Sugar-containing paediatric medicines can contribute to the aetiology of dental caries, and as many are sold over-the-counter (OTC) as are prescribed. This study evaluated a dental health education initiative among pharmacists in the north-west of England in an effort to increase the sales of sugar-free preparations. It also investigated the stocks they held, their recommendations to their customers and their knowledge of, and attitudes to, sugar in medicine as a cause of dental caries. Following a baseline questionnaire, a randomly selected group of pharmacists were sent a dental health education leaflet informing them of the role of sugar-containing medicines in the aetiology of dental caries and a list of sugar-free alternatives which they were asked to stock and recommend. Twelve months later, a second questionnaire was completed by both the test and control groups of pharmacists. The most commonly stocked and recommended OTC paediatric medicines contained sugar. Of the 14 preparations stocked by over 90% of the pharmacists only two were sugar-free. During the year of the study the mean number of sugar-free medicines stocked by the pharmacists in the test group reduced from 7.70 to 7.12 (P < 0.05) and in the control group from 8.39 to 7.45 (P < 0.05). Seventy-seven per cent of the pharmacists thought that sugar in medicines could contribute to caries, but recommended sugar-containing preparations more frequently than sugar-free alternatives. The dental profession needs to actively promote medicines that are sugar-free if there is to be a change from the use of iatrogenic sugar-containing preparations.