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The pH of beverages in the United States

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Background: Dental erosion is the chemical dissolution of tooth structure in the absence of bacteria when the environment is acidic (pH < 4.0). Research indicates that low pH is the primary determinant of a beverage's erosive potential. In addition, citrate chelation of calcium ions may contribute to erosion at higher pH. The authors of this study determined the erosive potential measured by the pH of commercially available beverages in the United States. Methods: The authors purchased 379 beverages from stores in Birmingham, Alabama, and categorized them (for example, juices, sodas, flavored waters, teas, and energy drinks) and assessed their pH. They used a pH meter to measure the pH of each beverage in triplicate immediately after it was opened at a temperature of 25°C. The authors recorded the pH data as mean (standard deviation). Results: Most (93%, 354 of 379) beverages had a pH of less than 4.0, and 7% (25 of 379) had a pH of 4.0 or more. Relative beverage erosivity zones based on studies of apatite solubility in acid indicated that 39% (149 of 379) of the beverages tested in this study were considered extremely erosive (pH < 3.0), 54% (205 of 379) were considered erosive (pH 3.0 to 3.99), and 7% (25 of 379) were considered minimally erosive (pH ≥ 4.0). Conclusions: This comprehensive pH assessment of commercially available beverages in the United States found that most are potentially erosive to the dentition. Practical implications: This study's findings provide dental clinicians and auxiliaries with information regarding the erosive potential of commercially available beverages. Specific dietary recommendations for the prevention of dental erosion may now be developed based on the patient's history of beverage consumption.
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The pH of beverages in the
United States
Avanija Reddy, DMD, MPH; Don F. Norris, DMD; Stephanie
S. Momeni, MS, MBA; Belinda Waldo, DMD; John D. Ruby,
DMD, PhD
S
weetened and avored beverage consumption
has increased dramatically over the past 35 years
in the United State s with carbonated soft drinks
being consumed the most frequently, and most
often by children, teens, and young adults.
1-3
In 1942, the
annual production of soft drinks was approximately 60
12-ounce servings per person; that number has increased
almost 10 -fold since 2005.
4
Between 1999 and 2002, daily
carbonated soft drink
and fruit drink con-
sumption by 13-to18-
year-olds was 26 oun-
ces, and the Center for Science in the Public Interest has
reported that in 2004, total consumption of these drinks
for every man, woman, and child was approximately 68
gallons per year.
4
The prevalence of dental erosion in the
21st century has also increased due to our enhanced
preference for sweet and sour.
5
The consumption of
acidic beverages contributes to an erosive oral milieu and
should be of concern to the dental practitioner.
6-9
The pH of commercial nonalcoholic, nondairy bev-
erages ranges from 2.1 (lime juice concentrate) to 7.4
(spring water).
10
Commercially available beverages with a
pH of less than 4.0 are potentially damaging to the
dentition.
11
Acids are added to beverages and compose a
avor prole giving the beverage a distinctive taste. Acids
provide a tartness and tangy taste that helps to balance
the sweetness of sugar present in the beverage; they are
key factors in the taste of the beverage. Phosphoric acid is
added to cola drinks to impart tartness, reduce growth of
bacteria and fungi, and improve shelf-life. Citric acid, a
Copyright ª 2016 American Dental Association. All rights reserved.
ABSTRACT
Background. Dental erosion is the chemical dissolution
of tooth structure in the absence of bacteria when the
environment is acidic (pH < 4.0). Research indicates that
low pH is the primary determinant of a beverages erosive
potential. In addition, citrate chelation of calcium ions may
contribute to erosion at higher pH. The authors of this
study determined the erosive potential measured by the pH
of commercially available beverages in the United States.
Methods. The authors purchased 379 beverages from
stores in Birmingham, Alabama, and categorized them (for
example, juices, sodas, avored waters, teas, and energy
drinks) and assessed their pH. They used a pH meter to
measure the pH of each beverage in triplicate immediately
after it was opened at a temperature of 25
C. The authors
recorded the pH data as mean (standard deviation).
Results. Most (93%, 354 of 379) beverages had a pH of
less than 4.0, and 7% (25 of 379) had a pH of 4.0 or more.
