Acidic drinks and foods can be very hard on our teeth. Even and especially if you brush your teeth well. Lucerne dentist Jürg Eppenberger shows ways out of the dilemma.
What exactly is tooth erosion?
Jürg Eppenberger *: The recurring effect of acids on tooth surfaces leads to the gradual destruction of teeth. Dentistry defines erosion as the destruction of teeth without the influence of caries. Substances that cause erosion are erosive.
How should we imagine this erosion?
Eppenberger: Acids have the power to soften and ultimately destroy tooth enamel, the hardest substance in the human body. Acids in the mouth soften the tooth surfaces. They are no longer sufficiently stable in the long term. Grinding and brushing the teeth then damages the teeth because the tooth surface is abraded too much.
Isn't a certain amount of tooth wear a normal process?
Eppenberger: Yes, in the course of life it is natural. The only question is how quickly and to what extent it wears away. Today we already see 30-year-olds who have pain when eating because all the enamel has been used up!
Yet it is always said that today's young people generally have very good teeth and little tooth decay.
Eppenberger: We have effectively achieved excellent results in Switzerland with our globally unique prophylactic measures. Many people have healthy teeth without fillings. But this can also be deceptive, because in modern society we now have to protect healthy teeth from acids, otherwise they won't last a lifetime despite being caries-free. It is already assumed that in Switzerland, as in other European countries, around 30 percent of the population have teeth with significant erosion damage. That's a lot!
Are acids a bigger problem today than they used to be?
Eppenberger: Yes, because there are more healthy tooth surfaces in the mouth today, but on the one hand we consume a lot more acidic foods and drinks. Many contain acids that are often not perceived as acidic, as they also contain a lot of sugar. The habit of repeatedly consuming such drinks in between meals and thus repeatedly exposing our teeth to acids is one problem. Another is stomach acid regurgitation, which occurs 5 times more frequently today than it did 30 years ago.
Does stomach acid destroy teeth?
Eppenberger: Yes, it is very aggressive and typically destroys the surfaces of the teeth on the tongue, palate and chewing surfaces. The eructation often occurs after eating or when lying down, i.e. at night, when saliva production, which could dilute the acid, is reduced.
What can those affected do?
Eppenberger: If you suffer from regular acid regurgitation, a general medical examination should be carried out, also because stomach acid can cause cancer in the oesophagus. There are also illnesses such as bulimia or anorexia in which those affected vomit regularly. It is essential that they receive medical and dental care.
The acidity of a food can be measured with the so-called pH value. Is there a value above which it becomes problematic?
Eppenberger: For a long time, foods with a pH value of less than 5.7 were classified as tooth-dissolving. Today we know that the pH value cannot be used as the sole indicator of the danger of a drink or food. Fortunately, proteins, calcium or other substances that are added to drinks or food can neutralize the acids and make them harmless. Yoghurt, for example, is safe despite having a pH of 4, even with a lemon flavor, because yoghurt contains a lot of calcium.
Is it best not to consume harmful foods and drinks?
Eppenberger: In principle, yes, or at least only rarely. A declaration of all acidic drinks would make sense in terms of health policy. This would make it easier to raise awareness of the dangers of tooth erosion.
It is probably unrealistic to give up beloved drinks altogether. What could a more practical approach to acidic foods and drinks look like?
Eppenberger: Basically, everyone should make an effort to know whether their favorite foods or drinks are acidic and could soften their teeth. The ingredients are listed on the food packaging. Secondly, it is important to consume acidic drinks or foods as few times a day as possible.
What do you mean by as rarely as possible?
Eppenberger: A maximum of twice a day. It is important to swallow acidic drinks quickly and immediately and not to pull them through your teeth or leave them in your mouth for a long time. Thirdly: Do not drink acidic drinks before going to bed and at night. Fourthly: Only drink unflavored mineral water - lemon mineral water is very erosive! - and no sports drinks during sport, and never suck lemon slices. Fifthly, it makes sense to eat acidic foods together with dairy products, such as fruit salad with quark or fruit juice with buttermilk or natural yoghurt with fruit without added sugar, etc.
