Drinks Destroy Teeth

Drinks Destroy Teeth

An Educational Outreach Programof the Indiana Dental Association

#1. This is a public health issue:

Educating the public about the drinks we consume and the potential damage is the biggest oral pubic health issue since we fought for fluoridated water.

#2. Encourage a decrease of sport and soft drinks consumption in all ages.

#3. Help promote our website: Drinks Destroy Teeth.com

I hope that by the end of this presentation, all of you will join me in the fight for our childrens oral heath. As public health professionals we need to spread the word about the sugary, acidic drinks and help reverse the current trend.

1The culpritsSoft drinksSports and energy drinks

There are more than 450 brands of soft drinks, sports drinks and energy drinks.

Manufacturers of these drinks often list numerous healthy reasons to use their products on websites and in other marketing.

This is a multi-billion dollar industry that uses famous sports spokespersons, gives proceeds from sales in high school vending machines to schools and has successfully increased their market share every year.

2Fruit juice and juice drinks

Virtually ALL toddlers consume juice or juice drinksAdvise parents toLimit consumption: 4 oz./dayOffer milk or water insteadUse a glass vs sippy cupNever put an infant or toddler to bed with a bottle

Parents who all try to furnish healthy drinks for their children mistakenly buy sugar-laden, acidic juices for their toddlers and young children - - often in place of water or milk. Put the juice in a bottle and this becomes the perfect incubator for decay and erosion.

I have a terrific website for professionals and parents. Healthchildren.org An extensive website by the American Academy of Pediatrics In 2007, the AAP, a group pf 60,000 primary care physicians, issued a policy statement called the use and Misuse of fruit juices in Pediatrics. Essentially drinking too much juice contributes to obesity, development of dental caries, diarrhea and other GI issues.Recommend 100% juice, no fruit drinksNo juice for under 6 months, 4 ounces for 6mo to 6 yearsWhole fruits at 6 and aboveDiscourage sippy cups, use a cup or glass, the sippy cup teaches poor habits such as continuous eatinghence sip all day risk cavities and continuous insulin demand on the pancreas.

Information and education are sorely needed.

Dominick Zero, Director of the Oral Health Research Institute advises us to select orange juice with calcium. The calcium blocks the affect of the acid in the juice.3Classic erosion patterns

This is a classic case of erosion in a moderate stage. Note the hallowed out areas on the cusp tips of the molars and premolars, this is known as cupping. As the erosion progresses there will be greater exposed dentin, loss of vertical dimension, sensitivity and generally a dental rehabilitation case before the age of 30.

There are other reasons for acidity. It is wise to explore the other causes of acid in the oral environment.

One health issue is gastroesophegeal reflux disease or GERD. Those who suffer from GERD also have higher incidence of esophageal cancers. This condition is seen in 5 and 6 year-olds and even infants are being treated for excessive acid production.

There is bulimia where dentists see the perimyolysis on the lingual surfaces of anterior teeth and not on the posterior teeth.

Environmental causes also need to be explored: from work exposures to caustic chemicals to swimmers who may spend hours of contact time in pools with poorly regulated pHs.

The previously mentioned conditions however are not the primary cause of erosion in teeth today, drinks are!4How Drinks Destroy TeethQuantity

Acidity

Sugar

Timing

The population at most risk are adolescents., especially boys , They are consuming greater quantities and exposure time matters. Study after study confirm there is a positive correlation between consuming soft drinks and caries and dental erosion.

5Quantity: the fluoride generation

This young boy in 1977 had all the advantages preventive dentistry could offer. In Indiana, 99% of the communities had fluoridated water, either as a community or in the school system water supply. Many thanks to the Oral Health Division of the Indiana Department of Health.

Preventive dentistry was working and we had declining decay rates.6The average 12-19 year-old drank 16oz. of soft drinks per day.

Quantity: 1977

In this same year the average serving size for soft drinks was 16 ounces.

