Recent trend: Soft drinks and caries

[Smilemaker100]

Hi there!

When I was reading a recent thread on the subject of acidic pH and acidogenic bacteria, I couldn't help but think about this recent trend which I have read about and actually seen in some of my patients. I am speaking of the trend among adolescent girls and young women who live on a "coke" diet to lose/control weight. But this trend (high soft drink consumption) has also been observed with increasing prevalence in children over the past 2 decades.

Coke consists of "empty calories" , however, it seems that some girls and women prefer it to nutritious meals from the major food groups as it has caffeine and somehow, they believe it helps them control their appetite. I have had two patients so far that have belonged to this group of women. They are usually young ( 18-30 years old), underweight and most IMPORTANTLY (at least from a dentist's perspective), they have carious lesions on EVERY single tooth and surface - this is no exagerration! The first time I came across a case like this, I asked the patient what her diet consisted of and she told me that she was drinking an average of 8 cans of coke a day. When I came across this young woman I had as a patient about a month ago at the hospital where I am doing my residency, who looked severly gaunt and displayed a similar pattern of carious lesions , I couldn't help but ask her how frequently she drank soft drinks...she drank about 10 or so cans of coke a day.

How many people out there have noted this trend among their patients?

Just to play devils' advocate: here are some sites that don't truly believe that soft drink consumption has a harmful effect on teeth
National Soft Drink Association
http://www.nsda.org/softdrinks/CSDHealth/csdanddental.html
http://www.britishsoftdrinks.com/htm/nw/nw-dental.htm

And here are some articles that imply the connection between heavy soft drink consumption and caries...You be the judge!!!!
http://www.agd.org/library/2003/jan/200301_soxman.html#ref8
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Text&db=PubMed&uid=14625946&dopt=Abstract
http://pediatrics.aappublications.org/cgi/content/full/113/1/152
http://www.nasn.org/positions/softdrinks.htm

http://www.cspinet.org/sodapop/liquid_candy.htm

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[UBTom]

Oy. Somebody ought to tell those girls that they are supposed to be drinking DIET Coke.

I love the original Coke, but one ain't gonna lose any weight drinking all that sucrose every day! (in addition to rotting one's teeth)..

 

[Biogirl361]

i'd about fall out of my chair if someone told me they drank 10 cokes a day... wow.
on a more serious note, how do you go about telling someone they have cavities on every surface of every tooth?

 

[grtuck]

Seeing that would be a little disheartening

Good thing you saw them when you did, how extensive was the decay? Were most/all the teeth restorable? Just curious...

grtuck

 

[Smilemaker100]

i'd about fall out of my chair if someone told me they drank 10 cokes a day... wow.
on a more serious note, how do you go about telling someone they have cavities on every surface of every tooth?

Yes, Biogirl36, I nearly fell out of my chair too when I heard that figure! I also was stunned when I first treated all these marijuana user patients in dental school...actually , my first patient in dental school was a young farmer who ate a dozen eggs on average for breakfast and smoked joints on a regular basis...after having so many patients confiding their drug habits to me ( especially those I saw in my oral surgery rotations), I became immune to the shock of it.

About the manner to tell a patient in regards to widespread cavities...well, I don't know...you just have to break it to them VERY VERY GENTLY and don't try to judge them when you talk to them even if you feel like giving them a big lecture on their dietary habits.

Here is my suggested treatment plan:

Firstly, nutritional counselling and oral hygiene education.
Secondly, you should prescribe a toothpaste such as Prevident 5000rpm (fluoridated treatment) which may hopefully cause the remineralization of some of the carious lesions. You can also suggest using fluoridated mouth rinses every night after brushing and flossing. You do have to be careful with the doses however...you have to estimate how much fluoride you're exposing to the patient so that the patient doesn't finish end up having fluorosis.

Thirdly, you have to tell them that the most urgent decayed teeth (those that might finish being endo cases)are the ones that are treated first. So that may mean extractions for the extremely hopeless teeth (either because it is irreperable or the patient doesn't have the financial means). Depending on how many teeth are missing, you may want to try to do some immediate dentures. When you can save the tooth, what you can do is excavate the caries from as many teeth as you can in one session and then place temporary dressings such as an IRM until their next appointment...this is especially important if they have several caries that are in proximity to the nerve and their next appointment is in a long time.

