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A comparison of sports and energy drinks – Physiochemical properties and enamel dissolution

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Poonam Jain at ATSU Missouri School of Dentistry and Oral Health
Poonam Jain
  • ATSU Missouri School of Dentistry and Oral Health
Emily Hall-May
Emily Hall-May
Emily Hall-May
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Kristi Golabek
Kristi Golabek
Kristi Golabek
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Ma. Zenia N. Agustin at Southern Illinois University Edwardsville
Ma. Zenia N. Agustin
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Abstract

The consumption of sports and energy drinks by children and adolescents has increased at an alarming rate in recent years. It is essential for dental professionals to be informed about the physiochemical properties of these drinks and their effects on enamel. The present study measured the fluoride levels, pH, and titratable acidity of multiple popular, commercially available brands of sports and energy drinks. Enamel dissolution was measured as weight loss using an in vitro multiple exposure model consisting of repeated short exposures to these drinks, alternating with exposure to artificial saliva. The relationship between enamel dissolution and fluoride levels, pH, and titratable acidity was also examined. There was a statistically significant difference between the fluoride levels (p = 0.034) and pH (p = 0.04) of the sports and energy drinks studied. The titratable acidity of energy drinks (11.78) was found to be significantly higher than that of sports drinks (3.58) (p < 0.001). Five of the energy drinks (Red Bull Sugar Free, Monster Assault, Von Dutch, Rockstar, and 5-Hour Energy) were found to have the highest titratable acidity values among the brands studied. Enamel weight loss after exposure to energy drinks was significantly higher than it was after exposure to sports drinks. The effect of titratable acidity on enamel weight loss was found to vary inversely with the pH of the drinks. The findings indicated that energy drinks have significantly higher titratable acidity and enamel dissolution associated with them than sports drinks. Enamel weight loss after exposure to energy drinks was more than two times higher than it was after exposure to sports drinks. Titratable acidity is a significant predictor of enamel dissolution, and its effect on enamel weight loss varies inversely with the pH of the drink. The data from the current study can be used to educate patients about the differences between sports and energy drinks and the effects of these drinks on tooth enamel.
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... Consumption of sports drinks has increased noticeably among young adults and athletes. These drinks are acidic in nature and considered as risk factors for teeth erosion [6]. Jain et al. have investigated several multiple brands of soft drinks and have reported that the mean pH level was 2.91 [6], which is below the critical level for enamel dissolution [7,8]. ...
... These drinks are acidic in nature and considered as risk factors for teeth erosion [6]. Jain et al. have investigated several multiple brands of soft drinks and have reported that the mean pH level was 2.91 [6], which is below the critical level for enamel dissolution [7,8]. ...
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Wear of a tooth surface is a multifactorial and challenging problem to diagnose and manage. Identification of the etiology of worn dentition is complex, requiring an interdisciplinary approach. The long-term success of prosthodontic rehabilitation will depend on dentist's ability to successfully assess occlusal vertical dimension, aesthetic and functional demands of the patient, and patient compliance to maintain good oral hygiene, use of the occlusal appliance and attending periodic care visits. In this case report, a 62 year-old man presented to the prosthodontics clinic to improve his smile and chewing ability. Comprehensive case history, clinical and radiographic examinations were established to collect the necessary data for a treatment plan. A full-mouth rehabilitation was accomplished in sequenced treatment phases.
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... immersed in artificial saliva for the rest of the time, 14.53 ml, respectively 32) . The titratable acidity of the vitamin drinks used in the present study was higher than that of orange juice and sports drinks, and was similar to that of energy drinks. ...
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... More so, enamel erosion has become an important issue with the increased consumption of acidic drinks, such as sports drinks, soft drinks, and citric juices. 3,5,8,9 More worrisome is that the afore-mentioned products have a pH value below the critical level for dissolving dental enamel. 3,8 Gambon et al. 10 point out that citric acid, for example, is a complex acid with respect to erosive potential. ...
