Word Of Mouth – A Dental Blog

I examined a patient yesterday after a routine visit with our hygienist.  This was a patient who was seen on a regular basis every 3-4 months.  I was startled to see the amount of change in the enamel surface of her teeth.  The signs of acid erosion were unmistakable; cupped out biting surfaces, existing fillings that now protruded beyond tooth surfaces, darkening of normal tooth enamel. When questioned, the patient said she had started drinking warm water with lemon as a breakfast drink and was frequently sucking on lemons.

The amount of tooth destruction was severe enough to share this incident in an effort to educate others and prevent this from occurring wherever possible.  I’ve found information through the Academy of General Dentistry that I share with you below.

Many people consume carbonated beverages, fruit juice, and highly acidic foods every day but probably don’t realize that they might be harming their teeth. The acid in the foods we eat and drink can cause tooth enamel to wear away, making teeth sensitive, cracked, and discolored.

What is tooth erosion?
Tooth erosion refers to the loss of tooth structure; the wearing away of the hard part of your teeth (enamel).

What causes tooth erosion?
Tooth erosion occurs when the enamel on your teeth is worn away by acid. Usually the calcium contained in saliva will help remineralize (or strengthen) your teeth after you consume small amounts of acid, but the presence of a lot of acid in your mouth does not allow for remineralization.

Acid can come from many sources, including:
• Carbonated drinks. All “fizzy” drinks, including soda (even diet varieties), contain a lot of acid and can dissolve enamel on your teeth very quickly. More damage is done when you drink large amounts and or you hold the drink in your mouth for a long time.
• Pure fruit juice. Sucking on limes or lemons can result in significant tooth erosion over short periods of time. Juice can have similar effects on your teeth because it contains a lot of acid.
• Bulimia and acid reflux. Bulimia, a disease in which a person vomits to avoid gaining weight and acid reflux(GRD) also can cause tooth damage due to stomach acids. Medical and dental help should be sought immediately if you or anyone you know suffers from a condition such as this.

What are some signs of tooth erosion?
• Sensitivity. Since protective enamel is wearing away, you may feel a twinge of pain when you consume hot, cold, or sweet foods and drinks.
• Discoloration. Teeth can become slightly yellow or brown because the dentin (underlying tooth structure below the enamel) is exposed.
• Rounded Teeth. Your teeth may have a rounded or “sand-blasted” look.
• Transparency. Your front teeth may appear slightly transparent near the biting edges.
• Advanced Discoloration. Teeth may become more yellow as more dentin is exposed because of the loss of tooth enamel.
• Cracks. Small cracks and roughness may appear at the edges of teeth.
• Severe Sensitivity. As more enamel is worn away, teeth become increasingly sensitive.
• Cupping. Small dents may appear on the chewing surface of the teeth. Fillings also might appear to be rising up out of the tooth.

What can I do to prevent tooth erosion?
Because there are different reasons why you may experience tooth erosion (e.g., swishing carbonated drinks, drinking a lot of juice or wine, eating disorders), talk to your dentist about your habits so that a plan for preventive action can be determined. Here are some general things you can do to protect your teeth:
• Reduce or eliminate drinking carbonated drinks. Instead, drink water, milk, tea, or coffee—but skip the sugar!
• Drink acidic drinks quickly and use a straw so that the liquid is pushed to the back of the mouth. Don’t swish them around or hold them in your mouth for long periods.  Stay away from sucking on lemons or limes.
• After consuming high-acid food or drinks, rinse with water to neutralize the acids, and wait an hour before brushing your teeth.
• Chew sugar-free gum to produce more saliva so your teeth can remineralize.
• Brush with a soft toothbrush and be sure your toothpaste contains a high amount of fluoride.

You can find more information on dentally related topics at  www.agd.org.

A recent article in the Journal of the American Dental Association (May, 2008) calls into question school policies that ban gum chewing in the classroom. In their article, “The potential of dental-protective chewing gum in oral health interventions” the authors Kiet A. Ly,MD, Peter Milgrom, DDS, and Marylynn Rothen, RDH,BS, conclude that the use of xylitol containing chewing gum can reduce tooth decay and suggest that the use of xylitol chewing gum be reconsidered in schools.
The authors site studies in Finland and by the U. S. Army, demonstrating the successful use of these gum products to prevent cavities in school age children and in soldiers. Since this article puts gum chewing in a new and more favorable light, I’ve taken the liberty to summarize some of the authors’ findings.

Gum chewing can be traced back to Greek culture and was in evidence throughout the Middle East and among Mayan Indians in the early centuries A.D. In the world today, more than one-half million tons are used annually. In the U. S. alone, more than ½ billion dollars is spent on chewing gum! A large percentage of chewing gum today is sweetened with sucrose, a sugar substance that bacteria (streptococci mutans) in the mouth use to produce acids that can cause cavities.

Today, more and more chewing gum products are using non-sucrose type sweeteners that do not produce acids the way sucrose containing gums do. The U.S. Food and Drug Administration has accepted these substitutes as being noncariogenic (not causing cavities). Additionally, gum chewing has been shown to stimulate the flow of saliva which helps clear food debris and bacteria from the mouth, potentially decreasing the cavity activity in the mouth.
In their article, the authors highlight xylitol, a polyol sweetener that reduces plaque, strep mutans levels and tooth decay, as well as promoting remineralization of tooth enamel. Gum chewing has been shown to have a positive influence on the health of our mouths. It can often be a potent stimulator of saliva flow. This increases the concentration of bicarbonate, resulting in decreased lactic acid levels which can cause tooth decay. This change in saliva can also cause remineralization of tooth enamel that has started to show signs of early decay. These positive changes are not found in gums containing sucrose.

Small quantities of xylitol can be found naturally occurring in fruits and vegetables. It has been used mostly as a sugar-free sweetener in foods and candies in the U. S. but its cost has prohibited a wider use in other applications. Studies conducted in the early 1970s demonstrated the effectiveness of xylitol in reducing dental cavities by almost 85%. Xylitol containing chewing gum has been included in rations among deployed U. S. Army troops with the aim of preventing tooth decay among soldiers who may not brush their teeth on a regular basis in the field and may have poor oral hygiene as a result.
With the significant body of evidence demonstrated by the authors, maybe it’s time to reevaluate our primary school policies that prohibit gum chewing and objectively weigh the risks vs. benefits. We also should give some consideration to the use of xylitol gum and associated products in adults who have demonstrated high risk of developing tooth decay.

RMS