Relative beverage erosivity zones based on studies of apatite
solubility in acid indicated that 39% (149 of 379) of the
beverages tested in this study were considered extremely
erosive (pH < 3.0), 54% (205 of 379) were considered
erosive (pH 3.0 to 3.99), and 7% (25 of 379) were consid-
ered minimally erosive (pH $ 4.0).
Conclusions. This comprehensive pH assessment of
commercially available beverages in the United States
found that most are potentially erosive to the dentition.
Practical Implications. This studys ndings provide
dental clinicians and auxiliaries with information
regarding the erosive potential of commercially available
beverages. Specic dietary recommendations for the pre-
vention of dental erosion may now be developed based on
the patients history of beverage consumption.
Key Words. Erosive potential; commercial beverages;
pH; dental erosion.
JADA 2016:
-(-):---
http://dx.doi.org/10.1016/j.adaj.2015.10.019
ORIGINAL CONTRIBUTIONS
JADA -(-) http://jada.ada.org - 2016 1
substance naturally occurring in citrus drinks and added
to many others, imparts a tangy avor and functions as a
preservative. Malic acid occurs naturally in apples, pears,
and cherries, and is added to many noncarbonated
beverages such as fruit drinks, fortied juices, sports
drinks, and iced teas because it enhances the intrinsic
avor. Malic acid also is added to articially sweeten
carbonated beverages to intensify taste and reduce the
amount of other added avorings. These additives give
the beverage its distinctive sugar and acid signature taste.
Dental erosion is the irreversible acidic dissolution of
surface tooth structure by chemical means in the absence
of microorganisms. It primarily occurs when hydrogen
ions interact with the surface uorapatite and hydroxy-
apatite crystals after diffusion through plaque-pellicle
biolma process termed proton-promoted dissolu-
tion.
12
Erosion may initially progress through the enamel
TABLE 1
pH of waters and sports drinks.*
WATERS AND SPORTS DRINKS pH (STANDARD
DEVIATION)
Extremely Erosive
Activ Water Focus Dragonfruit 2.82 (0.04)
Activ Water Vigor Triple Berry 2.67 (0.01)
Gatorade Frost Riptide Rush 2.99 (0.01)
Gatorade Lemon-Lime 2.97 (0.01)
Gatorade Orange 2.99 (0.00)
Powerade Fruit Punch 2.77 (0.01)
Powerade Grape 2.77 (0.01)
Powerade Lemon Lime 2.75 (0.01)
Powerade Mountain Berry Blast 2.82 (0.01)
Powerade Orange 2.75 (0.02)
Powerade Sour Melon 2.73 (0.00)
Powerade Strawberry Lemonade 2.78 (0.01)
Powerade White Cherry 2.81 (0.01)
Powerade Zero Grape 2.97 (0.01)
Powerade Zero Lemon Lime 2.92 (0.00)
Powerade Zero Mixed Berry 2.93 (0.01)
Powerade Zero Orange 2.93 (0.01)
Erosive
Activ Water Power Strawberry Kiwi 3.38 (0.03)
Clear American (avored water) Kiwi
Strawberry
3.70 (0.01)
Clear American (avored water) Pomegranate
Blueberry Acai
3.24 (0.01)
Clear American (avored water) Tropical Fruit 3.07 (0.01)
Clear American (avored water) White Grape 3.43 (0.01)
Dasani Grape 3.05 (0.01)
Dasani Lemon 3.03 (0.01)
Dasani Strawberry 3.03 (0.01)
Gatorade Blueberry Pomegranate Low Calorie 3.21 (0.01)
Gatorade Fierce Grape 3.05 (0.00)
Gatorade Fierce Melon 3.05 (0.00)
Gatorade Fruit Punch 3.01 (0.01)
Gatorade Rain Berry 3.17 (0.01)
Gatorade Rain Lime 3.19 (0.01)
Gatorade Rain Strawberry Kiwi 3.17 (0.01)
Propel Berry 3.01 (0.00)
Propel Grape 3.10 (0.01)
Propel Kiwi Strawberry 3.17 (0.00)
Propel Lemon 3.03 (0.00)
S. Pellegrino Sparkling Natural Mineral Water 4.96 (0.09)
Skinny Water Acai Grape Blueberry 3.81 (0.02)
Skinny Water Goji Fruit Punch 3.67 (0.01)
Skinny Water Raspberry Pomegranate 3.68 (0.01)
Sobe Life Water Acai Fruit Punch 3.22 (0.01)
Sobe Life Water Blackberry Grape 3.15 (0.01)
Sobe Life Water Cherimoya Punch 3.28 (0.00)
Sobe Life Water Fuji Apple Pear
3.53 (0.01)
Sobe Life Water Mango Melon 3.29 (0.01)
Sobe Life Water Strawberry Dragonfruit 3.32 (0.01)
* For manufacturer information, please see the Appendix (available
online at the end of this article).
