Turkiye Klinikleri Journal of Pediatrics

.: REVIEW
The Effects of Drugs Used by Children with Chronic Systemic Diseases on the Oral Cavity: Traditional Review
Kronik Sistemik Hastalığı Olan Çocukların Kullandığı İlaçların Oral Kavite Üzerindeki Etkileri: Geleneksel Derleme
Özge BEKTAŞa
aProgram of Oral and Dental Health, İstanbul Gelişim University Vocational School of Health Service, İstanbul, Türkiye
Turkiye Klinikleri J Pediatr. 2023;32(3):135-43
doi: 10.5336/pediatr.2023-95235
Article Language: EN
Full Text
ABSTRACT
 Children with chronic diseases are prescribed various drugs by pediatricians. In children with chronic systemic disease, daily use of pediatric liquid form medications may be routine. Drugs such as analgesics, antibiotics, antihistamines, antiepileptics, multivitamins and antitussives are chronically prescribed to children. Sweeteners and sugars are added to make the flavors of the drugs prescribed by pediatricians in suspension forms acceptable to pediatric patients. The high sugars such as sucrose and glucose in the content of these drugs cause the dissolution of tooth enamel by lowering the pH of the dental biofilm as a result of bacterial fermentation. These drugs can cause tooth erosion due to their acidic properties and reducing saliva flow as a side effect. In addition to their corrosive and cariogenic properties, pediatric drugs also have side effects such as periodontal disease, changing orthodontic tooth movement, decreasing or increasing saliva flow, and causing tooth discoloration. Various recommendations can be made to parents, dentists and pharmaceutical companies in terms of preventive measures related to chronic drug use. In children with chronic drug use, rinsing the mouth with water after taking these drugs may not be enough to prevent tooth damage. Regular topical fluoride applications and the addition of calcium, fluoride or phosphate to drug formulations can be recommended for these patients as reduce the risk of dental caries and erosion. The aim of this review is to evaluate the effects of frequently used drugs on oral and dental health in pediatric patients based on current literature research.

Keywords: Child; drug; chronic disease; oral health
ÖZET
 Kronik hastalıkları olan çocuklara pediatristler tarafından çeşitli ilaçlar reçete edilmektedir. Kronik sistemik hastalığı olan çocuklarda günlük olarak pediatrik sıvı formdaki ilaçların kullanımı bir rutin olabilir. Analjezikler, antibiyotikler, antihistaminikler, antiepileptikler, multivitaminler ve antitusifler gibi ilaçlar kronik olarak çocuklara reçete edilmektedir. Pediatristlerin süspansiyon formlarda reçete ettikleri ilaçların tatlarının kabul edilmesi ve çocuk hastalar tarafından daha rahat kullanılması için içerisine etken maddelerin dışında tatlandırıcılar ve şekerler eklenmektedir. Bu ilaçların içeriğindeki yüksek sükroz ve glikoz gibi şekerler, bakteriyel fermantasyonun bir sonucu olarak diş biyofilminin pH'sini düşürerek diş minesinin çözünmesine neden olmaktadır. Bu ilaçlar asidik özellikleri ve yan etki olarak tükürük akışını azaltması nedeniyle diş erozyonuna yol açabilir. Pediatrik ilaçların aşındırıcı ve karyojenik özelliklerinin yanı sıra periodontal hastalık, ortodontik diş hareketini değiştirme, tükürük akışını azaltma veya artırma, dişlerde renklenmelere neden olma gibi yan etkileri de vardır. Kronik ilaç kullanımı ile ilgili önleyici tedbirler açısından ebeveynlere, diş hekimlerine ve ilaç firmalarına çeşitli önerilerde bulunulabilir. Kronik ilaç kullanımı olan çocuklarda bu ilaçlar alındıktan sonra ağzın suyla çalkalanması diş hasarını önlemede yeterli olmayabilir. Diş çürüğü ve erozyon riskini azaltmak için bu hastalara düzenli topikal florür uygulamaları ve ilaç formülasyonlarına kalsiyum, florür veya fosfat eklenmesi önerilebilir. Bu derlemenin amacı, güncel literatür araştırmalarına dayanarak çocuk hastalarda sık kullanılan ilaçların ağız ve diş sağlığına etkilerini değerlendirmektir.