Fourthly, restore the teeth- preferably with amalgam for all the posterior teeth. You don't want to employ composites in a mouth that has extensive caries as composites are even more demanding when it comes to oral hygiene maintenance.

Finally, you may need to do some crowns/bridges and fabricate permanent partial dentures as a last step.

These steps all vary according to the patient. It's just my general opinion.
Any other ideas?

 

[DrJeff]

i'd about fall out of my chair if someone told me they drank 10 cokes a day... wow.
on a more serious note, how do you go about telling someone they have cavities on every surface of every tooth?

I've had to do that a few times. My "favorite" one was a guy who drove a delivery truck for Pepsi. He'd go through 2 to 3 2 liter bottles a day, just sipping away as he made his deliveries. It was really interesting to see the look on his face after I explained the caries equation and the role of diet, and then handed him the $17,500 treatment plan to fix everything

The scary thing about soft drinks and your patients, and I tell all my patients this, is that in the US, approximately 370 BILLION dollars of soda is sold a year and to get a good idea about the ratio of diet to "regular" soda, llok at the soda aisle in the supermarket because what they stock is what they sell. Also, the new "lower carb" Coke C2 and Pepsi Edge have approximately the same sugar content (18 to 20 grams/serving) as Coke and Pepsi did about 1 decade ago I won't even discuss Gatoraid and Powerade. Let's just say that due to the soft drink industry that there are alot Strep Mutans getting alot of sugar out there!

 

[aphistis]

I've had to do that a few times. My "favorite" one was a guy who drove a delivery truck for Pepsi. He'd go through 2 to 3 2 liter bottles a day, just sipping away as he made his deliveries. It was really interesting to see the look on his face after I explained the caries equation and the role of diet, and then handed him the $17,500 treatment plan to fix everything

The scary thing about soft drinks and your patients, and I tell all my patients this, is that in the US, approximately 370 BILLION dollars of soda is sold a year and to get a good idea about the ratio of diet to "regular" soda, llok at the soda aisle in the supermarket because what they stock is what they sell. Also, the new "lower carb" Coke C2 and Pepsi Edge have approximately the same sugar content (18 to 20 grams/serving) as Coke and Pepsi did about 1 decade ago I won't even discuss Gatoraid and Powerade. Let's just say that due to the soft drink industry that there are alot Strep Mutans getting alot of sugar out there!

This is a little off-topic, Dr. Jeff, but I've always wondered. How do you go about presenting a tremendously expensive treatment plan to a patient, and what kind of response do you typically get when you tell someone, whose oral health apparently doesn't mean that much to them, that it's going to cost five figures to reconstruct their mouth?

 

[Smilemaker100]

I've had to do that a few times. My "favorite" one was a guy who drove a delivery truck for Pepsi. He'd go through 2 to 3 2 liter bottles a day, just sipping away as he made his deliveries. It was really interesting to see the look on his face after I explained the caries equation and the role of diet, and then handed him the $17,500 treatment plan to fix everything

The scary thing about soft drinks and your patients, and I tell all my patients this, is that in the US, approximately 370 BILLION dollars of soda is sold a year and to get a good idea about the ratio of diet to "regular" soda, llok at the soda aisle in the supermarket because what they stock is what they sell. Also, the new "lower carb" Coke C2 and Pepsi Edge have approximately the same sugar content (18 to 20 grams/serving) as Coke and Pepsi did about 1 decade ago I won't even discuss Gatoraid and Powerade. Let's just say that due to the soft drink industry that there are alot Strep Mutans getting alot of sugar out there!

370 BILLION????? I am curious...where did you get that figure? Speaking of the consumption of beverages, there is an presently an inverse relationship between soft drink consumption and milk consumption. This particular issue is of concern in adolescent girls who need to consume more products in calcium at this stage in their lives as a preventative measure against osteoporosis later in life. Recent research has shown that there is higher consumption of soft drinks and the lowest levels of milk consumption ever recorded in this age category. These poor girls are going to end up having not only a great need for extensive dental treatment but also higher prevalence of kyphoscoliosis and hip fractures later in life than any women in previous generations. Personally speaking, I have always been a "milk-aholic". I LOVE milk and yogourts and consumed a lot of those products throughout my youth...so in addition to inheriting a big bone structure I also have strong bones! There has to be more aggressive campaigning for those "got milk" adds! Maybe I should place posters in my future practice with pictures of myself in the likeness of those "got milk" campaign posters

 

[DrJeff]

370 BILLION????? I am curious...where did you get that figure?

It was in one of the 5 or 6 dental journals that I get each month. I read it last fall, and actually can't recall the exact journal it was in

Speaking of the consumption of beverages, there is an presently an inverse relationship between soft drink consumption and milk consumption.

