According to the American Association of Oral and Maxillofacial Surgeons, an estimated 24 million adult Americans are totally without teeth. Almost half of the adult population are missing at least one tooth.

When it comes to dental decay (caries, cavities), it is not always what you drink and eat, but how you drink and eat it that matters.  True or False:  Cutting down on my sugar intake will reduce potential for cavities.  Hint --- This question really cannot be answered with a “true” or a “false.” 

The statement is true in general, but consider this very possible hypothetical:  One identical twin drinks five canned diet sodas a day and has no cavities year after year (keep in mind we’re not talking about the other possible health effects of this, only dental decay).  His twin brother drinks only one diet soda a day, yet has several cavities every six months.  How can this be? 

The first twin drinks two sodas with each meal other than breakfast, over about a 20 minute period, and brushes his teeth afterward.  He also has one during the afternoon, but drinks it fairly quickly (10 minutes maximum) and either brushes afterward or at least rinses well with water.

The second twin opens his soda at work in the early afternoon and “nurses” it for about four hours (a sip here, a sip there).  No rinsing with water, and no brushing.

You are thinking “But you said they were diet sodas.”  Exactly.  While regular sodas are worse, diet sodas greatly contribute to dental decay.  The acid can temporarily open up pores in the enamel allowing bacterial plaque, that is always on your teeth (even shortly after brushing), to more easily attack. 

This is biology we’re talking about here. Dentists and hygienists didn’t make up “The Rules.”  We just understand the biology, and are not here to take away all of your fun, but to help you understand the biology also.

Dental decay is caused by a very specific bacterium that becomes most active against tooth structure when provided with sucrose (sugar), or breakdown products from carbohydrates.  The bacterium also thrives with a low or acidic pH.  It takes very small and frequent “doses” or sips to “keep the machine running.” 

A rough figure of 20 minutes of cavity-potential-pH per sip of a high acidic and/or high sugar drink is a rule-of-thumb.  So, length of time, or duration, of acid and/or sugar contact with tooth structure is critical.  You are probably now adding up your daily hours of high cavity potential with your liquid intake. 

The high potential liquids list goes something like this: Sodas-Regular, Sports Drinks, Sweet Tea, Sodas-Diet, Fruit Juices, Coffee with sugar.  Of course we could list many, many more.  Every person with new dental decay needs to review his own situation.

“I am willing to shorten frequency and the length of time, but what are some alternatives to these types of drinks?” Here are some alternatives: Water, of course, tap or bottled. (But keep in mind children 12 y.o. and under need the fluoride that often only comes from city tap water, and is not present in bottled water). Tea or coffee, with or without artificial sweeteners seems to be acid neutral, but lemon in the tea could alter it toward the acidic side. Also, you will notice more staining of your teeth in a short time if either of these are sipped over long periods each day. [Side note: Since artificial sweeteners have their own database of questioned health and side effects, and not everyone can consume them, please consult your physician or your child’s pediatrician before changing your liquid or solid diet to include them].

And, of course, you could use a straw, and much of the sugary, acidic liquid will bypassyour teeth. This will also help with iced tea also, with regard to reducing stain buildup.

“You are talking about what I drink a lot. What about what I eat?”

Cake and candy bars can certainly contribute, but consider the frequency factor: Filling foods are not as critical if you actually get full and quit eating. If you nurse your candy bars for hours, like some folks nurse their sodas, then you may have a problem. Tiny soft or chewable candies that can be popped in, one after another, hour after hour, can be a real concern, as can candies - or even non-candies like raisons - that stick in your teeth. For those of you that like to open a bag of chips and watch a 2 hour movie: Chips contain carbohydrates that are converted to sugar in your mouth. Having enamel like the pirates in the Johnny Depp movies is not cool in the 21st Century (except maybe on Halloween).

In my experience, there are two groups of patients with occupational hazards with regard to dental decay: Those who cook or serve food, and sample small tastes throughout the day, and long distance drivers, many of whom eat often, and eat carbohydrate or sugar laden snacks, perhaps in order to stay awake. These are all examples of ways to consume solid foods, and types of solid foods that contribute to a high potential for tooth decay.

“Is chewing gum bad?” Not if it is sugarless, and if it is, you may even somewhat reduce your cavity potential, studies have shown. Breath mints, cough drops, hard candies, etc.? Make them sugarless, or you might have a problem. And while I am informing, not lecturing (remember dentists did not make up “The Rules”), please avoid chewing up that peppermint candy to get it down faster unless you are a fan of crowns (some call “caps”).

“What about artificially sweetened powered drinks (Crystal Light, Wyler’s, etc.). and flavored waters?” Many of the artificially sweetened powdered drinks are not acid neutral and the common addition of citric acid definitely makes them on the acidic side. Proceed with caution. New flavored waters are appearing every day, so check the contents for sugar or hints of acid producing ingredients.

The source of the decay may not be obvious. I often ask pregnant females whether they awake in the middle of the night to take antacids for their stomach. Many do, and most have not thought to look near the bottom shelf in the stores where they sell the (less marketable, I guess they think) sugarless antacids. Since brushing at 3:00 a.m. does not occur to most folks, the sugarless option keeps the antacid from causing any harm, since about ten percent of it seems to stay in the grooves of your teeth for the next several hours.

I recall a patient who could not fathom what was causing her cavities, especially since she was very tuned in with her health and her diet. We went through my entire list. Nothing. Then she returned for some restorations (fillings), and she said “Dried fruit. I snack on dried fruit all day.” Start looking at nutritional labels. Sometimes you have to be your own sugar sleuth.

Summary: Acids matter as much as sugars. Many foods are converted to sugars in the mouth. Fructose is still a sugar. Sports drinks, flavored waters, even diet sodas: Beware. Moderation in amount, limit the time, rinse often if you cannot brush afterwards.

Dr. Kyle W. Taylor