Dental Erosion and Tea

Seven_Sisters_Panorama,_East_Sussex,_England_-_May_2009.jpg

By Diliff – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=6739706

As a dental professional I worry about growing phenomenon of dental erosion on patients teeth. Yesterday I saw 6 patients of which 5 of them had erosion on their teeth ranging from mild to very severe. There is not necessarily difference between different age groups any more. Dental erosion affects all the age groups and often it is due to ignorance – not knowing that something we do everyday basis is damaging our teeth. And damaging for good. With this post I hope to raise awareness of one very common habit many of us have that could damage the enamel of the tooth. That is drinking tea.

What is Erosion?

People often know what erosion means when it comes to for example coastal erosion (hence the photo of beautiful Seven Sisters, UK). But when I mention the word erosion to the patient, they often look perplexed.

Dental erosion is one type of tooth wear where tooth looses its structure due to chemical dissolution by acids. These erosive acids enter the mouth through two routes – from outside (food, drinks, medicine, supplements) or from inside of the individual (stomach acid due to gastric reflux or bulimia). The loss of the tooth structure is permanent. It won’t grow back. So the prevention of the dental erosion is the most important thing to do.

With this post I will not go into all the things that cause dental erosion as I have written it in my previous post How Diet Affects Your Teeth? But what I didn’t write on that post was something I didn’t know back then. You see, this profession is constant learning as long as you are receptive. I knew that fruit teas are acidic but what I did not know is that only two types of teas are safe to drink when it comes to tooth wear.

pH of Different Teas

There are plenty of studies about the pH levels of different teas. Just google words erosive potential of teas. When I did this I also run into some worrying sites like this one where incomplete advice is given to people. The effects on teeth is completely left out when talking about alkaline diet even though the mouth is one important part of your overall health.

What people following alkaline diet are thinking is that foods consumed will become alkaline in your body. But remember when acidic foods (lemon, lime, berries, apples etc) or drinks (e.g. herbal and fruity teas, carbonated drinks, juices) enter the mouth, they stay acidic. Lets take the lemon as an example. In the alkaline diet’s pH chart they state that lemon is very alkaline (pH 10). But when entering mouth, it is highly acidic (pH 2.0)

The same site advises people to drink hibiscus tea as alkaline tea. A revelation, also hibiscus is not alkaline when entering mouth. It is in fact the most acidic tea there can be (pH level <3.0). Any drink with pH level below 5,5 will cause erosion on enamel if consumed regularly.

It worries me that people actually follow these constricted advices blindly. I don’t blame them. Many people are clueless when it comes to matters of health. Everyone following alkaline diet should read this article to determine if there are enough health benefits of the alkaline diet to risk the health of the teeth. The only downfall of this article is that it is not writing about health risks of alkaline diet.

Erosion-Enhancers

The herbal and fruity teas are acidic but certain factors can make them even more erosive. These are exposure time and temperature of the drink.

Nowadays people carry their drinks with them in a travel mugs enabling them to sip it during e.g. commuting and perhaps some of it is left for them to drink when they reach their desk. If the drink is acidic tea it means prolonged exposure to acids and if repeated often, it will result in tooth erosion. If there is sugar or honey added to the drink it will be even more erosive and also cariogenic.

Also the hotter the drink is the more erosive it is. And these travel mugs keep the drink warm for a long period of time.

Warning Signs of Erosion

The first sign of dental erosion is normally sensitivity to cold or pressure (when brushing the teeth or touching the surface of the tooth with your finger nail. The latter us professional do not encourage to do). This should raise an alarm in your mind and you should go through your diet to find out if you are consuming something regularly that is too acidic to your teeth. You will find help from my post How Diet Affects Your Teeth. Remember that the best drink teeth-wise between the meals is tap water because it is alkaline.