TABLE 1 (CONTINUED)
WATERS AND SPORTS DRINKS pH (STANDARD
DEVIATION)
Vidration Vitamin Enhanced Water Defense
Pomegranate-Acai-Blueberry
2.92 (0.01)
Vidration Vitamin Enhanced Water Energy
Tropical Citrus
2.91 (0.01)
Vidration Vitamin Enhanced Water Multi-V
Lemon Lime
3.59 (0.01)
Vidration Vitamin Enhanced Water Recover
Fruit Punch
3.61 (0.01)
Vitamin Water Connect Black Cherry-Lime 2.96 (0.01)
Vitamin Water Dwnld Berry-Cherry 3.04 (0.01)
Vitamin Water Energy Tropical Citrus 3.15 (0.01)
Vitamin Water Essential Orange-Orange 3.23 (0.00)
Vitamin Water Focus Kiwi-Strawberry 3.04 (0.01)
Vitamin Water Multi-V Lemonade 3.19 (0.01)
Vitamin Water Power C Dragonfruit 3.05 (0.00)
Vitamin Water Revive Fruit Punch 3.65 (0.01)
Vitamin Water Spark Grape-Blueberry 3.19 (0.01)
Vitamin Water XXX Acai-Blueberry-
Pomegranate
2.98 (0.01)
Vitamin Water Zero Go-Go Mixed Berry 3.08 (0.01)
Vitamin Water Zero Mega C Grape-Raspberry 3.05 (0.00)
Vitamin Water Zero Recoup Peach-Mandarin 3.01 (0.01)
Vitamin Water Zero Rise Orange 3.46 (0.00)
Vitamin Water Zero Squeezed Lemonade 3.19 (0.00)
Vitamin Water Zero XXX Acai-Blueberry-
Pomegranate
3.05 (0.01)
Minimally Erosive
Aquana regular 6.11 (0.23)
Birmingham, Alabama, municipal water 7.20 (0.05)
Dasani regular 5.03 (0.04)
Perrier carbonated mineral water 5.25 (0.10)
ABBREVIATION KEY. NIDCR: National Institute of Dental
and Craniofacial Research.
ORIGINAL CONTRIBUTIONS
2 JADA -(-) http://jada.ada.org - 2016
TABLE 2
pH of fruit juices and fruit drinks.*
FRUIT JUICES pH (STANDARD
DEVIATION)
Extremely Erosive
Lemon juice 2.25 (0.01)
Minute Maid Cranberry Apple Raspberry 2.79 (0.01)
Minute Maid Cranberry Grape 2.71 (0.01)
Ocean Spray Cranberry 2.56 (0.00)
Ocean Spray Cran-Grape 2.79 (0.01)
Ocean Spray Cran-Pomegranate 2.72 (0.01)
Ocean Spray Strawberry Kiwi Juice Cocktail 2.90 (0.01)
V8 Splash Berry Blend 2.94 (0.01)
V8 Splash Strawb erry Kiwi 2.99 (0.01)
V8 Splash Tropical Blend 2.93 (0.00)
Erosive
Amp Energy Juice Mixed Berry 3.62 (0.01)
Amp Energy Juice Orange 3.60 (0.01)
Barbers Orange Juice 3.81 (0.01)
Dole Pineapple Juice 3.40 (0.01)
Juicy Juice Apple 3.64 (0.01)
Juicy Juice Berry 3.78 (0.01)
Juicy Juice Sparkling Apple 3.47 (0.01)
Juicy Juice Sparkling Berry 3.50 (0.01)
Juicy Juice Sparkling Orange 3.49 (0.01)
Minute Maid Apple Juice 3.66 (0.01)
Minute Maid Natural Energy Mango
Tropical
3.34 (0.02)
Minute Maid Natural Energy Pomegranate
Berry
3.33 (0.01)
Minute Maid Natural Energy Strawberry
Kiwi
3.40 (0.01)
Minute Maid Orange Juice 3.82 (0.01)
Minute Maid Pi neapple Orange 3.71 (0.01)
Minute Maid Ruby Red Grapefruit Juice 3.07 (0.03)
Naked Blue Machine 3.81 (0.01)
Naked Orange Mango 3.75 (0.01)
Ocean Spray Orange Juice 3.83 (0.01)
Ocean Spray Pineapple Peach Mango
Juice Blend
3.64 (0.01)
Ocean Spray Ruby Red 3.07 (0.01)
