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Ever since prehistoric man was chewing tree bark and gnawing on the bones of wild animals, the erosion of tooth enamel has been a problem. And even though humans have come a very long way in minimizing the degree and consequences of dental erosion, it is still is an everyday problem.

Bruxism and attrition remain the main culprits, but the growing threat to tooth enamel, especially among young people, are the acids consumed by way of sugary, acidic soda pops, fruit juices and sports/energy beverages.

According to a study published recently in Dental Tribune, researchers in Texas, Indiana and California examined 900 middle-school students and found that 30 percent had suffered the corrosive effects of acid from such drinks. That number may be conservative in Central Florida.

“Fifty percent of the kids we see have problems related to soda,’’ said Dr. Brian O’Sullivan, a family dentist with a practice in Spring Hill. “It’s very, very destructive. We’ve had some teenagers that … when we saw them for the first time there was very little tooth structure remaining in the majority of their teeth,’’ O’Sullivan said.

That is why it is so important to detect the erosion and its cause early on. The earliest signs are decalcification, or white lesions, on the teeth, O’Sullivan said, and the next step is flaking of the enamel, followed by the decay internally into the tooth.

Dr. Afsoon Elmore is a general dentist in Fern Park who works on a referral-only basis, and limits her practice to children 8 years and younger. All told, about 95 percent of her patients present with dental erosion and of those about 60 percent exhibit serious or extreme conditions. She said she usually sees patients on their first birthday and even that early there can be signs of dental erosion as the result of sugars and acids.

“That’s where we see our first problem,’’ Elmore said. “The pattern we are seeing is that kids are not drinking water and the ones who are drinking water are drinking it from a bottle that does not have fluoride in it.’’

Far too many small children are drinking “Capri Suns, Gatorade, vitamin water, soda, chocolate milk, strawberry milk, and just lots of drinks with artificial color and high-fructose corn syrup,’’ Elmore said.

Elmore and O’Sullivan both emphasize the importance of obtaining a nutritional history and providing nutrition counseling as one of the best ways to combat this problem.

“We’ll talk to the parents about it and they say ‘We’ll get to work on it.’ My retort to that is ‘You buy the groceries in the house. Just stop buying soda,’’’ O’Sullivan said.

Elmore, 47, said a nutritional history “helps us give guidance to the parents for changes they can make so that they don’t ruin the adult teeth in the same manner.’’ It also can help siblings, Elmore said. If she sees severe decay in a 1-year-old, she will ask to see the child’s 4-year-old brother or sister, for example, to ensure that child isn’t in the same pattern.

These sugary, acidic drinks predominantly damage the front teeth, O’Sullivan said, and “sipping them all day can have a devastating effect on young people’s teeth.’’

And orthodontists have “an even more uphill battle,’’ he said. Ultimately, (dentists) receive the brunt of the problem, but when you combine the braces or brackets that are bonded to the teeth in order to move them, with the kids drinking soda and not doing a great job cleaning … when the brackets come off there are brown and white spots and circles where the brackets were. It’s a huge cosmetic problem,’’ O’Sullivan said.

Elmore agreed. “If you are chewing an apple, you are producing saliva and the saliva washes the teeth. But it takes 20 minutes for your saliva to get rid of that sugar (from drinks). … If you are sipping on a can of soda for two hours, you’re keeping an acid bath on your teeth,’’ she said.

Although unhealthy drinks are a rising cause of dental erosion, they are not the only one. O’Sullivan said he occasionally sees dental damage in adult patients who suffer from gastroesophageal reflux disease, and also in bulimics. “We sometimes see younger girls who have (damage from bulimia). It looks like someone has polished the enamel off the inside of their incisors,’’ he said.

O’Sullivan also has concerns about whitening toothpastes contributing to the erosion of enamel. Many of the toothpastes purporting to be to be whitening formulations are extremely abrasive. Over a period of time they are going to be damaging,’’ he said. “The whitening component is peroxide, but it also has an abrasive that is really not necessary. Claims are made that it will remove the stains and it will whiten and brighten your teeth,’’ said O’Sullivan, 53. “But it really does not improve that much over traditional toothpaste formulations.’’

Further, O’Sullivan said, over time “as your enamel is being thinned down from (the chemical whitening agents), the color of the dentin starts coming through. Dentin is dark and over time it will make your teeth darker,’’ which is the opposite of the user’s intent.

And bruxism, or teeth grinding, continues to exact a toll on enamel. “Everyone grinds,’’ O’Sullivan said, and that is “a bigger problem. The simple solution is the acrylic night guards that are reversible, sensible and pretty reasonably priced. As I tell patients, acrylic is a lot cheaper than enamel,’’ he said.

For young people who are candidates for erosion – and according to the Centers for Disease Control and Prevention cavities are on the rise among pre-schoolers – the best advice O’Sullivan and Elmore can offer is simple: Drink fluoridated water, use fluoridated toothpaste and cut out the sugary, acidic drinks.

“Read the nutrition labels and choose your foods wisely,’’ Elmore said. “Look for the total carbohydrates. Most of these type drinks have 39 carbs. But a Hershey bar has only 25 carbs,’’ she said. These drinks are “contributing to cardiovascular disease, obesity and diabetes; it’s all connected.’’

And if your youngster just can’t do without an occasional soft drink or fruit juice, “at a minimum, tell them to drink it quickly and rinse with water when they are done,’’ O’Sullivan said.



June 2008

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