Evaluating the buffering and acid-resistant properties of eggshell–titanium dioxide composite against erosive acids
Article
Full-text available
  • Oct 2018
Objective:: This paper reports on the buffering and acid-resistant properties of a modified eggshell-titanium composite against citric acid attack. Materials and methods:: Eggshell-titanium EB-TiO2 was prepared by ball-milling eggshell powder and titanium dioxide. Fourier Transform Infrared Spectroscopy (FTIR), X-ray Diffraction (XRD), and Transmission Electron Microscopy (TEM) were used to characterize EB-TiO2. The buffering property against citric acid at pH values of 2, 4, and 5 was measured using a pH meter. Five brands of toothpaste (Colgate, Colgate Sensitive, Aquafresh, Oralwise, and Sensodyne) were used to assess the acid-resistant properties of EB-TiO2. Enamel models were simulated by dissolving each brand of toothpaste with eggshell (control) and EB-TiO2. The samples were exposed to citric acid of pH 2. The average slope (kPa/s) was measured using a pressure sensor. An analysis of variance was used to analyze the kPa/s values (α =.05). Results:: The FTIR and XRD analyses suggest the surface modification of EB-TiO2. The TEM image revealed spherical-shaped particles in EB-TiO2. The pH test results showed that the buffering properties of eggshell and EB-TiO2 were comparable. Significant differences were observed in the acid resistance properties of the samples exposed to citric acids ( P < .05). The Colgate toothpaste infused with eggshell powder had the highest mean kPa/s values, whereas Sensodyne infused with EB-TiO2 had the lowest kPa/s values. Conclusion:: The salient features of this study indicate that modification of eggshell with titanium dioxide does not affect its carbonate buffering properties. Connecting the kPa/s values to acid-resistant properties, EB-TiO2 effectively reduces erosive attacks when added to toothpaste.
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... They are commonly marketed to boost physical and mental performance, 23 and the popularity of these drinks has been fueled by these claims. 24 Consumption of energy drinks is a public health concern among children, adolescents, and young adults 24 because they may cause dental problems, 25 cardiovascular and neurological issues, 18 and in rare cases, death. 26 ...
Digital Promotion of Energy Drinks to Young Adults Is More Strongly Linked to Consumption Than Other Media
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Full-text available
  • Oct 2018
Objective: To examine whether digital marketing strategies are more strongly associated with energy drink use than other marketing and whether Theory of Planned Behavior (TPB) constructs mediated the effects of digital marketing on energy drink use. Design: A cross-sectional online survey using the TPB was administered in 2016. Setting: Illawarra region of New South Wales, Australia. Participants: A total of 359 young adults aged 18-24 years completed the survey. Participants were mainly students. Main outcome measures: Relative impacts of digital and other marketing on energy drink use and the mediating effects of TPB constructs: attitudes, subjective norm, and perceived behavioral control. Analysis: Stepwise regression analysis was employed to compare the effects on energy drink use from digital and other marketing. Mediation analysis was used to examine the mediating effects of the TPB constructs. Results: Digital marketing was more strongly associated than other marketing with young adults' energy drink use. Attitudes, subjective norms, and perceived behavioral control mediated the effects of digital marketing on energy drink use. Conclusions and implications: The marketing of unhealthy food and beverages such as energy drink products on the Internet requires greater scrutiny. Future interventions may focus on strategies to attenuate young adults' attitudes toward energy drinks, denormalize energy drink use, and strengthening self-efficacy to reject energy drinks among this age group.
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Erosion Potential of Alternative Beverages
Article
  • Mar 2023
Consumption of beverages considered to be healthier alternatives to carbonated beverages and sports and energy drinks is increasing. However, little is known about the potential for these beverages to cause dental erosion. This in vitro study examines pH, titratable acidity and enamel weight loss as three indicators of erosion potential of eight alternative beverages and a control solution. The results show that all tested beverages demonstrated the potential to erode human dental enamel.
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La educación para la salud bucal en adolescentes para la prevención del degaste dental. Perspectiva actual.
Article
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Se destaca la importancia de la educación en salud dental en los adolescentes dado el incremento del desgaste dental. La frecuencia en acudir a una consulta por molestias en los dientes, y en mayor parte, por un tema estético, el desgaste dental se puede presentar en grados severos y moderados; esto debido actualmente a la alimentación, como la ingesta de ácidos, bebidas carbonadas y también efectos de la fuerza ejercida por el cepillo dental. En esta investigación se relacionan las causas que pueden provocar la pérdida de estructura dental, así como las posibilidades de preverlo a partir de la educación. La metodología aplicada en este trabajo fue de tipo transversal y descriptiva, con revisión bibliográfica de distintas fuentes de investigación.