Anahtar Kelimeler: Çocuk; ilaç; kronik hastalık; ağız sağlığı
REFERENCES:
  1. Sangeetha K, Sagar B, Reddy V, Chour R, Talathi R, Shilpa S. Effects of different children health drinks on stainability of anterior tooth colored restorative materials-an in vitro study. J Pediatr Dent. 2015;3(3):92-6. [Crossref] 
  2. Pani SC, Alenazi FM, Alotain AM, Alanazi HD, Alasmari AS. Extrinsic tooth staining potential of high dose and sustained release iron syrups on primary teeth. BMC Oral Health. 2015;15:90. [Crossref]  [PubMed]  [PMC] 
  3. Mistry P, Batchelor H; SPaeDD-UK project (Smart Paediatric Drug Development - UK). Evidence of acceptability of oral paediatric medicines: a review. J Pharm Pharmacol. 2017;69(4):361-76. [Crossref]  [PubMed] 
  4. Nirmala SV, Popuri VD, Chilamakuri S, Nuvvula S, Veluru S, Minor Babu MS. Oral health concerns with sweetened medicaments: Pediatricians' acuity. J Int Soc Prev Community Dent. 2015;5(1):35-9. [Crossref]  [PubMed]  [PMC] 
  5. Passos IA, Sampaio FC, Martínez CR, Freitas CH. Sucrose concentration and pH in liquid oral pediatric medicines of long-term use for children. Rev Panam Salud Publica. 2010;27(2):132-7. [Crossref]  [PubMed] 
  6. Babu KL, Doddamani GM, Naik LR, Jagadeesh KN. Pediatric liquid medicaments - Are they cariogenic? An in vitro study. J Int Soc Prev Community Dent. 2014;4(2):108-12. [Crossref]  [PubMed]  [PMC] 
  7. Brigic A, Kobaslija S, Zukanovic A. Cariogenic potential of inhaled antiasthmatic drugs. Med Arch. 2015;69(4):247-50. [Crossref]  [PubMed]  [PMC] 
  8. Al-Majed I, Maguire A, Murray JJ. Risk factors for dental erosion in 5-6 year old and 12-14 year old boys in Saudi Arabia. Community Dent Oral Epidemiol. 2002;30(1):38-46. [Crossref]  [PubMed] 
  9. Babu KL, Rai K, Hedge AM. Pediatric liquid medicaments--do they erode the teeth surface? An in vitro study: part I. J Clin Pediatr Dent. 2008;32(3):189-94. [Crossref]  [PubMed] 
  10. Scatena C, de Mesquita-Guimarães KSF, Galafassi D, Palma-Dibb RG, Borsatto MC, Serra MC. Effects of a potentially erosive antiasthmatic medicine on the enamel and dentin of primary teeth: An in situ study. Microsc Res Tech. 2018;81(9):1077-83. [Crossref]  [PubMed] 
  11. Low IM, Duraman N, Mahmood U. Mapping the structure, composition and mechanical properties of human teeth. Mater Sci Eng C. 2008;28(2):243-7. [Crossref] 
  12. Costa CC, Almeida IC, Costa Filho LC. Erosive effect of an antihistamine-containing syrup on primary enamel and its reduction by fluoride dentifrice. Int J Paediatr Dent. 2006;16(3):174-80. [Crossref]  [PubMed] 