Simply Apple 3.67 (0.01)
Simply Orange Orang e Juice 3.78 (0.00)
Tango Energy Juice 3.47 (0.00)
Tropicana 100% Juice Apple Juice 3.50 (0.02)
Tropicana 100% Juice Orange Juice 3.80 (0.01)
Tropicana Apple Orchard Style Juice 3.57 (0.00)
Tropicana Grape Juice 3.29 (0.01)
V8 Fusion Cranberry Blackberry 3.56 (0.01)
V8 Fusion Pomegranate Blueberry 3.66 (0.00)
V8 Fusion Strawberry Banana 3.66 (0.00)
Very Fine Grapefruit Juice 3.22 (0.03)
Welchs 100% Gr ape Juice 3.38 (0.00)
Welchs Apple Juice
3.57 (0.01)
Welchs Orange Juice 3.73 (0.00)
* For manufacturer information, please see the Appendix (available
online at the end of this article).
TABLE 2 (CONTINUED)
FRUIT JUICES pH (STANDARD
DEVIATION)
Minimally Erosive
Campbells Tomato Juice 4.01 (0.01)
Naked Protein Zone 4.69 (0.01)
Tropicana Orange Juice (With Calcium) 4.09 (0.01)
V8 Vegetable Juice 4.23 (0.01)
V8 Vegetable Juice Low Sodium 4.17 (0.01)
V8 Vegetable Juice Spicy Hot 4.19 (0.00)
FRUIT DRINKS pH (STANDARD
DEVIATION)
Extremely Erosive
Barbers Lemonade 2.69 (0.00)
Barbers Orange Drink 2.96 (0.00)
Bug Juice Berry Raspberry 2.99 (0.01)
Bug Juice Grapey Grape 2.83 (0.00)
Country Time Lemonade 2.72 (0.01)
Crystal Light Fruit Punch 2.96 (0.02)
Crystal Light Raspberry Ice 2.77 (0.01)
Hi-C Tropical 2.81 (0.03)
Kool-Aid Mix Cherry 2.71 (0.00)
Kool-Aid Mix Grape 2.83 (0.01)
Kool-Aid Mix Lemon-Lime 2.73 (0.01)
Kool-Aid Mix Orange 2.77 (0.01)
Kool-Aid Mix Pink Lemonade 2.66 (0.01)
Kool-Aid Mix Tropical Punch 2.69 (0.00)
Minute Maid Fruit Punch 2.86 (0.00)
Minute Maid Lemonade 2.57 (0.01)
Minute Maid Orangeade 2.85 (0.00)
Minute Maid Pink Lemonade 2.59 (0.00)
Simply Lemonade 2.61 (0.01)
Snapple Kiwi Strawberry 2.77 (0.01)
Snapple Mango Madness 2.89 (0.01)
Sobe Black and Blueberry Brew 2.69 (0.00)
Sobe Citrus Energy 2.63 (0.00)
Sobe Power Fruit Punch 2.43 (0.02)
Sobe Strawberry Banana 2.62 (0.01)
Sun Fresh Lemonade 2.68 (0.01)
Sunny D Smooth 2.92 (0.01)
Sunny D Tangy Original 2.86 (0.01)
Tropicana Cranberry Cocktail 2.70 (0.01)
Tropicana Juice Beverage Cranberry 2.59 (0.00)
Tropicana Juice Beverage Grape 2.58 (0.00)
Tropicana Lemonade 2.70 (0.01)
Tropicana Twister Blue Raspberry Rush 2.62 (0.00)
Tropicana Twister Cherry Berry Blast 2.63 (0.00)
Tropicana Twister Orange Strawberry
Banana Burst
2.89 (0.01)
Tropicana Twister Strawberry Kiwi Cyclone 2.59 (0.01)
Welchs Blueberry Kiwi Blast 2.57 (0.01)
Welchs Cranberry 2.59 (0.02)
Welchs Grape Juice Cocktail 2.92 (0.01)
Welchs Ruby Red Grapefruit Juice 2.97 (0.01)
ORIGINAL CONTRIBUTIONS
JADA -(-) http://jada.ada.org - 2016 3
lamellae, exposing dentinal tubules leading to dentinal
sensitivity; however, with continuous erosive insult to the
surface enamel, larger areas of the dentoenamel junction
will eventually become exposed, leading to enhanced
sensitivity.