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Quantifying the degree of white spot lesions on enamel caused by different commercial beverages using the Canary Caries Detection System: An in vitro study
Article
  • May 2022
Background. The use of sports and energy drinks has drastically increased in the adolescent population. This population often is in orthodontic treatment, and the use of such drinks with poor oral hygiene promotes the development of white spot lesions (WSLs). Quantifying the degree of the lesion has been limited in the past. The hypothesis was that the Canary Caries Detection System could be used to quantify the degree of WSLs caused by different commercial beverages. Methods. A total of 105 extracted human premolars were divided into seven groups (n=15). Each group was tested in one of six beverages or a phosphate-buffered solution (control). The teeth were exposed to its beverage three times a day for 15 minutes for 28 days. Canary numbers and ambient light and fluorescent photographs were collected at baseline (T0 ) and on days 14 (T1 ) and 28 (T2 ). Results. The paired t test and one-way ANOVA found that T0 to T1 measurements were statistically significant (P<0.0015) and that T0 to T2 measurements were statistically significant (P<0.0001). Visually, the ambient light photographs and fluorescent photographs from T0 to T1 and T1 to T2 correlated with the increase in Canary numbers. Conclusion. This in vitro study revealed a statistically significant increase in the T0 to T1 Canary numbers and a statistically significant increase from T0 to T2 Canary numbers for all the test beverages. Changes in Canary numbers indicated significant changes in mineral density (i.e., demineralization) and development of WSLs on enamel after exposure to sports and energy beverages.
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An investigation in the remineralization and acid resistant characteristics of nanohydroxyapatite produced from eggshell waste via mechanochemistry
Article
Full-text available
  • Dec 2020
Objectives This study focuses on the properties of nanohydroxyapatite (nHAp) in terms of remineralization and acid resistance. The nHAp were produced from waste eggshells via the mechanochemistry process. Materials and methods The characterization was based on Fourier Transform Spectroscopy, X-ray diffraction, Field Scanning Electron Microscope (FESEM), and High-Resolution Electron Microscope to determine the surface morphology of the nHAp. The acid and remineralization properties were evaluated using bovine enamel and dentine models ( n = 5) while the buffering properties against acids were studied using a pH meter. The biocompatibility of the produce nHAp was assessed in vitro against NIH 3T3. Results The XRD and FTIR results confirm that nHAp were successfully produced from eggshell waste after 5 h of milling. The HRTEM reveals a semi-sphere morphology with an average dimension of 9 to 20 nm. The buffering test suggests that nHAp were highly effective in neutralizing common dietary acids. Also, the nHAp exhibits outstanding remineralization and occluding properties. The cytotoxicity assay suggests that the nHAp had a low toxicity. Conclusion The study concludes that using eggshell waste to produce nHAp will help in waste management and at the same time, provide valuable biomaterial for the treatment of tooth sensitivity.
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Perbedaan Kekerasan Permukaan Enamel Gigi Setelah Perendaman Dalam Berbagai Minuman Berenergi
Article
Full-text available
  • Dec 2019
Latar belakang. Enamel merupakan jaringan keras gigi yang dapat mengalami proses mineralisasi dan rentan terhadap serangan asam. Komposisi minuman yang banyak mengandung asam mempercepat kerusakan pada permukaan gigi. Minuman berenergi merupakan salah satu minuman yang banyak dikonsumsi oleh masyarakat untuk meningkatkan energi. Minuman tersebut mengandung gula, asam sitrat dan mempunyai pH rendah yang dapat menyebabkan demineralisasi pada enamel gigi. Demineralisasi yang terjadi terus menerus akan membentuk porositas pada permukaan enamel sehingga dapat menyebabkan larutnya mineral kalsium dan berpotensi terjadinya erosi gigi. Penelitian ini bertujuan untuk mengetahui perbedaan kekerasan permukaan enamel gigi setelah direndam dalam berbagai minuman berenergi. Metode. Tiga puluh dua gigi premolar rahang atas dibagi menjadi empat kelompok, dilanjutkan dengan pengukuran pH berbagai minuman berenergi. Kekerasan enamel gigi (pretest) diukur menggunakan alat Vickers Hardness Tester dan Zoom Stereo Mikroskop. Kelompok pertama (kontrol) direndam dalam aqua® pH 7,36, kelompok kedua direndam dalam minuman energi redbull® pH 3,32, kelompok ketiga direndam dalam minuman monster® pH 3,30 dan kelompok keempat direndam dalam minuman rockstar® pH 2,71 selama 24 jam. Kekerasan enamel gigi kemudian diukur kembali (posttest). Hasil. Data diuji secara statistik menggunakan uji oneway ANOVA dan post hoc LSD. Hasil uji oneway ANOVA pada pretest menunjukkan tidak ada perbedaan kekerasan permukaan enamel gigi yang signifikan. Hasil uji oneway ANOVA pada posttest menunjukkan terdapat perbedaan kekerasan permukaan enamel gigi yang signifikan. Hasil uji post hoc LSD menunjukkan terdapat perbedaan kekerasan enamel gigi yang signifikan pada semua kelompok. Kesimpulan. Minuman energi yang mempunyai pH rendah dapat menyebabkan penurunan kekerasan permukaan enamel gigi.