  13. Evans WE, McLeod HL. Pharmacogenomics--drug disposition, drug targets, and side effects. N Engl J Med. 2003;348(6):538-49. [Crossref]  [PubMed] 
  14. Adcock KG, Hogan SM. Extrinsic iron staining in infant teeth from iron-fortified formula and rice cereal. J Pediatr Pharmacol Ther. 2008;13(3):162-5. [Crossref]  [PubMed]  [PMC] 
  15. Iron fortification of infant formulas. American Academy of Pediatrics. Committee on Nutrition. Pediatrics. 1999;104(1 Pt 1):119-23. [Crossref]  [PubMed] 
  16. Pasdar N, Alaghehmand H, Mottaghi F, Tavassoli M. Experimental study of iron and multivitamin drops on enamel microhardness of primary tooth. J Int Soc Prev Community Dent. 2015;5(6):518-24. [Crossref]  [PubMed]  [PMC] 
  17. James PM, Parfitt GJ. Local effects of certain medicaments on the teeth. Br Med J. 1953;2(4848):1252-3. [Crossref]  [PubMed]  [PMC] 
  18. Hekmatfar S, Piraneh H, Jafari K. Evaluation of the relationship between pH and titrable acidity of five different of iron supplements with the absorption of iron ions in the anterior primary teeth (an in vitro study). Dent Res J (Isfahan). 2018;15(5):367-71. [Crossref]  [PubMed]  [PMC] 
  19. Martinhon CC, Italiani Fde M, Padilha Pde M, Bijella MF, Delbem AC, Buzalaf MA. Effect of iron on bovine enamel and on the composition of the dental biofilm formed "in situ". Arch Oral Biol. 2006;51(6):471-5. [Crossref]  [PubMed] 
  20. Hamasha AA, Zawaideh FI, Al-Hadithy RT. Risk indicators associated with dental erosion among Jordanian school children aged 12-14 years of age. Int J Paediatr Dent. 2014;24(1):56-68. [Crossref]  [PubMed] 
  21. Sales-Peres SH, Pessan JP, Buzalaf MA. Effect of an iron mouthrinse on enamel and dentine erosion subjected or not to abrasion: an in situ/ex vivo study. Arch Oral Biol. 2007;52(2):128-32. [Crossref]  [PubMed] 
  22. Başak ZB. Erken çocukluk döneminde kullanılan vitamin ve demir preparatlarının eroziv etkilerinin değerlendirilmesi [Doktora Tezi]. Ankara: Gazi Üniversitesi; 2013. [Link] 
  23. Pushpanjali K, Khanal SS, Niraula SR. The relationship of dental extrinsic stains with the concentration of trace elements in water sources in a district of Nepal. Oral Health Prev Dent. 2004;2(1):33-7. [PubMed] 
  24. Miguel JC, Bowen WH, Pearson SK. Influence of iron alone or with fluoride on caries development in desalivated and intact rats. Caries Res. 1997;31(3):244-8. [Crossref]  [PubMed] 
  25. Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;342(5):314-9. [Crossref]  [PubMed] 
  26. Hadjiloizou SM, Bourgeois BF. Antiepileptic drug treatment in children. Expert Rev Neurother. 2007;7(2):179-93. [Crossref]  [PubMed] 