According to the American Journal of Preventive Medicine, the consumption of milk decreased 12% from 1977 to 1996 and sweetened beverages increased 15%. The largest drop in milk consumption occurred in 2-18 year-olds. Milk consumption is beneficial to teeth, bone health and the prevention of obesity. The trend shows larger serving sizes and more servings per day than three decades ago.

7Quantity: 1996 By 1996 the average serving size was 28oz per day

Bottled water sales increase

Sweetened drink sales increase

Milk consumption decreases

I have before you the serving sizes available the local service station.

While this may be an exaggeration, lets look at the serving sizes form our local speedway service station. 8Quantity: 2010Consumption now includes large quantities of sports and energy drinks.

Teenage boys drink, on average, three or more cans of soda per day.

10 percent of boys drink seven or more cans each day.

The average for teenage girls is two cans per day,

10 percent of girls drink more than five cans every day.

Gatorade spent 24 million dollars developing G1-G2 and G3, promoting triple the consumption, urging athletes to drink one before another during and another after the sports event.

They are brilliant. The company has increased sales by 20% /year since 1966 and show no sign of stopping. Only education will reverse the trend.Many consumers switched to sports drinks thinking it a better choice. In fact sports drinks are worse for teeth due to timing, the quantity consumed and the amount of titratable acid which attacks teeth. Remember the comment about citric acid chelating calcium.

It has been reported the Kokomo school system removed soft drinks from the school vending machines and replaced them with sports and energy drinks. Our message is not getting through.

9

AcidityLow pH in drinks is bad note that cola has 2.4 acid pH

High pH is good note that water is neutral at 7.0 acid pHTwo of the most common acids in soft and sport drinks are phosphoric and citric acid.

Phosphoric acid is extremely erosive at 2.5pH and much less at 3.3pH.

Citric acid are known to chelate calcium at a higher pH which makes it more damaging to enamel.

The titratable or available acid in a drink is even more important than the pH alone and this is where sports drinks can inflict more erosive action than soft drinks. The warmer the drink the greater the amount of available acid hence more erosion.

In 2008, three universities, Indiana, California at San Francisco and Texas at San Antonio found tooth erosion in 30% of 900 children between the ages of 10 and 14.10SugarLiquid candy. Some sodas and energy drinks have up to 13 teaspoons of sugar!

The sugar content, whether it is sucrose, high fructose corn syrup or glucose is astounding: Mountain Dew AMP has 11 teaspoons of sugar per 12 oz serving, Coke has 10, Sunkist Orange has 13. According to the Department of Agriculture and the Department of Health and Human Services, in 2000, one third of daily sugar intake originates in regular soft drinks. These are empty calories devoid of key vitamins and minerals and have been linked with obesity and diabetes. Back to teeth:

I think most people would find it difficult to crunch on 11 to 13 teaspoons of sugar in one sitting. Yet that is what we do with every regular soda.Sugar fuels the bacteria which produces acid that creates a cavitation or hole in a tooth. Even swishing with water after does not return the mouth to health, the pH of the plaque remains low. Xylitol gum helps return the plaque complex to a neutral PH. 11TimingAthletes and children who drink acidic drinks when a dry mouth is present or when they are dehydrated are especially vulnerable to the acid attack.

The best drink for a dehydrated individual is plain water.

If sports drinks must be consumed, drink plain water before and after to mitigate the harmful effects.

Sports drinks are promoted for athletes by coaches. When they consume a sports drink in a dehydrated state, the acid hits the enamel without the benefit of the natural salivary proteins to protect the enamel. Natural saliva protects the teeth from acidic drinks. When there is little or no saliva acid does its greatest damage.

Water is the best drink to rehydrate.

12Sipping all dayEvery sip counts as an exposure.

Drinking all day does more damage .