7,13,14
As the oral cavity pH drops to less than
4.0, the tooth surface erodes, and with each unit of
decrease in pH there is a 10-fold increase in enamel
solubility resulting in a 100-fold increase in enamel
demineralization as the pH approaches 2.0 from 4.0.
11
Importantly, the consumption of beverages with higher
concentrations of available hydrogen ions (pH < 4.0)
results in the immediate softening of the tooth surface
that becomes quite susceptible to removal by abrasion
and attrition.
15
The frequent consumption of acidic beverages is a
developing problem for children, teenagers, and adults.
The dramatic increase in consumption of acidic soft
drinks, fruit juices, fruit drinks, sports drinks, and
carbonated beverages is now thought to be the leading
cause of dental erosion observed among children and
adolescents.
16-18
A literature review of dental erosion in
children indicates its prevalence may range from 10%to
80%.
19
Primary teeth, having a thinner enamel layer,
are more susceptible to rapid erosion into den tin,
leading to exposure of the dental pulp.
19
It is evident that
erosion causes many clinical problems, with restorative
treatment becoming necessary to replace lost tooth
structure, eliminate dental pain, and restore function and
esthetics.
Research has indicated pH, not titratable acidity, is
the critical determinant of a beverages erosive poten-
tial.
10,19-24
Citrate may also contribute to dental erosion
by removing calcium ions through ligand-promoted
dissolution (chelation) at a higher pH approaching 6.
12
The purpose of this study is to determine the
hydrogen ion concentration (pH) of beverages including
new products that are commercially available in US
stores, gas stations, and vending machines. Information
obtained from this study will enable dental care practi-
tioners to make appropriate dietary beverage suggestions
when counseling patients on the damaging effects of acid
in drinks.
METHODS
We purchased nonalcoholic, nondairy beverages from
convenience stores, grocery stores, gas stations, and
vending machines in the Birmingham , Alabama, area.
We studied and categorized a total of 379 beverages.
Groups included waters and sport drinks (Table 1); juices
and fruit drinks (Table 2); sodas (Table 3); and energy
drinks, teas, and coffee (Table 4). We used an Accumet
AR15 pH meter (Fisher Scientic) to measure the pH of
each beverage in triplicate immediately after opening at a
temperature of 25
C. We recorded the pH data as range
and mean (standard deviation [SD]). Nutritional infor-
mation labels on the containers were used to determine
the type of acids added to the beverages.
RESULTS
All pH data were expressed as range and mean (SD).
Seventy waters and sports drinks had a pH range of 2.67
to 7.20 and a mean (SD) value of 3.31 (0.77)(Table 1).