  27. Iapadre G, Balagura G, Zagaroli L, Striano P, Verrotti A. Pharmacokinetics and drug interaction of antiepileptic drugs in children and adolescents. Paediatr Drugs. 2018;20(5):429-53. [Crossref]  [PubMed] 
  28. Jacobsen PE, Henriksen TB, Haubek D, Ostergaard JR. Developmental enamel defects in children prenatally exposed to anti-epileptic drugs. PLoS One. 2013;8(3):e58213. [Crossref]  [PubMed]  [PMC] 
  29. Jacobsen PE, Henriksen TB, Haubek D, Østergaard JR. Prenatal exposure to antiepileptic drugs and dental agenesis. PLoS One. 2014;9(1):e84420. [Crossref]  [PubMed]  [PMC] 
  30. Patil RB, Urs P, Kiran S, Bargale SD. Global developmental delay with sodium valproate-induced gingival hyperplasia. BMJ Case Rep. 2014;2014:bcr2013200672. [Crossref]  [PubMed]  [PMC] 
  31. Joshi NH, Deshpande AN, Deshpande NC, Rathore AS. Comparative evaluation of oral hygiene status and gingival enlargement among epileptic and healthy children as related to various antiepileptic drugs. J Indian Soc Periodontol. 2017;21(2):125-9. [Crossref]  [PubMed]  [PMC] 
  32. Nayyar AS, Khan M, Vijayalakshmi KR, Suman B, Subhas GT, Nataraju B, et al. Phenytoin, folic acid and gingival enlargement: Breaking myths. Contemp Clin Dent. 2014;5(1):59-66. [Crossref]  [PubMed]  [PMC] 
  33. Rocha S, Ferraz R, Prudêncio C, Fernandes MH, Costa-Rodrigues J. Differential effects of antiepileptic drugs on human bone cells. J Cell Physiol. 2019;234(11):19691-701. [Crossref]  [PubMed] 
  34. Burrow SJ, Sammon PJ, Tuncay OC. Effects of diazepam on orthodontic tooth movement and alveolar bone cAMP levels in cats. Am J Orthod Dentofacial Orthop. 1986;90(2):102-5. [Crossref]  [PubMed] 
  35. Kumandas S, Koklu E, Gümüs H, Koklu S, Kurtoglu S, Karakukcu M, et al. Effect of carbamezapine and valproic acid on bone mineral density, IGF-I and IGFBP-3. J Pediatr Endocrinol Metab. 2023;19(4):529-34. [Crossref]  [PubMed] 
  36. Akhoundi MSA, Sheikhzadeh S, Mirhashemi A, Ansari E, Kheirandish Y, Allaedini M, et al. Decreased bone density induced by antiepileptic drugs can cause accelerated orthodontic tooth movement in male Wistar rats. Int Orthod. 2018;16(1):73-81. [Crossref]  [PubMed] 
  37. Tan H, Gürbüz T, Dağsuyu IM. Gingival enlargement in children treated with antiepileptics. J Child Neurol. 2004;19(12):958-63. [Crossref]  [PubMed] 
  38. Craig TJ, Richardson MA, Pass R, Haugland G. Impairment of the gag reflex in schizophrenic inpatients. Compr Psychiatry. 1983;24(6):514-20. [Crossref]  [PubMed] 
  39. Friedlander AH, Friedlander IK, Marder SR. Bipolar I disorder: psychopathology, medical management and dental implications. J Am Dent Assoc. 2002;133(9):1209-17. [Crossref]  [PubMed] 