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Ultrastructural changes in the cemento‐enamel junction caused by acidic beverages: An in vitro study
Article
  • Oct 2019
The present in vitro study was aimed at evaluating the morphological changes in the cemento‐enamel junction (CEJ) after exposure to acidic beverages using the scanning electron microscopy (SEM). The initial pH and titratable acidity (TA) was analyzed from follow groups: (I) Coca cola, (II) orange juice, (III) Cedevita, (IV) Red Bull, (V) Somersby cider, and (VI) white wine. The CEJ samples (n = 64), obtained from unerupted third molars, were allocated to one control (artificial saliva, n = 16) and six experimental groups (n = 8). The experimental samples were immersed in beverages (50 ml) for 15 min, three times daily, 10 days, and in artificial saliva between immersions. SEM analysis was performed in a blind manner, according to scoring scale. One‐way ANOVA and Tukey's post hoc tests, as well as Kruskal–Wallis and Mann–Whitney U test used for statistical analysis. The pH values of the acidic beverages ranged from 2.65 (Coca cola) to 3.73 (orange juice), and TA ranged from 1.90 ml (Coca cola) to 5.70 ml (orange juice) of NaOH to reach pH 7.0. The SEM analysis indicated statistically significant differences between the control samples and those immersed in acidic beverages. The Groups IV, I, and II, showed the highest CEJ damage grade while those of the Group VI were the lowest. All the tested acidic beverages caused morphological changes in the CEJ with a smaller or larger exposure of dentine surface, and were not always related to the pH or TA of acidic beverages. Acidic beverages caused morphological changes in the cemento‐enamel junction (CEJ) of extracted teeth. Depending on the type of acid challenge, cementum depression, CEJ splitting, as well as smaller or larger exposure of dentine surface was noticed.
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Multivariate statistical analysis comparing sport and energy drinks
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Two different multivariate statistical techniques (principal component analysis and cluster analysis) have been applied on 75 commercial beverages (38 sport drinks and 37 energy drinks) considering 14 related nutrition factors (calories, total carbohydrate, sugars, sodium, potassium, magnesium, vitamin C, vitamin A, vitamin E, niacin, vitamin B6, vitamin B12, pantothenic acid and thiamine) to put in evidence the presence of homogeneous groups among the considered drinks. Three different groups have been obtained containing, respectively, 51, 7 and 17 beverages, each group characterised by different amounts of particularly meaningful variables.
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Energy Drinks: A New Health Hazard for Adolescents
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A new hazard for adolescents is the negative health effects of energy drink consumption. Adolescents are consuming these types of drinks at an alarming amount and rate. Specific effects that have been reported by adolescents include jitteriness, nervousness, dizziness, the inability to focus, difficulty concentrating, gastrointestinal upset, and insomnia. Health care providers report that they have seen the following effects from the consumption of energy drinks: dehydration, accelerated heart rates, anxiety, seizures, acute mania, and strokes. This article is a comprehensive literature review on the health effects of energy drinks. Findings from this article indicate the need for educational intervention to inform adolescents of the consequences of consuming these popular drinks. School nurses are in a unique position to teach adolescents about the side effects and possible health issues that can occur when energy drinks are consumed.
