This study was carried out to assess the practice of self-medication by parents/guardians due to oral problems in their children. The main results of this study suggest that the practice of self-medication is expected and that some participants believe that self-medication does not bring any health problems for children. Thus, it is necessary to develop health promotion strategies aimed at clarifying and raising awareness of the population about the risks related to the practice of self-medication.

Although there are several studies on the practice of self-medication, most of them have been carried out in adults (Arrais et al. 2016; Loyola Filho et al. 2002). In addition, studies carried out in children and adolescents are usually not specific about self-medication for oral problems (Tarciuc et al. 2020; Telles Filho and Pereira Júnior 2013). Addressing the practice of self-medication in children is relevant because pediatric patients are recognized as a special population for drug therapy. This is due to the constant physiological and anatomical changes that occur during childhood, impacting the pharmacokinetics and dynamics of compounds (Batchelor and Marriott 2015). In this sense, the drug dose to be administered to pediatric patients should be adjusted to provide similar internal exposure and pharmacodynamic effects (Batchelor and Marriott 2015). Thus, performing self-medication in children is extremely dangerous, regardless of the purpose, since child intoxication due to medicines can compromise the functioning of organs and generate sequelae (Moraes et al. 2013).

In this study, a small portion of participants reported being in favor of the self-medication of children for oral problems. In a study carried out in a pediatric emergency care center, there was a frequency of 67.2% of parents/guardians in favor of self-medication of children (Nogueira et al. 2015), which is higher than that observed in the present study. The specific circumstances of each study can explain these discrepancies. Research participants by Nogueira et al. (2015) were accompanying their children in an emergency room, in which patients usually have painful symptoms. Therefore, there is a greater probability that parents/guardians have already self-medicated their children prior to the dental appointment and observed symptoms relief.

In the present study, a frequency of 32.4% of self-medication was observed in children with oral problems, with a significant association between parental self-medication and self-medication in children. Other studies on the subject found higher frequencies of self-medication (Paulino et al. 2019; Thikkurissy et al. 2012). In addition, a study carried out during the COVID-19 pandemic found a frequency of self-medication higher than 70% (Sen Tunc et al. 2021). A recent study using Google Trends showed an increase in the number of global self-medication searches since the pandemic's beginning (Onchonga 2020). Since the present study was partially conducted during the COVID-19 pandemic, it is possible that the use of self-medication observed could also be influenced by the pandemic.

On the other hand, a Brazilian study evaluating self-medication in children and pre-adolescents found a frequency of self-medication of 20.9% (De Lima et al. 2016). However, it should be noted that this study assessed patterns of self-medication for dental infections. Furthermore, studies on self-medication for general health problems in children found frequencies ranging between 6.6% (Arrais et al. 2016) and 70% (Tarciuc et al. 2020). Comparisons should be made with caution, as these are studies evaluating the practice of self-medication in other contexts.

Some studies have argued that the practice of self-medication can be influenced by different factors, such as age, gender, education, monthly income and accessibility to the health system (Loyola Filho et al. 2002; Brlić et al. 2014). In the present study, there was a significant association between lower monthly income and parental self-medication and being in favor of self-medication in children. Still, there was no association between the practice of self-medication in children and the gender, educational level and monthly income of the participants, corroborating data from other studies (Pereira et al. 2007; Nogueira et al. 2015; Paulino et al. 2019).

Symptoms of tooth eruption, toothache and traumatic cold sore/ulcer were the leading causes for the practice of self-medication in children. In this sense, the temporary relief of pain was the primary motivator for the practice of self-medication. These findings are similar to other studies that showed that toothache is the main trigger for self-medication in children (Paulino et al. 2019; Sen Tunc et al. 2021). Traumatic cold sore/ulcer also causes painful sensation (Johnston et al. 2022), leading to negative impacts on children and adolescents' oral health-related quality of life (Gherunpong et al. 2004). Tooth eruption symptoms can also cause reactions in children; therefore, parents concerned about the symptoms end up self-medicating their children. On the other hand, a study found that non-pharmacological methods such as teething rings, cuddle therapy and rubbing the gums effectively improved tooth eruption symptoms (Memarpour et al. 2015).

Analgesics were the drugs most frequently used in the practice of self-medication in children, as found in other studies (Stolbizer et al. 2018; Paulino et al. 2019; Bhattarai et al. 2020; Sen Tunc et al. 2021). Accessibility, exemption from using a prescription and low cost can facilitate the use of analgesics. Many parents/guardians believe that these drugs are not toxic or bring little harm to health (Sen Tunc et al. 2021). However, studies point to analgesics as one of the main causes of intoxication in children aged zero to five years (Maior et al. 2017; Matos et al. 2002; Pereira et al. 2013). Hommez et al. (2018) showed that patients treated at the emergency dental service had a high risk of analgesic overdose and patients' lack of knowledge of the maximum daily dose was identified as one of the reasons for overdose.

Anesthetics and anti-inflammatory drugs have also been indicated as the drugs of choice for self-medication in children. A study showed that Ibuprofen or Paracetamol were the most recommended medicines to relieve tooth eruption symptoms (Thompson and Huntington 2019). Paulino et al. (2019) observed that the use of topical anesthetics and anti-inflammatory drugs were chosen for pain relief, but less frequently than analgesics. According to the study by Plutzer et al. (2012), mothers who received information about symptoms commonly associated with tooth eruption and ways to manage them were less likely to use topical and oral medicines and relied more on non-pharmacological techniques, such as rubbing the gums to relieve discomfort. In xxxx, since 2010, antibiotics are only available with a medical prescription, which makes it more difficult to obtain this medicine. This is reflected in the study since only three participants reported the use of antibiotics in the children, being all of them reused leftover antibiotics.

Self-medication can be carried out through the acquisition of medicines without a prescription, the sharing of medicines, the reuse of leftover medicines and the use of old prescriptions (Pereira et al. 2007). In this study, the choice of medicines was mainly based on the recommendation of family members, and many parents/guardians stated that they had already used previous prescriptions. Sen Tunc et al. (2021) found a frequency of 67.7% of parents/guardians who reported the use of medicines previously prescribed for their children and also evidenced the practice of self-medication based on advice from close relatives and pharmacists. This finding was attributed to the difficulty in accessing health services during the COVID-19 pandemic (Sen Tunc et al. 2021), which may also have occurred in the present study. Other studies confirm the reuse of old prescriptions for self-medication and highlight that this occurs more frequently in children under seven years of age (Beckhauser et al. 2010; Telles Filho and Pereira Júnior 2013).

This study has some limitations that should be recognized. The cross-sectional nature of the study made it impossible to assess causality. Also, the convenience sample limits the extrapolation of results to the general population, impacting the generalisability of the study. Therefore, it is important to carry out further studies with larger/representative samples to assess self-medication for oral problems in children.

Despite these limitations, the results of this study are original and relevant, indicating that the practice of self-medication in children is common. Therefore, dentists and health professionals must instruct parents/guardians about the risks of self-medication during appointments. Informational brochures with accessible language can be made available at basic health units, offices, pharmacies, and on the internet. In addition, these results can serve as data to aid in the implementation of public policies to prevent self-medication and to avoid harmful consequences to children.