  40. Clark DC. Dental care for the patient with schizophrenia. Can J Dent Hyg. 2008;42(1):17-24.
  41. Günay S, Sarıaydın M, Yılmaz Demirci N. KOAH tedavisinde yeni bronkodilatörler ve Kombinasyonları [New bronchodilators and combinations in COPD treatment]. Tuberk Toraks. 2016;64(3):240-5. Turkish. [Crossref]  [PubMed] 
  42. Browne GJ, Penna AS, Phung X, Soo M. Randomised trial of intravenous salbutamol in early management of acute severe asthma in children. Lancet. 1997;349(9048):301-5. [Crossref]  [PubMed] 
  43. Carhuamaca-Salvador M, Bustos de la Cruz J, Chávez-Rimache L, Chumpitaz-Cerrate V. Riesgo de caries dental en pacientes pediátricos asmáticos en tratamiento con la terapia inhalatoria de salbutamol y budesonida, Perú []Risk of dental caries in pediatric asthmatic patients undergoing treatment with salbutamol and budesonide inhalation therapy, Peru.]]. Rev Fac Cien Med Univ Nac Cordoba. 2019;76(4):222-6. Spanish. [Crossref]  [PubMed] 
  44. Taşkın M, Hazar Bodrumlu E. Astım hastalığı ve çocuklarda ağız diş sağlığı [Asthma and oral health in children]. J Int Dent Sci. 2017;2(1):1-4. [Crossref] 
  45. Chellaih P, Sivadas G, Chintu S, Vaishnavi Vedam VK, Arunachalam R, Sarsu M. Effect of anti-asthmatic drugs on dental health: A comparative study. J Pharm Bioallied Sci. 2016;8(Suppl 1):S77-S80. [Crossref]  [PubMed]  [PMC] 
  46. Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald JM, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J. 2008;31(1):143-78. Erratum in: Eur Respir J. 2018;51(2). [PubMed] 
  47. Scatena C, Galafassi D, Gomes-Silva JM, Borsatto MC, Serra MC. In vitro erosive effect of pediatric medicines on deciduous tooth enamel. Braz Dent J. 2014;25(1):22-7. [Crossref]  [PubMed] 
  48. Paganini M, Dezan CC, Bichaco TR, de Andrade FB, Neto AC, Fernandes KB. Dental caries status and salivary properties of asthmatic children and adolescents. Int J Paediatr Dent. 2011;21(3):185-91. [Crossref]  [PubMed] 
  49. Guergolette RP, Dezan CC, Frossard WT, Ferreira FB, Cerci Neto A, Fernandes KB. Prevalence of developmental defects of enamel in children and adolescents with asthma. J Bras Pneumol. 2009;35(4):295-300. English, Portuguese. [Crossref]  [PubMed] 
  50. Janson C, Chinn S, Jarvis D, Burney P. Physician-diagnosed asthma and drug utilization in the European Community Respiratory Health Survey. Eur Respir J. 1997;10(8):1795-802. [Crossref]  [PubMed] 
  51. Hobbins S, Chapple IL, Sapey E, Stockley RA. Is periodontitis a comorbidity of COPD or can associations be explained by shared risk factors/behaviors? Int J Chron Obstruct Pulmon Dis. 2017;12:1339-49. [Crossref]  [PubMed]  [PMC] 
  52. Lopez-de-Andrés A, Vazquez-Vazquez L, Martinez-Huedo MA, Hernández-Barrera V, Jimenez-Trujillo I, Tapias-Ledesma MA, et al. Is COPD associated with periodontal disease? A population-based study in Spain. Int J Chron Obstruct Pulmon Dis. 2018;13:3435-45. [Crossref]  [PubMed]  [PMC] 
  53. Wu FY, Liu JF. Asthma medication increases dental caries among children in Taiwan: An analysis using the National Health Insurance Research Database. J Dent Sci. 2019;14(4):413-8. [Crossref]  [PubMed]  [PMC] 
  54. Chumpitaz-Cerrate V, Bellido-Meza JA, Chávez-Rimache L, Rodríguez-Vargas C. Impact of inhaler use on dental caries in asthma pediatrics patients: A case-control study. Arch Argent Pediatr. 2020;118(1):38-46. English, Spanish. [Crossref]  [PubMed] 
  55. Yaghobee S, Paknejad M, Khorsand A. Association between asthma and periodontal disease. Front Dent. 2008;5(2):47-51. [Link] 
  56. GINA 2019: a fundamental change in asthma management. Updated 2019. Erişim tarihi: 28.12.2023 Erişim linki: [Link] 