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Effects of Commercial Energy Drink Consumption on Athletic Performance and Body Composition
Article
  • Apr 2010
Energy drinks are frequently marketed to individuals interested in athletics and an active lifestyle. From 2001 to 2008, estimates of energy drink use in adolescent to middle-aged populations ranged from 24% to 56%. Most energy drinks feature caffeine and a combination of other components, including taurine, sucrose, guarana, ginseng, niacin, pyridoxine, and cyanocobalamin. This article examines the evidence for 2 commonly purported uses of energy drinks: athletic performance enhancement and weight loss. Observed ergogenic benefits of energy drinks are likely attributable to caffeine and glucose content. There is conflicting evidence regarding the impact of energy drinks on weight loss, although some data suggest that combining energy drink use with exercise may enhance body fat reduction. As with any pharmacologically active substance, energy drinks are associated with adverse effects. Combining energy drinks with alcohol exacerbates safety concerns and is an increasingly common practice contributing to toxic jock identity among college-aged male athletes. Practitioners should monitor identified populations likely to consume these loosely regulated beverages.
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Erosive potential of beverages sold in Australian schools
Article
Dental erosion is an increasingly prevalent problem in Australia. The aim of this study was to analyse the composition and erosive potential of beverages sold for consumption in Victorian schools. Fifteen drinks were selected and analysed to determine their pH, titratable acidity and ionic composition (calcium, fluoride and inorganic phosphate). The erosive potential of the beverages was measured by analysing weight loss, surface loss and the release of calcium ions from human enamel following a 30-minute or 24-hour exposure. The association of the chemical parameters with the measures of erosion was determined using Spearman's rank correlation. All beverages tested except the milks and the bottled water produced significant dental erosion in vitro. The only chemical parameter that correlated significantly with all measures of erosion was the initial pH of the beverage (p < 0.01). Levels of fluoride similar to those of Australian reticulated water were found in the carbonated beverages. The majority of the tested beverages sold from school canteens exhibited erosive potential.
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Acidic beverages increase the risk of in vitro tooth erosion
Article
  • May 2008
Acidic beverages are thought to increase the potential for dental erosion. We report pH and titratable acidities (ie, quantity of base required to bring a solution to neutral pH) of beverages popular in the United States and lesion depths in enamel and root surfaces after beverage exposure, and we describe associations among pH, titratable acidity, and both enamel and root erosive lesion depths. The pH of 100% juices, regular sodas, diet sodas, and sports drinks upon opening and the titratable acidity both upon opening and after 60 minutes of stirring were measured. Enamel and root surfaces of healthy permanent molars and premolars were exposed to individual beverages (4 enamel and 4 root surfaces per beverage) for 25 hours, and erosion was measured. Statistical analyses included 2-sample t tests, analyses of variance with post hoc Tukey studentized range test; and Spearman rank correlation coefficients. All beverages were acidic; the titratable acidity of energy drinks was greater than that of regular and diet sodas that were greater than that of 100% juices and sports drinks (P < .05). Enamel lesion depths after beverage exposures were greatest for Gatorade, followed by those for Red Bull and Coke that were greater than those for Diet Coke and 100% apple juice (P < .05). Root lesion depths were greatest for Gatorade, followed by Red Bull, Coke, 100% apple juice, and Diet Coke (P < .05). Lesion depths were not associated with pH or titratable acidity. Beverages popular in the United States can produce dental erosion.
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Buffering capacities of soft drinks: The potential influence on dental erosion
Article
  • Dec 1999
The pH of fruit juices and carbonated drinks are known to be low and have, therefore, been implicated in the increasing incidence of erosion. The ability of a drink to resist pH changes brought about by salivary buffering may play an important part in the erosion process. The aims of this study were to measure the initial pH of several widely available soft drinks and determine their buffering capacities. As part of a larger study, the following groups of drinks were tested: pure fruit juices, non-fruit-based carbonated drinks, fruit-based carbonated drinks, flavoured spring waters, and plain carbonated mineral waters as positive controls with still water as the negative control. The measurement of pH was carried out using a pH electrode connected to an Orion EA940 Ionanalyser. One hundred millilitres of each drink was then titrated with 1 M sodium hydroxide, added in 0.5 mL increments, until the pH reached 10. Each titration was repeated three times. The average initial pH was lowest for the non-fruit-based drinks (2.81+/-0.274) and highest for plain mineral water (7.4+/-0.1002). The buffering capacities can be ordered as follows: fruit juices>fruit-based carbonated drinks and flavoured mineral waters>non-fruit-based carbonated drinks>sparkling mineral waters>still mineral water. It is concluded that fruit juices and fruit-based carbonated beverages, with their increased buffering capacities, may induce a prolonged drop in oral pH.