Fifty-one juices had a pH range of 2.25 to 4.69 and a
mean (SD) value of 3.48 (0.47)(Table 2). Sevent y-eight
fruit drinks had a pH range of 2.43 to 3.87 and a mean
(SD) value of 2.99 (0.31)(Table 2). Ninety-four sodas had
a pH range of 2.32 to 5.24 a nd a mean (SD) value of 3.12
(0.52)(Table 3). Sixty-eight energy drinks had a pH range
TABLE 2 (CONTINUED)
FRUIT DRINKS pH (STANDARD
DEVIATION)
Erosive
Barbers Fruit Punch 2.96 (0.00)
Bug Juice Fruity Punch 3.09 (0.00)
Bug Juice Leapin Lemonade 3.06 (0.00)
Bug Juice Whistlin Watermelon 3.40 (0.01)
CapriSun Surfer Cooler 3.08 (0.00)
Crystal Light Green Tea Raspberry Mix 3.11 (0.02)
Fuze Banana Colada 3.45 (0.03)
Fuze Blueberry Raspberry 3.20 (0.01)
Fuze Green Tea Honey and Ginseng 3.28 (0.02)
Fuze Orange Mango 3.34 (0.02)
Fuze Peach Mango 3.53 (0.01)
Fuze Strawberry Banana 3.54 (0.01)
Fuze Strawberry Gu ava 3.55 (0.02)
Fuze Strawberry Melon 3.18 (0.01)
Fuze Tropical Punch 3.17 (0.01)
Jumex Guava 3.38 (0.02)
Jumex Mango 3.41 (0.01)
Jumex Peach 3.33 (0.02)
Jumex Strawberry Banana 3.68 (0.01)
Kool-Aid Burst (Tropical) 3.07 (0.01)
Little Hug Grape 3.09 (0.01)
Little Hug Orang e 3.00 (0.01)
Mondo (Legendary Berry) 3.07 (0.01)
Mondo (Primo Punch) 3.10 (0.01)
Sesame Street Elmos Punch 3.87 (0.01)
Sobe Fuji Apple Cranberry (low calorie) 3.16 (0.01)
Sobe Orange Carrot 3.34 (0.00)
Sobe Pina Colada 3.25 (0.01)
TumE Yummies Fruitabulous Punch 3.35 (0.00)
TumE Yummies Orangearic 3.34 (0.01)
TumE Yummies Soursational Raspberry 3.18 (0.00)
TumE Yummies Very Berry Blue 3.33 (0.00)
Vitamin Stix Dragonfruit Acai 3.11 (0.01)
Vitamin Stix Passionfruit Citrus 3.19 (0.01)
Vitamin Stix Strawberry Kiwi 3.06 (0.01)
Welchs Orange Pineapple 3.20 (0.01)
Welchs Strawberry Kiwi 3.03 (0.01)
ORIGINAL CONTRIBUTIONS
4 JADA -(-) http://jada.ada.org - 2016
TABLE 3
pH of sodas.*
SODA pH (STANDARD
DEVIATION)
Extremely Erosive
7UP Cherry 2.98 (0.01)
Boylans Black Cherry 2.76 (0.02)
Boylans Grape 2.91 (0.01)
Boylans Sugar Cane Cola 2.54 (0.01)
Canada Dry Ginger Ale 2.82 (0.01)
Coca-Cola Caffeine Free 2.34 (0.03)
Coca-Cola Cherry 2.38 (0.03)
Coca-Cola Cherry Zero 2.93 (0.01)
Coca-Cola Classic 2.37 (0.03)
Coca-Cola Lime Diet 2.96 (0.03)
Coca-Cola Zero 2.96 (0.03)
Crush Grape 2.76 (0.01)
Crush Orange 2.87 (0.01)
Dr. Pepper 2.88 (0.04)
Fanta Grape (2 liter) 2.67 (0.02)
Fanta Orange 2.82 (0.02)
Fanta Pineapple (2 liter) 2.79 (0.02)
Fanta Strawberry 2.84 (0.01)
Grapico 2.77 (0.03)
Hansens Cane So da Cherry Vanilla
Crème
2.91 (0.01)
Hansens Cane So da Kiwi Strawberry 2.59 (0.01)
Hansens Cane So da Mandarin Lime 2.57 (0.01)
Hansens Cane So da Pomegranate 2.55 (0.00)
Hawaiian Punch (Fruit Juicy Red) 2.87 (0.01)
Jolly Rancher Grape 2.60 (0.01)
Jolly Rancher Orange 2.88 (0.01)
Jones Blue Bubblegum 2.99 (0.01)
Jones Green Apple Soda 2.65 (0.01)
Jones Mandarin Orange 2.93 (0.00)
Jones M.F. Grape 2.89 (0.02)
Jones Orange & Cream Soda 2.79 (0.01)
Jones Strawberry Lime 2.81 (0.02)
Mr. Pibb Xtra 2.80 (0.01)
Natural Brew Draft Root Beer 2.90 (0.00)
Pepsi 2.39 (0.03)
Pepsi Max 2.74 (0.01)
Pepsi Max Ceasere 2.70 (0.01)
Pepsi Wild Cherry 2.41 (0.03)
RC Cola 2.32 (0.02)
Schweppes Tonic Water 2.54 (0.03)
Sunkist Orange
2.98 (0.01)
Sunkist Peach 2.89 (0.01)
Sunkist Strawberry 2.99 (0.01)
Tab 2.72 (0.01)
Vault 2.77 (0.02)
Vault Red Blitz 2.80 (0.01)
Vault x 2.89 (0.03)
* For manufacturer information, please see the Appendix (available
online at the end of this article).