A very scary, but all too true statement. It still boggles my mind when I see a patient walk into one of my operatories and put a bottle of soda down before they sit in the chair And it's the most prevalent amongst the adolescent population by far

There has to be more aggressive campaigning for those "got milk" adds! Maybe I should place posters in my future practice with pictures of myself in the likeness of those "got milk" campaign posters

Personally if you want to get a dental specific "milk mustache", I prefer using the IRM cut with s high speed residue looK, now thats a winning look

 

[Zurik5]

From my experience, as limited as it may be, I?ve noticed that this phenomenon usually goes hand in hand with nicotine addiction and/or various other (addictions) problems that the patient might have.

I have a family history of Pepsi abuse, and just recently made the switch to diet Pepsi/Coke and now use sweetener in my coffee. Caffeine addiction is a horrible, horrible thing. "Getting off of sugar" was one of the hardest things I?ve ever done.

 

[peekaboo]

Sorry I'm not a dentist but I just have to add my 2 cents : If you want to see teeth that have been on a soda diet look at my thread. Cream Soda is not as bad as coke but it still rotted most of my teeth out in the past 2 years. I would drink almost a litre a day....for good reasons but you end up with a bad outcome.

The coke doesn't really control your appetite as surgar makes you hungry but soda is a good diaretic ,I'm not sure how to spell that but bascaily it irratates your stomatch and allows easier bowl movements....more than without it. Aswell you loose fluid as the high sugar content makes you urinate quite frequantly.

So the girls are most likely eating the same amounts or more....its not staying on.

 

[Biogirl361]

i agree with zurick that it is hard to stop drinking pop once you are used to it. i drink about 2 cans a day, 1 if i am really trying to be good. it would be very hard to lose it completely, as i imagine it is with other addictions. fortunately, no cavities yet for me... must have a real benign clone set

 

[toothcaries]

They are usually young ( 18-30 years old), underweight and most IMPORTANTLY (at least from a dentist's perspective), they have carious lesions on EVERY single tooth and surface - this is no exagerration!

interesting..
i have 2 girls exactly like this in my practice at school.
both had an itch for that code red mountain dew stuff.
i literally finished my 3rd year operative requirements in those 2 mouths.

 

[N1DERL&]

Sorry for the newbie question, but what is caries?

 

[UBTom]

to N1DERL&:

"Caries" is the technical term for tooth decay.

to Peekaboo:

It's NOT the sugar that makes you want to take a leak. It's the caffeine in coke that has a diuretic effect. The sugar actually causes one to retain water (it's a solute that tends to "suck in" water). As for coke having a laxative effect (makes bowel movements easier) I believe that is also a side effect of caffeine. However, caffeine has nowhere near the laxative effect of a nice high-fiber diet! Bottom line: a "coke" diet does NOT work.

As far as drinking sodas and tooth decay go, it really depends on the kind of soda you drink. If you drink tons of soda sweetened with aspartame,, you will not get the kind of rampant decay that tends to happen from drinking tons of soda sweetened with sucrose (all else being equal, such as oral hygiene habits).

I went through four years of dental school on Diet Mountain Dew, which has no sucrose but is loaded with caffeine. My teeth have no cavities.

If you must drink soda, drink DIET soda!

HTH.

 

[N1DERL&]

Thanks UBTom! Glad to know you're cavity free..

 

[ShawnOne]

What do you think are the consequence of a large amount of aspartame in our diet??

What's what I want to know!

 

[UBTom]

I don't know how much people trust the FDA (there are always conspiracy theories floating around, heh heh), but here's their official view:

http://vm.cfsan.fda.gov/~dms/qa-adf9.html

 

[kenniemd]

I read somewhere that it's not just the sugar that causes cavities, the acid does as well. This is present in the diet versions of most soft drinks as well. And speaking of dieting related caries, maybe some of these coked up girls might be bulimic as well (when they ingest anything besides coke). The teeth have a nice way of telling the dentist who's been saying hello to the john since the stomach acids they regurg. have a damaging effect on teeth.