The continual bath of acid and sugar assault the enamel with every sip. The teeth are not allowed to recover/ remineralize before they are hit again with another splash. Look around, we are constantly drinking something. It is as ubiquitous as cell phones. I even see people take drinks into church, unheard of five years ago. On college campuses, at schools, driving,studying, at any public event we are drinking and it often is not water. 13Why do we need the program?Decay and erosionErosion and tooth loss

The tooth on the left is a maxillary second molar, is almost unrecognizable due to the erosion and decay. This damage is in a 15 year-old male who is a regular dental patient and is drinking lemonade because his mom wont let him have pop.The anterior lingual erosion is not from bulimia but excessive sports and soft drinks which also led to thinning enamel and fractures of the incisal edges.

This is what Indiana dentists are seeing. We cannot wait for statistics to act on something we already know.

Sports drinks and soft drinks are destroying the teeth of an entire generation.

We need to educate everyone, dentists, teachers, nurses, parents, young adults, children : all consumers with teeth.14Cupping of molar cusp tips

This best represents the cupping seen in posterior teeth. Conservative bonded restorations may be placed but it is more important to stop the cause. Stop drinking soft drinks and sports drinks. It is important for us to document and diagnose the irreplaceable loss of enamel.

15Thin enamelChipping and decay

This is the mouth of my lemonade drinker, who, from the looks of the tissues is brushing pretty well. Of course, you cannot see the second molars. If you see the right premolars are more rounded than the left and there is a concavity beginning on the lingual surface of the first molar.

Please observe the thinning lingual enamel of the incisors on the right and the class III, caries and incisal chip. This young man needs full coverage crowns and cannot drive yet! I am afraid for the future of his oral health.16Severe erosionLoss of chewing surfaces

This is a case of severe erosion and one of the first cases I personally observed 14 years ago, 1996. This erosion is in a very clean mouth in a male in his 20s who drank 12 Dr. Pepper a week, and exercised three hours a day, I suspect he drank and swished back and forth when his mouth was dry, brushed his teeth while in a softened state and then had no chewing surfaces.

This person had no posterior occlusion and had amalgam restorations taller than the surrounding enamel.

17Decalcification

Decalcification is the precursor to decay. By definition is caused by acid.

I have dozens of examples of decalcification from orthodontists. While hygiene is a factor, a highly charged environment of acid and sugar promote permanent decalcification and decay. Almost every one of these cases insists they do not drink that much pop. I doubt their reporting. 18Rapid recurrent decay

The extensive recurrent decay observed around the alloy happened in 18 months from placement. This 21 year-old admitted he was addicted to Mountain Dew and drank almost no water.

It is not enough to diagnose alone. The etiology needs to be explored, quantity, acid, sugar and timing prove extremely destructive.19Drinks Destroy TeethDentistry fights back.

Drinksdestroyteeth.com

Website

Knowledge is power.

Now begins the campaign: Drinks Destroy Teeth provides a website with information for individuals, health professionals and educators.It will also have downloadable pages dentists may use in the office and for teachers. You have a copy of the brochure. It also looks nice in back and white too.

There are approximately 166,000 4th and 5th graders in Indiana. It is our goal to reach this population.

We hope to track the number of students who hear our message by asking classes to enter a drawing for classroom supplies upon completion of the lab. 20

This is the home page. We invite everyone here to link their website to ours. This site has information for patients, a terrific site for teachers

The lesson plans are complete with Indiana curriculum guidelines, a very important aspect for all Indiana teachers. In some schools the teachers must account for all classroom contact hours and have it relate to the curriculum guidelines. We have made this part of their job easy.It also has wonderful, illustrated lab sheets. And a drawing for classroom supplies. This way we can track the classes who are doing the labs.

It has a site for healthcare professionals, giving them a mini lesson in erosion and what to look for.21Educate School Nurses Teachers

Education and prevention is the goal of the Drinks Destroy Teeth campaign.22Prevention saves teeth from decay and erosion4th and 5th graders. Are targeted with two science lessons.

