Background <p>Pediatric liquid medicines are indispensable and widely used in childhood disease management, but often contain fermentable sugars and acidic excipients that may increase the risk of dental caries and tooth erosion. This study conducted a physicochemical evaluation of pediatric liquid medicines marketed in Ghana to determine their potential contribution to dental caries and tooth erosion, conditions associated with acidic and sugar-containing formulations.</p> Methods <p>Thirty pediatric liquid medicines across six therapeutic classes (analgesics, antitussives, antihistamines, antibiotics, antimalarials, and non-steroidal anti-inflammatory drugs) were analysed. Physicochemical parameters assessed included pH, total titratable acidity (TTA; % citric acid equivalents), sucrose content (%), and total soluble solids content (TSSC; °Brix). All analyses were performed in triplicate, and comparisons across therapeutic classes were conducted using one-way analysis of variance (ANOVA) followed by post hoc multiple comparison tests, with statistical significance set at <i>p</i> &lt; 0.05.</p> Results <p>The pH of the medicines ranged from 2.76 to 7.57, with 70% below the critical enamel demineralisation threshold (pH 5.5). TTA varied from 0.01% to 1.66%, with antibiotics and non-steroidal anti-inflammatory drugs exhibiting the highest mean values. Sucrose content ranged from 0.0% to 75.6%, with 43.3% of products exceeding the 10% cariogenic threshold. TSSC values ranged from 4.2°Brix to 61.8°Brix, with several formulations exceeding the high-risk threshold of 30°Brix. Comparative analyses revealed no statistically significant differences in pH (<i>p</i> = 0.130), TTA (<i>p</i> = 0.063), or sucrose content (<i>p</i> = 0.952) across therapeutic classes. However, a statistically significant difference was observed for TSSC (<i>p</i> = 0.010), indicating variability in overall soluble solid concentration among the therapeutic categories. Antitussives and NSAIDs showed the highest overall erosive potential, while antihistamines and non-steroidal anti-inflammatory drugs demonstrated elevated cariogenic risk. Locally manufactured products generally had higher sucrose content, whereas some imported formulations exhibited higher titratable acidity.</p> Conclusions <p>Many pediatric liquid medicines marketed in Ghana exhibit physicochemical properties that may contribute to dental caries and tooth erosion. These findings underscore the need for targeted public health interventions, including regulatory policies to limit sugar and acidity in paediatric formulations, promotion of sugar-free alternatives, and integration of oral health counselling into paediatric prescribing practices, particularly in low- and middle-income settings.</p>