· By Sarah Hensley
The Top Causes of Tooth Decay and How to Prevent Tooth Erosion
Beyonce’s Master Cleanse diet using her “Master Cleanse lemonade”, Kourtney Kardashian’s “special detox water” or any of a dozen celebrity green juice and smoothie recipes (vogue.com.au), what do they have in common?
The advocates can usually afford excellent dental care to rebuild the enamel that will inevitably be lost if too much acidic fruit juice is consumed.
There is evidence that tooth erosion is becoming more common, particularly affecting the younger generations due to either greater consumption of soft drinks or health conscious sports/energy drinks and fruit juice/smoothie drinking.
Some studies show adolescents and young adults are drinking nearly 1 litre per person per day of acidic beverages. In a UK dental survey of 1308 children at 12 years old 5% showed tooth erosion and when re-examined 2 years later 13% showed deep erosive lesions in enamel. In addition we see more people moving to a vegan and vegetarian diet, great for general health and the planet(!), however not so good for teeth. In a study looking at raw food diet there was considerably greater erosion when compared to a control population, likely due to greater fruit intake.
I once had an executive of a well-know cola company in my chair and they said that their cola brand had a similar acidity to fruit juice. I hadn’t really thought too much about this before as we all remember the experiment at school where you put a lost baby-tooth in cola and watch it dissolve over the following days, but what would happen if it was apple or lemon juice in water? Everyone knows that cola is bad for your teeth both from acidity and sugar content but less appreciate the potential damage that fruit juice and smoothies can cause.
Gradually the outer enamel layer is stripped away, thinning the teeth, making them sensitive and causing the thin edges of the teeth to chip away. The effects are often most noticeable on the front teeth as they are most closely associated with the acidic juice but can also impact the back teeth too.
So what are the main culprits that cause tooth decay?
Firstly let's consider the main culprits in tooth erosion. This is usually from either acid consumed in the forms of fruit juices and smoothies, carbonated sodas or vinegars (including the on-trend apple cider vinegar!). Alternatively acids from the gut can erode teeth and this can be from reflux, GERD or even excessive morning sickness to eating disorders. Tooth enamel starts to dissolve away when the pH is lower than 5.5. In general, the lower the pH and more often the exposure the more enamel will be lost.
Typical pH of common drinks:
Pepsi cola 2.4
Apple juice 3.4
Carrot juice 4.2
Orange juice 3.7
Flavoured mineral water 3.3
Vitamin C fizzy tab 3.9
Rosehip tea 3.2
French salad dressing 4.0
However it is not purely the acidity that demonstrates the risks of tooth erosion. Slowly sipping on drinks and swishing it around the mouth increases the acidic impact as it increases the exposure time and new acid is continuously renewed by new sips.
How Temperature Affects Tooth Erosion
Temperature also has an effect. If the same acidic beverage is consumed at a higher temperature compared to a room or refrigerated temperature the high temperature solution will be more destructive. Some fruit tea drinks can be very damaging.
Often our mainstay when we become aware of a problem with our teeth is understandably to reach for the toothbrush. Unfortunately when acid has been on the surface of enamel it softens the surface and subsurface of the tooth. The toothbrush and in particular toothpastes (some are worse than others!) cause greater abrasion of the enamel. Studies have looked at how long should you wait to brush your teeth after acid exposure but even waiting an hour there was still significant effect of surface loss as the enamel hadn’t fully rehardened!
Does When You Brush Your Teeth Affect Tooth Erosion?
This brings up the debate of when should you brush your teeth in the morning. My answer is always it depends on what you are having for breakfast- if you are having something acidic like fresh fruit then best to brush before breakfast, if it’s plain porridge or toast then cleaning after breakfast is fine!
Do Mouth Rinses and Mouthwashes help?
So if you’re not reaching for your toothbrush then what about mouth rinses? Pontefract et al (2001) looked at a number of mouth rinses to measure enamel erosion and found Listerine (pH 3.6) caused significant erosion. This was supported in other studies that recommended avoiding acidic mouth rinses as a pre-rinse before toothbrushing or after erosive challenges such as fruit juices.
How to Prevent Tooth Decay
Dentists have limited options to recommend to their patients that show erosion but obviously want to maintain healthy lifestyles. Limiting the frequency of intake is crucial, rinsing with water after consumption to try and neutralize and limit acidity. There is some research to suggest using a straw to avoid contact with the front teeth, however, it is questionable whether it is feasible to position the straw in such a way to enjoy a beverage and avoid tooth damage- after all despite all the above in this article it is important to enjoy life too!
Further it was just this experience that led us to invent Dr. Heff’s Remarkable Mints. My wife had found her enamel was eroding away after making her own green juices (yes she can consider this too as she has a husband as a dentist albeit as a dentophobic she dreaded the idea of sitting in the dentist chair).
Hence the concept of a mint you can enjoy after an acidic challenge that contains green tea extract that acts as a protease inhibitor so maintains the collagen of teeth that are undergoing an erosive challenge, allowing remineralisation to occur. Dr Heff’s Remarkable Mints have scientific evidence from dental school at the University of Illinois to show how remineralisation can occur on eroded teeth and Toothfriendly tested patients and found immediate neutralization of acid on teeth, maybe a better alternative than gagging on a straw?