 

[UBTom]

to KennieMD:

It's a question of How Long the teeth are exposed to acid. With Diet soda, the exposure to acid (Carbonate to be precise) is transient and easily neutralized by saliva.

However, if it's sucrose-sweetened soda, the acid Persists LONG after drinking it because Strep Mutans will be growing on the stuff for hours on end until you brush your teeth and disrupt the bacterial plaque.

Longer exposure = higher incidence of caries.

And yes, chemical erosion of teeth from stomach acid is frequently seen in both bulimic patients and those who experience frequent heartburn (Gastroesophageal Reflux Disease, AKA GERD). Also, this kind of erosion is frequent in those who drink TONS of orange juice, which has a pH of 3.4.

Some people will have a hard time believing it, but Diet soda is actually better for your teeth than Orange Juice!

I would much prefer my patients to be drinking diet soda than anything else like coffee, juice, regular soda, etc. Diet soda is the least of all the "sweet" evils.

HTH.

 

[Apollyon]

I was drinking so much Cherry Coke for years, I became borderline diabetic (sometimes upwards of 3 2 liter bottles or 1 to 2 12packs daily). Quit without a problem (now all diet Cherry Coke). Last dental exam 4 months ago, no caries!

 

[zoolander]

What do you think of the risks to teeth from diet soda?

My dentist asked me the other day, Do you drink a lot of soda? When I replied- only diet soda- he said, Yeah, I can tell. He mentioned that the CO2 carbonation can cause acid-mediated damage to teeth.

Can my teeth handle diet soda? Can any interventions reverse or at least slow this slow decay?

 

[peekaboo]

I went through four years of dental school on Diet Mountain Dew, which has no sucrose but is loaded with caffeine. My teeth have no cavities.

If you must drink soda, drink DIET soda!

HTH.

I thought that only the colas had caffine....Coke, Pepsi, Jolt , ??

I'm from Canada and I don't believe our mountain dew diet or not has caffine or much less any soda that is not a cola annd if it does have caffine it must be labled a "cola". Or maybe thats the diff between diet sodas and non diet...the caffine?

edit: I just saw mountain dew has lots of caffine...shame on you mountain dew!

 

[peekaboo]

What do you think of the risks to teeth from diet soda?

My dentist asked me the other day, Do you drink a lot of soda? When I replied- only diet soda- he said, Yeah, I can tell. He mentioned that the CO2 carbonation can cause acid-mediated damage to teeth.

Can my teeth handle diet soda? Can any interventions reverse or at least slow this slow decay?

Well this is what my dentisit wanted me to do and that was to use PreviDent paste to aid with the flouride treatments. But to tell you the thruth using that paste is such a chore that I ended stopping after a while as it's very hard not to ingest it as it mixes with your saliva as you are supposed to keep the paste in your mouth for a period of time..

 

[grtuck]

If your teeth are having the problems that the dentist said they are having, then prevident will be quite beneficial to them. Since diet soda pop has no sugar, it is not as bad a soda with sugar, but it is still slightly acidic. Of course that doesn't stop me from drinking a couple cans of diet dew a day

grtuck

 

[UBTom]

to grtuck:

Word. I don't think I would have made it through dental school if not for Diet Dew.

to Zoolander:

If you have good oral hygiene habits and a normal diet, diet soda poses minimum risk to your teeth. If you eat lots of sugary foods (candy, Twinkies, sweet pastries, cake, cookies, ice cream, etc.) and don't brush your teeth, drinking diet soda ain't gonna help your teeth any.

 

[dientesfuertes]

If your teeth are having the problems that the dentist said they are having, then prevident will be quite beneficial to them. Since diet soda pop has no sugar, it is not as bad a soda with sugar, but it is still slightly acidic. Of course that doesn't stop me from drinking a couple cans of diet dew a day

grtuck

"Slightly acidic"??? I think most sodas have a pH in the neighborhood of 2-3. Even non-colas like Sprite and diet sodas are still very acidic. Enamel begins to decalcify at any pH lower than 5.4 (or 5.5, depending on who you ask). So even though a diet or caffeine-free soda may be more "healthy," it can still cause serious damage to your teeth by way of acid erosion.