Another sign of tooth wear is change in tooth colour. As the enamel gets permanently thinner, the yellower tooth structure the dentin under the enamel will start to show through. Your teeth will look yellower than before and no whitening done will change that as the whitening substance is not able to reach the dentin.

When the shape of your tooth is changing, the erosion is already severe. Thinning enamel will easily chip off making your teeth look less attractive than they used to be. Often people feel embarrassed about their teeth at this point.

So my message to you all is to prevent dental erosion! Think what you put in your mouth and how often you do that. Occasional acidic drink will not make any difference but when consumed often, it will cause problems.

Is Any Tea Safe to Drink?

Yes! The pH level of green tea and black tea are on the safe side. Black tea also contains fluoride which helps to prevent tooth erosion. But remember, they are only safe if no sugar (including honey) or lemon is added. Sugar will cause the pH level of the saliva to drop below 5,5 and lemon is very acidic like I mentioned already above.

Here are some studies for further reading

Erosive potential of herbal teas

International Journal of Science and Research (IJSR): Dental Erosion and Tea: A Systematic Review

You might also like

Eeny Meeny Miny Moe – Which Type of Tooth Wear?

How Diet Affects Your Teeth

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New Natural Remedy (Fluoride-Free) for Decay

Dental Revelations

Just kidding. Just wanted to have your attention.

Today I am going to write about fluoride. And the reason for doing this is that I keep on running into articles and websites promoting fluoride-free toothpastes (and water). Not only they recommend non-fluoride toothpastes but also they tell that the fluoride is toxic or poison when entering body.

It is rather entertaining to read these articles but sooner or later the amusement turns into annoyance. Especially after comments like this

I love the look on dental hygienist’s faces when I refuse the fluoride treatments or toothpaste for me and my kids

When the adults practice their anti-fluoride beliefs on their kids it is simply heart breaking. I have seen kids whose milk teeth were so badly decayed that most of them had to be removed. I have seen kids in pain because of the decay. Why would you want to put your kid through such experiences? They wouldn’t thank you if they knew what caused their bad teeth as an adult. But they will never find out the truth because they have been told that it runs in the family to have weak teeth… yeah right. There is no such thing as weak teeth that are hereditary. It’s all about oral hygiene habits and lifestyle habits. What could be called hereditary is the bacteria in mouth that you might get from your parents as a baby. If the parents neglect their teeth (poor oral hygiene and lifestyle habits) there is great amount of cavity causing bacteria in the mouth and if that bacteria is transferred to the baby there are big chances the child will struggle with decaying. And this means this child needs fluoride. And if the parents do not offer it… pain, screaming in fear at the dentist, sedation/general anaesthesia, fillings, extractions, malposition of the permanent teeth because of the loss of the milk teeth… So unnecessary!

To be honest, I can understand the worry over the fluoridated water to some extent. After all it goes into your body.

But the fluoride toothpaste! You are not meant to swallow it, are you? With young kids you can’t prevent them swallowing the toothpaste but that’s why you use only very tiny amount of it.

But you adults, come on! The local effect of the fluoride is important in prevention of decay. You brush for 2 minutes (hopefully) and that’s the time the fluoride stays in your mouth. Then you spit it out and rinse with water (I don’t but that’s why I glow in the dark…ha-ha). No fluoride has entered your body.

But still some people mix all sorts of things with “healing properties” to be used as a toothpaste. Herbs, clay, coconut oil etc. I just read an article about coconut oil that was recommended by Dr. Somebody to be used instead of fluoride toothpaste. And as if the article wasn’t full of baloney but the comments at the end of the article were even more so.

…I laugh when dentists tell their patients not to brush for an hour….. why leave the acidity on your teeth to do damage for an hour – five times a day – seven days a week etc…. it adds up!

This person refers to a previous comment where somebody said he vigorously rinses his mouth with water after eating anything (which is fine). I’m sure all the professionals know what will happen to the teeth if one brushes every day after every meal – five times a day – seven days a week etc.

