Valley Health Magazine

By Jill Throckmorton, RDH & Sylvia Caruso, RDH

When you are thirsty what do you reach for? Coke? Gatorade? Water? There are hundreds of beverages to choose from, but there is a lot you need to know about these drinks if you want to make healthy choices to protect your teeth.

The consumption of carbonated beverages, sports drinks, energy drinks and fruit drinks has increased 500% in the past 50 years, according to The Journal of Contemporary Dental Practice. Americans now drink more than 50 gallons of flavored beverages per person per year, surpassing all other beverages, including coffee, milk, alcohol, and bottled water.

We know that carbonated beverages are packed with sugar and sugar feeds the bacteria in our mouths that cause dental decay. Decay is a bacterial disease, and it isn’t the only thing that destroys tooth surfaces. Acids are also added to most beverages and are a huge hidden factor in the destruction of teeth through erosion.

Dental erosion is defined as the wearing away of the tooth surface by acid. Erosion is not only caused by acidic things we eat or drink, such as flavored drinks, vinegar products, fruits, and pickles, but can also be caused by acid reflux or eating disorders such as bulimia nervosa (frequent vomiting).

Having a dry mouth, brushing teeth incorrectly and grinding teeth make matters worse. Although we may not be able to control all the causes and contributing factors of erosion, we can control what we drink.

CAUSES OF EROSION

Acids are added to beverages to improve flavor and tartness. Soft beverages— sports drinks, energy drinks and juice drinks—contain many different quantities and kinds of acids. Carbonic acid, citric acid, malic acid, and phosphoric acid are the most common acids found in beverages. Carbonic acid alone does not contribute much to dental erosion, but combined with phosphoric acid, malic acid, and citric acid, a strong acid cocktail is created that changes the pH of the mouth (the measure of the acidity or alkalinity of a solution). Solutions above 7.0 are considered alkaline and solutions under 7.0 are acidic. In a healthy individual, the mouth maintains a neutral pH of 7.0. However, when acidic drinks are introduced, the pH drops below neutral to destructive levels.

Tooth dentin (the root and inside portion of tooth) begins to dissolve at a pH of 6.5, and enamel (the outside covering of the tooth and the hardest most mineralized substance in the human body) dissolves at a pH of 5.5. Most soft drinks, sports drinks, energy drinks, and juices have a pH between 2.3 and 4.0, well below the neutral point. †Diet sodas are also a concern because even though they do not have added sugar, the pH level is still between 3.0-3.7, which can still erode the teeth.

The pH of flavored beverages is not all we need to know in order to make smart choices. †According to dental experts, we also need to consider the total number of acid molecules, known as titratable acids (TA). The greater the TA, the longer it will take for the saliva to bring the pH of the mouth back to neutral. This means that even though sport and energy drinks aren’t as acidic as carbonated drinks in terms of pH level, the mouth stays acidic longer, which can destroy enamel at a much faster rate.

Acid, carbonation, and caffeine in beverages can encourage GERD (gastro-esophageal reflux disease) or acid reflux. Acid reflux is a common condition that affects 7% of adults on a daily basis and 36% of adults once a month. Acid reflux can force stomach (hydrochloric) acids up into the esophagus and mouth. Stomach acid has a pH of 1.5-2.0 and can sit on the teeth and in the esophagus for hours†causing severe erosion of both. So not only are your teeth exposed to acids while drinking certain beverages, they can be exposed to an even stronger acid hours later while sleeping due to acid reflux.

Over 300 prescription medications can cause dry mouth and people who suffer from dry mouth are much more susceptible to acid erosion. Normal amounts of saliva are necessary to neutralize acids quickly, but if saliva has been minimized, the teeth will be exposed to acids much longer. If the mouth is dry, the pH level can take twice as long to return to normal, doubling the time acids have to work on the teeth. Because having a dry mouth can be uncomfortable, many people with dry mouth sip on flavored beverages or suck on hard candy throughout the day to keep their mouth moist. Unfortunately, this keeps the teeth in a continual acid bath, contributing not only to erosion, but to rapid, severe dental decay.

PREVENTION
Once the enamel or dentin has been eroded, it cannot repair itself. Therefore, it is important to take steps to protect the teeth before excessive damage occurs.†Early diagnosis by your dentist is crucial in determining the cause and treatment for dental erosion. Dental restorations (fillings) may be needed to reinforce the remaining tooth structures. Unfortunately, it is very difficult to determine whether dental erosion is caused by foods and drinks, acid reflux, or a combination of both. Because of this, your dentist may feel it is necessary to refer you to a medical specialist if he or she suspects that erosion is related to acid reflux or other gastric problems.

It is also important to limit the number and length of exposures to acidic beverages. The biggest problem with flavored drinks is that we sip them over long periods of time rather than drinking them down quickly (as we do with water). Each time we put sugar or acid in our mouths, we expose our teeth to at least 20 minutes of acid. If you have only one sip, you will have 20 minutes of acid exposure before your saliva can neutralize it. Likewise, if you have one sip every 5 minutes for an hour, you will have one hour and 20 minutes of acid exposure. Imagine the length of acid exposure to those who drink 48-ounce sodas two or three times a day. 
The amount of flavored drinks children consume goes up every year. According to The Journal of Contemporary Dental Practice, 40 percent of pre-school children drink eight ounces of flavored beverages every day and the average teenager drinks 21-28 ounces a day. Children’s teeth are more porous, and consequently more susceptible to erosion. In addition, acid-damaged teeth are more susceptible to tooth decay, which is the most common childhood disease in America.

Here are some things you can do to protect yourself and your teeth:

• Limit your exposure. If you have already had an acidic drink such as orange juice for breakfast or a sport drink for lunch, opt for water for the rest of the day.
• Drinking beverages through a straw will minimize contact with the teeth.
• Chew gum sweetened with xylitol (instead of other sugars). Chewing helps produce saliva that raises the oral pH level more quickly and neutralizes acids faster. Xylitol can also actually kill decay-causing bacteria.
• Request fluoride treatments at your dentist’s office and use toothpastes and mouth rinses containing fluoride.
• Do not brush your teeth for one hour after consuming an acidic beverage. The enamel is at its weakest and most susceptible to toothbrush abrasion (notching and wear along the gum line) right after acid exposure.
• Swish with water with a pinch of baking soda immediately after drinking an acidic beverage. Baking soda is alkaline and can help neutralize acids more quickly.
• If you suffer from dry mouth, stay away from sipping on flavored beverages and sucking on hard candies (remember, tart = citric acid). Instead, sip on water and use moisturizing gels or sprays designed for dry mouth. Salivary flow can also be stimulated with chewing sugar-free gum, preferably with xylitol as the sweetener.
• Consider custom-made fluoride trays designed by your dentist that can be worn at night for those individuals with severe erosion or acid reflux. The fluoride will strengthen the enamel and reduce sensitivity; the trays will hold the fluoride in place and act as a barrier if acids come up from the stomach during the night.
• The best beverage choices for healthy teeth are water, tea and milk. If you must have a flavored beverage, choose root beer, which is the least erosive
Think about what you are putting in your mouth. Are the drinks you are choosing filled with acids and sugars? Are you drinking them too often? Do you already have the signs and symptoms of acid erosion?

If you do have signs of erosion, make healthier beverage choices (water is always best) and see your dentist regularly. Your dentist can help you protect your teeth from further damage and restore the damage already done, bringing back your healthy smile!