The reason the 4th and 5th graders were chosen is because they make a receptive audience. ( by 6th grade they know it all)

We are taking this campaign directly to the 4th and 5th graders who have a mixed dentition and will benefit the most. It is our hope this campaign will expand to middle school and high school students, to PTOs , other health professionals and coaches. We are teaching them about science and about a subject many of their peers, teachers and parents and even college students do not know. (they like that) Also ACID is a new concept. They know what sugar is, and what carbonation is and what decay is. The lessons will teach them about acid and what destruction acid can do. The second lab introduces them to pH, also a new concept to this age group. They will be asked to make a display for the school and enter it in the DDT display contest.

The Two science inquiry lessons will be distributed by the Indiana education service centers which serve most of the public schools in the state.There are 1048 public and private elementary schools in the Indiana. It is our goal to reach all of them. The private schools will be a little more difficult. We will enlist our membership who may have connections in the private schools to either go to the schools or make our materials available to 4th and 5th grader teachers. The website will have wonderful lesson plans which are cross-curricular and meet the Indiana curriculum guidelines.The kits will provide pH paper, measuring spoons and further information. 23StudentsEducate through science labs to measure acid, sugar and pH levels of various drinks

The first lab is called The Disappearing Egg we have five or six hard boiled eggs and soak all but one in various drinks, milk, sports drinks, soft drink and 4% vinegar. The students then dramatically see the shells dissolve in 24 hours or become thicker when soaked in milk. This is their first experience with acid as a scientific topic. They are asked to predict the liquid with the greatest acidity.

In the second lab, Drinks That Destroy Teeth the students will measure the amount of sugar per 12 ounce drink into empty bottles.Then they test each beverage and learn which has the lowest pH. And see if their predictions of lab one were correct. They predict which beverage has the potential to damage a tooth either through decay or erosion or both.

24Athletes

Children are learning many new skills at this age. One of the most important is how to make informed choices.

As this population ages they expect to retain their dentition. Erosion and Decay do not happen magically, prevention works.

Just as success in sports depends upon preparation, these lessons teach them how their body works.

What they drink matters, how much sugar and acid are contained in what they drink. How they drink and the amount consumed all affect the health of their teeth..25Health Care ProfessionalsSwimmers can be prone to acid erosion if the pH of the pool is not well controlled.

Causes of acid erosion:Sports drinks Soft drinks Juices GERD Swimming Bulimia

The information for Health Professionals gives valuable information to use the condition of the teeth to screen for acid related health problems.

Before dentists diagnose acid erosion, the etiology must be discovered.

As we discussed before there are many causes of acid erosion.In children the cause is more than likely sweetened acidic drinks, but there are other causes such as GERD, Swimming pool pH and bulimia. To consider. Dentists can refer patients for needed medications, hygiene practices, mouth guards and counseling.

Dentists hold many pieces of advice which can mitigate the acid exposures.

26Repair and Prevention

Fluoride toothpaste

Fluoridated water

Use a straw

Drink at one sitting or with food.

Prevention involves advising patients to use fluoride toothpastes, change their drinking choices, use a straw and

use a casein phosphopeptide-amorphous calcium phosphate complex ( CPP-ACP )to remineralize the enamel.

Discourage brushing immediately after drinking sport or soft drinks decreases to actual loss of softened enamel.

Advise patients to swish with water and prescribe a xylitol based chewing gum especially for sugar laden drinks.

27DrinksDestroyTeeth.comDentistry fights back

Knowledge is power!

Now begins the campaign: Drinks Destroy Teeth will host a website with information for individuals, health professionals and teachers.

The website will have downloadable pages dentists may use in the office and for teachers.

In summary, we are sponsoring two labs appropriate for 4th and 5th graders.

THANK YOU FOR YOUR TIME AND ATTENTION TODAY and ask for your help to spear the word thatDrinks destroy teeth!28