Erosion or to be precise it is abrasion that will happen to the teeth and that is irreversible damage which will lead to hypersensitivity of the teeth and make the teeth more prone to decaying.

Facts Simplified

There are minerals in the enamel of the tooth (hydroxyapatite). Minerals like calcium are lost everyday from the enamel because of the acids the bacteria produce from the carbohydrates in the diet.

The saliva tries to minimise the loss of minerals by neutralising the acids (remineralisation) but saliva can’t do magic if the host’s lifestyle is giving it too much to handle. Snacking (eating more frequently than 5-6 times a day), drinking acidic or sugary drinks in daily basis between the meals, eating sweets the wrong way (yes, there is a right way of eating them), adding sugar to the tea/coffee (even milk contains sugar) and consuming them between the meals. All these habits produce too much acid for the saliva to handle and it is not able to return all the lost minerals back to the enamel.

Loosing too much minerals from the enamel means decaying.

So to prevent that you need to find a way to compensate the lost minerals. The most important one is the calcium. And when combined with fluoride it repairs the enamel with very strong fluorapatite that is hard for the acids to break. It is much stronger material than hydroxyapatite that the enamel is originally made of. Some professionals even say that area of the enamel that has been replaced by fluorapatite won’t ever get decay.

But even if you do use fluoride in some form you will get decay if you have poor oral hygiene and your eating habits are harmful to the teeth. The fluoride will only slow down the decaying process.

There are exceptions of course. There are individuals who neglect their teeth and never get a decay. They might not use fluoride toothpaste or they might not brush at all. I will emphasise that they are exceptions. Average Joe will get decay I’m afraid. I have already written about this on my previous post. I wrote that it is very rare for people to have good enough oral hygiene habits. It is about one in thousand patients who do not need my interference in looking after their teeth. So most of us need minerals (calcium and fluoride) to protect the teeth from our laziness and unhealthy lifestyle.

Fluoride we cannot get through our diet unless you eat fish with the bones but even then there is no localised effect on teeth. So we need it from somewhere else. And the fluoridated water is simply not enough as it passes through the mouth and does not provide long enough localised effect (so don’t use that as an excuse). That’s why we use the toothpaste.

Right Way of Eating Sweets (Thought You Might Want to Know)

You can eat sweets without getting decay. Us dental professionals are a living proof of that. You see we looooove to eat sweets but rarely get decay. I will tell you how we do it.

  1. If you buy pack of sweets eat them in one go and have xylitol chewing gum, slice of cheese or fluoride tablet once you are finished. If you eat one sweet every 10 minutes for the next two hours you will have an acid attack in you mouth for approx. 2 hours and 30 minutes. Or even worse example. If you take one sweet every 30 minutes for the full working day it means you have had an acid attack the whole time you were working. Acid attack means losing minerals. And I have already told you earlier what happens if you loose too much minerals which you certainly will do if you have 7-8 hour-long constant acid attack.
  2. Eat sweets as dessert. You get acid attack already because of eating and you can avoid getting an extra acid attack by eating the sweet in one go after a meal. Have xylitol chewing gum, slice of cheese or fluoride tablet once you are finished
  3. Whenever possible and if you stomach can take it, buy sweets that are sweetened by xylitol. Now people often blame the xylitol for the laxative effect of sugar-free sweets. But it is often not the xylitol that causes the upset stomach. It is the maltitol syrup. So seek products that are sweetened 100% by xylitol.

 

Please note: This post is directed to healthy adults. People whose saliva flow is impaired through illness or medication need more intensive fluoride treatment on their teeth.

Wild West of the Home Whitening

Dental Revelations Blog-0310

Oh dear, where to begin.

The reason I chose this topic for my next post is that I was reading a dental blog that gave homemade teeth whitening tips to people. I’m sure the intention was good when they listed all known household items than can whiten the teeth. You see people love to get self help tips on their health – especially on their teeth to avoid seeing the dentist. But dental professionals should know better not to advice certain things as they can very quickly cause permanent damage to the teeth.