What about brushing your teeth when they have been softened by the acid? When should you brush?
Eppenberger: Your question really brings the problem to light. After an "acid attack", the tooth surfaces are softened within around four minutes. That is very fast. If you brush your teeth afterwards, you also brush away softened tooth surfaces. However, we all know that brushing your teeth is necessary, otherwise tooth decay or gingivitis will develop. If acids are involved, we have a dilemma. But there are two ways out.
Namely?
Eppenberger: Before consuming acidic drinks or food, clean your teeth with a soft toothbrush or sonic toothbrush and a slightly abrasive toothpaste containing fluoride and tin (according to a study by the University of Bern, Elmex Erosion Protection in the purple packaging, for example, is suitable). Or rinse with water immediately after consuming acidic drinks or food. Water helps! If you want to do it really well, rinse with rinsing solutions containing tin and fluoride (see box).
Or simply wait half an hour to brush your teeth.
Eppenberger: That doesn't help. It takes hours or even days for the softened enamel to regain sufficient protection against abrasion. In the event of vomiting or acid regurgitation, however, you should wait before brushing your teeth. This is because stomach acid that gets into the mouth attacks the enamel very severely. It is better to rinse your mouth immediately with water or milk and brush your teeth later.
How do you recognize if your teeth are damaged by acid?
Eppenberger: Regular dental check-ups are important because specialists can detect damage at an early stage and take preventive measures. You may discover yellow stains on the surface of your teeth or fillings that appear too large and protrude beyond the surface of your teeth. If teeth become sensitive when eating - not only with cold food - the damage is often already very advanced. Frayed, sharp and thin cutting edges on the front teeth in the upper jaw are an urgent warning sign.
What treatment options are there for damaged teeth?
Eppenberger: The first step is always to find out the cause of the acidity, which is often not so easy. Then you try to prevent these acid influences, also by changing your eating habits. There are also various ways of protecting or reconstructing the affected teeth.
What exactly?
Eppenberger: This depends on the severity, age and needs of the patient. The aim is to grind the tooth surfaces as little as possible. Very small defects are sealed with plastic. For larger defects, tooth-colored composite fillings can prevent further loss of tooth surface. If several surfaces per tooth are affected, ceramic or porcelain can also be used to rebuild the tooth substance lost due to acid. In the case of very extensive defects, which are fortunately very rare, crowns may also be necessary. Early detection and early prevention are therefore important.
What softens teeth? What does not?
Acidic drinks soften the tooth surfaces:
- Soft drinks such as Coca Cola, Fanta, Ice Tea, Pepsi, Orangina, Rivella, Sprite, Schwepps etc.
- Sports drinks such as Gatorade, Powerade, Isostar.
- Energy drinks such as Red Bull etc.
- Fruit juices such as apple juice, grapefruit juice, orange juice, multivitamin juice.
- Alcoholic drinks such as Bacardi, Breezer, Smirnoff, wine, sparkling wine.
- Various items such as fruit teas, vinegar, ready-made salad dressings, apple sauce, apricots, fruit.
Drinks without tooth attack
- Soft drinks: Natural mineral water, sparkling or still
- Sports drinks: Perform
- Fruit juices: fruit juices containing CPP-ACP
- Alcoholic beverages: Beer
- Dairy products: Milk, sour milk, all yogurt.
Acid damage: how to prevent it
Suggestions from Prof. Adrian Lussi from the Ten Medicine Clinic at the University of Bern.
- Reduce your consumption of acidic foods and limit it to a few main meals.
- Drink drinks quickly and do not pull them through your teeth. Avoid sipping.
- Immediately after consuming acid, rinse with water or ideally with rinsing solutions containing stannous fluoride. The best thing after an energy drink is a big gulp of water. It costs nothing and is easily available even on a long party night. Water helps!
- Tooth-friendly chewing gum to stimulate salivation.
- Use calcium-enriched drinks or foods.
- Before consuming acid, clean your teeth gently with a soft toothbrush or sonic toothbrush with a toothpaste containing fluoride and tin.
Author: Dr. med. dent. Jürg Eppenberger
Published in: Zentralschweiz am Sonntag on August 16, 2015