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Effect of storage media upon the surface microorphology of resin-based restorative materials
Article
  • Oct 2002
The aim of this study was to evaluate the effect of different storage media upon the surface micromorphology of resin-based restoratives. One resin-modified glass-ionomer (Fuji II LC Improved), one polyacid-modified composite resin (Dyract AP), one microfilled composite resin (Durafill VS), and one hybrid composite resin (Filtek Z250) were tested. For each material, 45 standardized cylindrical specimens were randomly made. After 24 h, samples were finished and polished, and their surface roughness measured to obtain Ra (micro m) baseline values (Bv). Fifteen specimens of each material were then stored at 37 +/- 1 degrees C, for 24 h, either in distilled deionized water or in artificial saliva, or else subjected to a pH-cycling regimen. At the end of 10 days of storage, final readings (Fv) of surface roughness were obtained. The Analysis of Covariance (alpha=0.05), considering the covariate Bv showed a significant interaction between restorative materials and storage media (P value=0.0000). Multiple comparison Tukey's test revealed that the surface roughness of resin-based restoratives subjected to a pH-cycling model was significantly higher compared with both distilled deionized water and artificial saliva. Micromorphological changes were noticed in a situation of acid challenge.
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In vitro study on dental erosion provoked by various beverages using electron probe microanalysis
Article
Tooth erosion is often based on chemical processes, among others the use of soft drinks or diverse beverages. The aim of this in vitro study was to analyse the erosive potential of different acidic beverages. Over a time span of 6 hours, dental slices (n=6 slices per tooth) from fully retained wisdom teeth were incubated with different beverages (coca cola, ice tea with lemon, apple juice and white wine). The controls were incubated with a 0.9% sodium chloride solution under the same conditions (37 degrees C, humidified atmosphere of 5% CO2 and 95% air). The quantitative elementary analysis for calcium, phosphorus, oxygen and other trace elements in the dental slices in various depths ranging from 5 to 50 microm was carried out using an electron probe micro-analyser (Jeol JXA 8900RL). A beverage-induced loss of minerals, particularly of the 2 main components calcium and phosphorus, especially in the uppermost layers of the enamel down to a depth of 30 microm could be observed. In the depth of 10 microm, the following total mineral loss could be determined: white wine (16%), coca cola (14.5%), apple juice (6.5%) and ice tea with lemon (6.5%). A direct correlation between the loss of minerals and the pH value of the beverages was not observed, because of the buffering effect of the drinks. The conversion of the weight percentages from the chemical analysis of Ca and P to their atomic percentages showed that during erosion the 2 main components were not dissolved in significantly different percentages. In this study the erosive potential of the tested soft drinks and other beverages could be demonstrated. However, it must be considered that numerous modifying factors influence the enamel surface, so an extrapolation from the in vitro study to an in vivo situation can only be applied with caution.
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Influence of drinking patterns of carbonated beverages on dental erosion
Article
As a hard tissue dental disease, dental erosion has a multifactorial etiology. The majority of dental erosion that originates from extrinsic sources is the result of dietary intake, particularly acidic beverages. Several preventive means have been proposed to minimize the damage to the dentition, including a reduction in the consumption of causative beverages and the adoption of a specific method of drinking, utilizing a straw instead of a cup. This article presents two cases involving the clinical and radiographic features of erosion lesions associated with chronic and excessive intake of acidic carbonated beverages. These examples embody how drinking patterns influence the formation of erosion lesions in various anatomic locations within the dentition. The clinical and radiographic evidence presented in this report cautions against the use of nonspecific terms, such as "cup versus straw," and instead suggests implementing a more precise description of the suggested method. In view of the extensive damage inflicted by the chronic, excessive intake of carbonated beverages, preventive measures are considered to be the only effective course of management. This article offers illustrative examples of erosion lesions associated with long-term excessive intake of carbonated beverages. The influence of the drinking method--that is, a straw positioned into the labial vestibule versus a cup--on the anatomic location of the erosion lesions will be demonstrated through clinical and radiographic evidence.
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