It's not just cavities anymore

It's not just cavities anymore
Web Posted: 03/12/2008 12:35 AM CDT
Don Finley
Express-News
Fluoride, sealants and more frequent patient visits have given dentists fewer cavities to drill and fill over the past three decades. But a growing thirst for soft drinks, fruit juices and acidic foods has given rise to another destructive phenomenon, experts say.
Dental erosion, the irreversible destruction of the hard enamel surface of the tooth, appears to be on the rise. And because it first creates a smooth, shiny appearance to the enamel, patients are unlikely to notice it — especially since it causes no pain or sensitivity in its early stages.
"When the enamel wears away, it cannot be replaced," said Dr. Bennett Amaechi, associate professor of community dentistry at the University of Texas Health Science Center. "Also, it damages the aesthetics of teeth, and the only way you can correct it is with a crown or some form of restoration, which is very costly."
In the first large attempt to measure the phenomenon in the United States, Amaechi and other researchers examined 900 10- to 14-year-olds in San Antonio, San Francisco and Indiana, and found that about 30 percent of them suffered from measurable dental erosion.
The still-unpublished study, conducted in 2004 and '05, found rates well below the 57 percent found in European children the same age. But some experts say the problem here is growing.

"I started talking about erosion 10 or 15 years ago when I lectured to other dentists, and they would give me this quizzical look," said Dr. Paul Casamassimo, professor of pediatric dentistry at Ohio State University, who has studied erosion but was not involved in this study. "Now, more and more people are saying we see it all the time."





Big contributors to the problem are acidic drinks and foods — especially soft drinks, along with some sports drinks, citrus fruits and fruit juices, wine, salad dressings and even some herbal teas. Locally, some Mexican food products — flavored beer salt, candies, powders and pastes, particularly the Lucas brand — are extremely high in acidic content, Amaechi said.

"The pH (level) you need for enamel to start breaking down is 5.5. And the pH of something like Coca-Cola or Sprite is in the neighborhood of 2.7. The lower the pH, the more acidic the drink," he said, pointing out that the pH of battery acid is 1. "Orange juice is about 3.8. Lucas is 2 to 3. We want people to be aware of that, so that even if they are taking it, they aren't taking it frequently."

Despite the high acidic content of local favorites, the rates in San Antonio were similar to those in San Francisco and Indiana, Amaechi said.

Tooth brushing immediately after consuming acidic foods isn't the answer, Amaechi said. If the acid etches the tooth enamel, brushing while the acid is still present worsens the damage. Instead, rinsing the mouth and waiting a half hour or more before brushing can prevent damage. A fluoride-containing mouth rinse is best, although rinsing with milk can help neutralize the acid. And rinsing with water, particularly if it is fluoridated, is better than nothing.

Certain medical conditions are also associated with dental erosion, including gastric reflux disorder and bulimia, which can expose the teeth to stomach acid. Long-term aspirin therapy can erode the teeth. So can professional wine tasting and competitive swimming in highly chlorinated pools.

Amaechi said it's not clear why Europeans might have a bigger problem, although the Europeans have done much of the research on dental erosion to date. It will require more studies in this country to confirm if the 30 percent found in this study is correct.