with deficient enamel production, they wrote.
Additionally, structural enamel defects, such as vacuolar changes and cystlike lesions, were frequently observed. Quantitative analysis showed a moderate to large reduction in enamel thickness associated with amoxicillin exposure (Cohen’s d = 0.79, 95% confidence interval: 0.40 to 1.36), with stronger effects at higher doses.
Additional research, including a study on ampicillin and gentamicin, found decreased enamel volume and mineral density, while NSAIDs such as celecoxib and indomethacin impaired key proteins, reducing calcium and phosphorus levels and weakening enamel’s structure.
Nevertheless, the review had limitations. There was significant variability across the studies in factors such as dosing and timing of exposure, administration methods, and how outcomes were measured, the authors added.
“Improved understanding of the interactions between pharmacological exposures and dental development may ultimately inform safer therapeutic approaches and preventive strategies,” Zamri and colleagues concluded.
