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Acid Attack: Soft Drinks and Tooth Erosion

Yahoo! Lifestyle: UK

Already under fire for being high in sugar, caffeine and other unhealthy substances, fizzy drinks and fruit juice are also highly acidic. If you drink them regularly thoughout the day, the acid they contain attacks tooth enamel, wearing it down and leaving teeth more sensitive(1).

Consumption of soft drinks in the UK has been steadily increasing since 2005. In 2011, the average person drank a whopping 235.3 litres(2)! This isn't as high as the European average (941 litres) or the American average (1801 litres), but sales of soft drinks continue to increase.

Acid erosion in children's teeth

With life expectancy increasing, we all need to be protecting our teeth for later in life. However, dentists are seeing a growing number of cases of tooth damage in younger patients: "Dental erosion isn't just more common – it's also appearing earlier, and often in children," Professor Colon explains. "Since 2000, many studies on the subject have appeared in international journals and most have been focused on children and adolescents. This is because acid erosion at this age is most likely to be down to lifestyle."

Some of the most recent research, published in 2010, was carried out in Iceland on 2251 children. It was shown that at the age of 12, 16% of the children had at least one tooth affected by acid erosion. At 15, this increased to 31%(3). The statistics and the teeth most likely to be affected vary from country to country. The results of different studies are also affected by age and the methods of evaluation. Overall, however, the results of research show that more and more cases of acid erosion are being observed in milk teeth, and this pattern is mirrored for adult teeth as well(1).

Unlike cavities, which penetrate more deeply, signs of erosion affect the surface of the teeth. Professor Colon explains: "These lesions start with weakening of the enamel and end up revealing the dentine (the yellowish part of the tooth), which then wears down too. In the children examined as part of the research, acid erosion mainly affected the incisors, which lost their slightly curved surface. The first molars were also flattened and had a pummelled appearance. This kind of wear is characteristic of acid erosion and charts the path of drinks through the mouth."

Acid is the main culprit

The connection between acidic drinks and erosion has long been established. Children with this kind of dental damage often drink a lot of fizzy drinks and eat acidic food(1), and it's the same story for adults. In 2011, a British study(4) estimated that adults aged between 18 and 30 who drank particularly acidic beverages had 6.5 times the risk of dental erosion.

While acid erosion is still rare in milk teeth, what's to say this won't change in ten or twenty years' time if children's habits remain the same? "When erosion affects the dentine, which is more sensitive than the enamel, lesions will develop more quickly," the specialist explains. "The teeth become hypersensitive, and there are often serious consequences for both appearance and function."

All drinks apart from water and milk contain acid. "Teeth begin to lose mineral content when they are exposed to a pH of less than 5.5," says Professor Colon. "Fizzy drinks, energy drinks, iced tea, fruit juice, flavoured water, wine and beer all have pH levels of between 2.5 (equal to lemon juice) and 4.5. The acidity isn't necessarily apparent in the taste." Note that the sugar contained in most of these drinks makes the problem worse, as it's transformed into acid by the bacteria responsible for tooth decay.

How we drink makes a difference

As Professor Colon explains, it's inevitable that our teeth will come into contact with acidic food and drinks. "It's a question of proportion. The acidity of a product, how far it can be neutralised by saliva in the mouth, and the way you consume the product all play a part, too."

Mini fruit juices, fizzy drinks and fruit yoghurts designed for small children expose teeth to acid at a young age. Kids get into the habit of choosing these drinks whenever they're thirsty during the day. When they get older, they continue to drink sugary drinks out of habit, rather than opting for bottled water or milk. Teenagers tend to drink fizzy drinks while revising for exams or watching TV. Some even take a bottle to bed with them ,as well. "People who tend to get thirsty a lot and have dry mouths - athletes and people who work in hot environments like building sites or bakeries, for example, are all likely to drink fizzy drinks and fruit juices often. However, the acidity is even more harmful in these cases, as there is less saliva in the mouth to neutralise it," Professor Colon points out. Yo-yo dieters, often women, are also more likely to consume too many diet drinks and acidic dressings like vinaigrette without realising the effects on their teeth.

How to protect your teeth from erosion

Looking at the long-term risks, many studies have concluded that there is a real need for further research into the factors that cause tooth erosion and ways of preventing it. One way this could be done is by adding protective substances to acidic soft drinks. Soft drinks manufacturers began development in this area around 20 years ago, but have been unsuccessful to date.

In the meantime, parents and fizzy drinks addicts can take certain precautions to limit damage to their teeth. Reducing how many soft drinks you consume by replacing them with still water or milk (some sparkling water is also slightly acidic) is the first, obvious way to prevent erosion.

To help neutralise the acid, Professor Colon also recommends consuming fizzy drinks and fruit juice with meals: "This means there'll be increased levels of saliva. You can also finish off your meal with protective food like dairy. Use drinking straws to limit contact with your teeth and rinse your mouth out with water. You can also chew sugar-free gum to neutralise acid. Brushing your teeth after eating will also help limit mild erosion and stop it from getting worse." It's important to see your dentist about erosion to get any damage repaired. This will protect your teeth against acid in the future and reduce sensitivity.

___ Sources:
Interview with Pierre Colon in July 2012, Professor at Paris Diderot University, clinical practitioner in restorative dentistry and endodontics at the Garanciére de Rothschild Hospital (AP-HP) in Paris. He is researching the chemistry of materials as part of the Biomaterials and Biological Interfaces team at the Multimaterials and Interfaces Laboratory UMR CNRS 5615 at Lyon I University.

1 - Taji S, Seow WK. A literature review of dental erosion in children. Aust Dent J. 2010 Dec; 55(4):358-67, available online
2 - The UK 2012 Soft Drinks Report, Zenith International, available online
3 - Arnadottir IB, Holbrook WP, Eggertsson H et al. Prevalence of dental erosion in children: a national survey. Community Dent Oral Epidemiol. 2010 Dec; 38(6):521-6, available online
4 - Bartlett DW, Fares J, Shirodaria S et al. The association of tooth wear, diet and dietary habits in adults aged 18-30 years old. J Dent. 2011 Dec; 39(12):811-6, available online

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