  57. Karaman D, Kara K, Durukan İ. Çocuk ve ergen psikiyatrisi polikliniğine başvuran hastalara tedavi uygulamaları [Treatment practices for patients applying to the child and adolescent psychiatry outpatient clinic]. Anatol J Clin Investig. 2012;6(4):225-30. [Link] 
  58. Kumar M, Chandu GN, Shafiulla MD. Oral health status and treatment needs in institutionalized psychiatric patients: one year descriptive cross sectional study. Indian J Dent Res. 2006;17(4):171-7. [Crossref]  [PubMed] 
  59. Gurbuz O, Altinbas K, Kurt E. Psikiyatrik hastalarda ağız sağlığı [Oral health in psychiatric patients]. Curr Approaches Psychiatry. 2011;3(4):628-46. [Crossref] 
  60. Fitzsimons R, van der Poel LA, Thornhill W, du Toit G, Shah N, Brough HA. Antihistamine use in children. Arch Dis Child Educ Pract Ed. 2015;100(3):122-31. [Crossref]  [PubMed] 
  61. Del Cuvillo A, Sastre J, Montoro J, Jáuregui I, Ferrer M, Dávila I, et al. Use of antihistamines in pediatrics. J Investig Allergol Clin Immunol. 2007;17 Suppl 2:28-40. [PubMed] 
  62. Hellwig E, Lussi A. Oral hygiene products, medications and drugs - hidden aetiological factors for dental erosion. Monogr Oral Sci. 2014;25:155-62. [Crossref]  [PubMed] 
  63. Neves BG, Farah A, Lucas E, de Sousa VP, Maia LC. Are paediatric medicines risk factors for dental caries and dental erosion? Community Dent Health. 2010;27(1):46-51. [PubMed] 
  64. Cavalcanti AL, de Oliveira KF, Xavier AF, Pinto DS, Vieira FF. Evaluation of total soluble solids content (TSSC) and endogenous pH in antimicrobials of pediatric use. Indian J Dent Res. 2013;24(4):498-501. [Crossref]  [PubMed] 
  65. Hartling L, Ali S, Dryden DM, Chordiya P, Johnson DW, Plint AC, et al. How safe are common analgesics for the treatment of acute pain for children? A systematic review. Pain Res Manag. 2016;2016:5346819. [Crossref]  [PubMed]  [PMC] 
  66. Brislin RP, Rose JB. Pediatric acute pain management. Anesthesiol Clin North Am. 2005;23(4):789-814, x. [Crossref]  [PubMed] 
  67. Maguire A, Baqir W, Nunn JH. Are sugars-free medicines more erosive than sugars-containing medicines? An in vitro study of paediatric medicines with prolonged oral clearance used regularly and long-term by children. Int J Paediatr Dent. 2007;17(4):231-8. [Crossref]  [PubMed] 
  68. Xavier AF, Moura EF, Azevedo WF, Vieira FF, Abreu MH, Cavalcanti AL. Erosive and cariogenicity potential of pediatric drugs: study of physicochemical parameters. BMC Oral Health. 2013;13:71. [Crossref]  [PubMed]  [PMC] 
  69. Saeed S, Bshara N, Trak J, Mahmoud G. An in vitro analysis of the cariogenic and erosive potential of pediatric liquid analgesics. J Indian Soc Pedod Prev Dent. 2015;33(2):143-6. [Crossref]  [PubMed] 
  70. Nazifova A, Georgieva G, Milkov M. The effect of nutrients on oral dental health. Scr Sci Medica. 2022;54(Suppl 1):10-2. [Crossref] 
  71. Lukaski HC. Vitamin and mineral status: effects on physical performance. Nutrition. 2004;20(7-8):632-44. [Crossref]  [PubMed] 
  72. Mittal S, Singh BP, Sharma AK, Mittal K, Justa A, Vaid P. Surface changes of primary tooth enamel by commonly used pediatric liquid medicaments: a scanning electron microscope study. J Pediatr Dent. 2017;5(1):14-20. [Crossref] 
  73. Tupalli AR, Satish B, Shetty BR, Battu S, Kumar JP, Nagaraju B. Evaluation of the erosive potential of various pediatric liquid medicaments: an in-vitro study. J Int Oral Health. 2014;6(1):59-65. [PubMed]  [PMC] 

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4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com