 

[grtuck]

Ok, sounds good to me, I haven't tested the ph of the different types of soda pop. I was just making a general statement, but if you know the ph then that's probably better (much more accurate)

Is there a place I can look up the ph of soda pop so that I can be better informed? And yes, acid is bad for our teeth, I agree, but I still like my diet Dew!!!

grtuck

 

[aphistis]

Ok, sounds good to me, I haven't tested the ph of the different types of soda pop. I was just making a general statement, but if you know the ph then that's probably better (much more accurate)

Is there a place I can look up the ph of soda pop so that I can be better informed? And yes, acid is bad for our teeth, I agree, but I still like my diet Dew!!!

grtuck

Heck, if you're that curious about it, you could go titrate it yourself.

More earnestly, I don't think knowing the pH to ten decimal places is as important as simply recognizing that soda's acidity is well in excess of what it takes to initiate dental erosion.

 

[Biogirl361]

my litmus paper says 2.5

 

[grtuck]

Glad to see that others are as sarcastic as I am

grtuck

 

[UBTom]

"Slightly acidic"??? I think most sodas have a pH in the neighborhood of 2-3. Even non-colas like Sprite and diet sodas are still very acidic. Enamel begins to decalcify at any pH lower than 5.4 (or 5.5, depending on who you ask). So even though a diet or caffeine-free soda may be more "healthy," it can still cause serious damage to your teeth by way of acid erosion.

Hi Dientes,

The difference is time of exposure. Remember that aspartame-sweetened soda exposes teeth to acid attack ONLY during the time it remains in the mouth, which is not very long. Transient decalcification is also easier for saliva to reverse than prolonged exposure-- Remember how we had to re-etch in pediatrics if a kid accidentally slobbers into your field while you are placing a sealant.

On the other hand, sucrose-sweetened sodas like Sprite and colas exposes teeth for far longer due to the stickiness of sucrose, which exposes your teeth to strep mutans acid attack right up to the next time you brush your teeth.

Aspartame-sweetened soda is still the least of all sweetened evils, and least likely to cause serious damage like sucrose-sweetened drinks do. If you have normal dental hygiene habits and eat normally (no excess sweets), diet soda poses minimal threat to your teeth.

I am in agreement with Grtuck-- I say keep that Diet Dew coming! It's my poison of choice too.

 

[dientesfuertes]

Tom, no disagreement here.
It is an excellent point that you make that diet sodas are much less "evil" than sucrose-sweetened drinks. My only reason to post about the acidity of sodas was to point out that they do have the ability to damage tooth structure over prolonged exposure. Certainly, a few servings a day - along with proper oral hygiene - aren't going to pose much of a threat. But if you have a can in one hand constantly throughout the day, I think you'll agree that it might be a good idea to cut back some. Thanks for the clarification and valuable information.

 

[UBTom]

Yep, I totally agree with you there Dientes..

I also want to mention that drinking too much soda of any kind also increases the risks of developing heartburn and reflux (from the buildup of fizz and gas in the stomach), which is also another way teeth may be damaged.

As is true with everything else, moderation is key!

 

[DrJeff]

Aspartame-sweetened soda is still the least of all sweetened evils, and least likely to cause serious damage like sucrose-sweetened drinks do. If you have normal dental hygiene habits and eat normally (no excess sweets), diet soda poses minimal threat to your teeth.

I am in agreement with Grtuck-- I say keep that Diet Dew coming! It's my poison of choice too.

My mouth is living proof that you can be addicted to Diet Pepsi and/or Pepsi One and be caries free

I also tell many of my "sugar addicts" that they should look into the Atkins Diet/South Beach Diet, any 'ol low carb diet as a means to control their decay. If they're strict to those lifestyles, you'll see them eliminating almost all of those sugary bad habits.

Plus, if your discussing the caries equation and the sugar role and you mention aspartame(Equal, etc) and the patient gives you the standard, immediate "oh that tastes awful to be so I can't use it!" tell them to try Splenda(Sucralose), it has all the lovely anti-cariogenic values of aspartame with alot less incidence of a chemical after taste We've actually started keep individual packets of Splenda in my office and will hand them out along with the standard toothbrush, floss, toothpaste and sugar free gum that we give to our patients in for prophies