(This is a reminder for all of us not to believe everything you read from the net especially regarding your health)

Stains

There are two types of stains on your teeth. Surface stains and deep stains.

Surface stains build up from coffee, tea, red wine, smoking and certain spices, mouthwashes and vitamin supplements (iron in a liquid form).

Deep stains are those that will make the natural colour of your teeth (which you will see after scale and polish when the surface stains have been removed) yellower. The older you get the yellower the teeth will get (or have you seen elderly people with pearly white teeth? If you have they are false).

So what will damage your teeth? I will tell you. Starting from the worst. But at first for clarification

  • I will not give any instructions on how to use these substances
  • it won’t be a comprehensive list of the substances that is adviced to use for teeth whitening purposes but a list of most common ones

Lemon

Would you love to get white teeth with practically no money spent at all (as you get the lemons anyway for cooking etc) plus super sensitive teeth and eroded enamel to go with the deal? Yes? Use lemon.

An advice to use lemon for teeth whitening isn’t under any circumstance acceptable by a dental professional. Lemon is highly acidic fruit and can erode the teeth when used regularly. Erosion will result in sensitive teeth. Imagine if you already have thinned enamel for any reason and you start to use lemon for whitening purposes. You will soon find out it wasn’t a wise move as your teeth will become so sensitive to the cold that even breathing through your mouth hurts. Also the thin enamel will make you more prone to decay.

In 2005 BBC had to apologise publicly for a lemon tooth whitening tip when one of it’s programmes recommended lemon as a money saver to families. I happened to watch this programme and couldn’t believe what I was seeing. Thank goodness British Dental Health Foundation soon found out about the programme as well and complained to the BBC.

I’m not convinced that the apology reached everyone who watched the programme.

Strawberry and Baking Soda

Now combination of these two used daily for longer period of time will damage your enamel. Baking soda works as abrasive and strawberry as an acid. A very bad combination.

Safe frequency of use is once a week.

Baking Soda

It is slightly abrasive to teeth and can damage the teeth especially if used with vigorous brushing technique.

Do not use baking soda if you have braces. It can soften the glue.

Salt

Salt crystals can scratch the enamel. Make sure to let the salt dissolve in the water before using it (kinda looses the point of using the salt, doesn’t it?).

Hydrogen Peroxide

Hydrogen Peroxide is the only known substance that removes deep stains. It doesn’t remove the surface stains so a scale and polish is normally needed prior to the whitening.

There are products over the counter (OTC) that contains hydrogen peroxide but these should be used under a supervision of a dentist as the excessive use of hydrogen peroxide will weaken the enamel.

After Words

If you cause damage to your enamel by these abrasive or acidic home whitening products, it will be permanent. Thin enamel not only make the teeth sensitive to cold and prone to decay but it also makes the teeth look darker in colour. The dentin under the enamel is more yellow than the enamel and it will start to show through when the enamel gets thinner.

Important facts to remember

  • you can never ever change the natural colour of your tooth by lemon, baking soda, strawberry, whitening toothpastes etc. You may be able to remove the stains from the surface of the tooth but not the actual colour that is different with every individual
  • you should never replace fluoride toothpaste with any of the above means. Thinning of the enamel together with lack of fluoride will speed up sensitivity and decaying
  • all the means of whitening the teeth will result in damage of the enamel at certain level
  • any of the whitening products do not whiten fillings or crowns
  • the surface stains will carry on building up after the whitening if you carry on smoking and drinking coffee/tea/red wine. Also the new whitened natural colour of your teeth (whitened by hydrogen peroxide) will little by little get more yellow for the same lifestyle reasons

An impartial information about the risks of teeth whitening is almost impossible to find. The internet is full of practices advertising themselves and saying it’s all fine and dandy to do the whitening. So be cautious!

If you are interested in reading reliable article click here.