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THINK BEFORE YOU DRINK
Recently doctors and hygienists in dental offices around the country are seeing a spike in the number of patients who present for check ups with worn layers of enamel or “dental erosion”. This newsletter is to help our patients and their friends become aware of routine daily activities such as consuming acidic foods, beverages, and medications; swimming in chlorinated pools that may be the culprits and advise you about prevention strategies.
What exactly is “erosion?”
Dental erosion is caused by the weakening of the outer mineralized layer of the tooth. This weakening results in the removal of tooth structure that cannot be reversed. Erosion is one of the leading factors contributing to tooth sensitivity and decay. Understanding and avoiding these factors is crucial because often erosion is not recognized until the irreversible damage is complete. A neutral pH level in the mouth can range from 6.75 to 7.25. Tooth structure begins to soften and demineralize when the pH levels fall between 6.0 and 5.5. The lower the pH level, the higher the acidity level, thus, when people consume foods and beverages with high acidity, their risk of erosion increases. Patients who have recession are also at greater risk of erosion because cementum (the outer layer of exposed root surface) is softer to begin with than enamel.
In addition to the PH level, there is another factor that determines how long your teeth are exposed. That is the “titratable acidity” (TA) of the specific product. This is the time needed after consumption for the decreased pH level to return to the resting level. For example, the starting pH of Red Bull Energy Drink was the highest out of the four, meaning it was the least acidic, but it had the highest TA level and created the most erosion damage.
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A Comparison of PH and TA Levels in Four Beverages |
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Drink |
PH |
TA |
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Coca Cola Classic |
2.49 |
18.3 |
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Diet Coke |
3.12 |
20.1 |
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Gatorade |
3.12 |
14.8 |
|
Red Bull |
3.41 |
51.9 |
Exposure Time Matters
The number of times a day you are exposed to the acids is important because the more exposure, the higher the risk of erosion So if you keep that can of diet soda on your desk all day or drink your sports drink intermittently over the entire baseball game, you are increasing the risk. Some researchers suggest drinking through a straw may decrease the risk.
Sports and Energy Drinks
Sports and Energy Drinks, flavored waters are contributors to erosion. However, the inclusion of calcium, fluoride, or phosphorous at the time of the acid exposure may reduce the risk of erosion, One study examined enamel erosion using a sports drink containing calcium, and compared it to a commercial sports drink and water. The results demonstrated great promise. On the reverse side, when calcium was not present in the traditional sports drink, the expected outcome erosion damage occurred.
Given the flavorless taste of water and the attraction to bottled water, there are several alternatives available including a wide range of flavored waters. Although flavored water may appeal to the taste buds, some products pose the same risks. Reading the label of flavored water is essential for protecting teeth. Many of the flavored waters contain citric acid or some other form of acid to create a pleasant and desirable taste. The pH levels of many flavored waters range from 2.74 to 3.34. The perception among consumers that flavored water is as harmless to teeth as unflavored water is false.
Alcoholic Beverages
All alcoholic beverages can cause erosion if consumed frequently enough, but one of the greatest concerns is wine consumption. The pH levels of wine range from 2.3 to 3.8; beer pH levels range from 4.0 to 5.0. When an acidic beverage is consumed with food, the risk of erosion is decreased because some foods, such as proteins or fats, offer a neutralizing mechanism to the tooth surface and stimulate salivary flow. The risk of erosion increases when an acidic beverage is consumed without food and over time. This puts leisurely wine drinkers and professional wine tasters at high risk. Wine tasters may sample wines several times a day and hold the wine in their mouths for up to a minute at a time making their risk of erosion significant.
Medications & Illness
Whether it is long or short term, the illness itself may result in reduced salivary flow, vomiting and/or acid reflux disease. On top of that, medications taken during the illness cause may dry mouth and when patients are medically compromised, they tend to postpone dental care both at home and their routine office visits.
Various prescription medications and asthma inhalers can create a highly acidic environment. Over-the-counter products such as chewable vitamin C tablets, aspirin and cough drops are culprits as well. One analysis of various pediatric medications found that many contained large amounts of sugar in addition to low pH levels and high TA levels.
Acidity in the Environment
Swimming can pose an environmental risk of dental erosion. A healthy and balanced pool has an average water pH of 7.5. If the water is over-chlorinated, the pH level could be less than 3.0. Given that most swimmers take in mouthfuls of water during the duration of their time in the pool, the water pH level in swimming pools could contribute to erosion of tooth structure.
Certain acidity in air quality can put people at risk. For example battery manufacturers and galvanizing workers are at risk of erosion due to their daily occupational exposure to acid.
A Word About Tooth Whitening Products
Although most professionally supervised whitening agents are safe, there is no regulation of the over-the-counter products. Therefore some are highly acidic and damaging. The use of fluoride while whitening considered a good preventive measure. Studies demonstrated a reduction in harm to enamel structure when fluoride was part of the whitening product
A Summary of Preventive Measures
- Do not to brush for at least 30 minutes after an acid exposure. This includes drinking acidic beverages, eating acidic fruit, vomiting, swimming, etc.
- Swish with unflavored water after acid exposure to decrease pH level
- Consume your low PH beverages at once, with meals or through a straw.
- Drink plain water, it is great for your body as well as your teeth.
- Be sure swimming pools are not over-chlorinated.
- Visit the dentist regularly for erosion evaluation
- Fluoride treatments are helpful for patients with frequent exposures to an acidic environment.
- Eat food when consuming alcoholic beverages to neutralize the acids
- Read labels and be on the lookout for “citric” or other acids as an ingredient
- Use professional or professionally approved whitening products and consider the concurrent use of fluoride.
With your increased awareness about the significant risks posed by some drinks, foods, and behaviors, in addition to professional care and calcium phosphate technologies you can continue to enjoy most of your favorite foods, beverages and activities.
Have a great day!
Dr. Marks and Your Dental Team
ph: 814-234-0329 - email: drmarks@the611dentist.com