TABLE 3 (CONTINUED)
SODA pH (STANDARD
DEVIATION)
Erosive
7UP 3.24 (0.02)
7UP Diet 3.48 (0.00)
A&W Cream Soda 3.86 (0.01)
Ale 8-One 3.13 (0.01)
Boylans Orange Cream 3.59 (0.01)
Boylans Orange Soda 3.22 (0.00)
Boylans Original Birch Beer 3.80 (0.00)
Buffalo Rock Ginger Ale 3.23 (0.01)
Coca-Cola Caffeine Free Diet 3.04 (0.01)
Coca-Cola Diet 3.10 (0.05)
Dr Pepper Che rry 3.06 (0.02)
Dr Pepper Diet 3.20 (0.00)
Dr Pepper Diet Cherry 3.32 (0.01)
Fresca (1 liter) 3.08 (0.01)
Grapico Diet 3.04 (0.01)
Hansens Cane Soda Black Cherry Diet 3.47 (0.02)
Hansens Cane Soda Creamy Root Beer
Diet
3.73 (0.01)
Izze Sparkling Blackberry 3.28 (0.01)
Izze Sparkling Clementine 3.27 (0.01)
Izze Sparkling Pomegranate 3.01 (0.01)
Jones Cream Soda 3.04 (0.01)
Jones Red Apple 3.40 (0.02)
Jones Root Beer 3.42 (0.02)
Mellow Yellow 3.03 (0.00)
Mountain Dew (regular) 3.22 (0.07)
Mountain Dew Code Red 3.27 (0.01)
Mountain Dew Diet 3.18 (0.01)
Mountain Dew Voltage 3.05 (0.01)
Mug Root Beer 3.8 8 (0.02)
Pepsi Diet 3.02 (0.01)
Sierra Mist 3.09 (0.02)
Sierra Mist Diet 3.31 (0.01)
Sprite 3.24 (0.05)
Sprite Zero 3.14 (0.01)
Sunkist Diet 3.49 (0.01)
Sunkist Solar Fusion Tropical Mandarin 3.02 (0.01)
Welchs Grape Soda 3.11 (0.02)
Minimally Erosive
A&W Root Beer 4.27 (0.02)
A&W Root Beer Diet 4.57 (0.00)
Barqs Root Beer 4.11 (0.02)
Boylan
s Creme Soda 4.17 (0.02)
Boylans Diet Black Cherry 4.00 (0.01)
Boylans Diet Root Beer 4.05 (0.02)
Boylans Root Beer 4.01 (0.01)
Canada Dry Club Soda 5.24 (0.03)
IBC Root Beer 4.10 (0.02)
Maine Root Root Beer 4.36 (0.02)
ORIGINAL CONTRIBUTIONS
JADA -(-) http://jada.ada.org - 2016 5
TABLE 4
pH of energy drinks and teas and
coffee.*
ENERGY DRINKS pH (STANDARD
DEVIATION)
Extremely Erosive
24:7 Energy Cherry Berry 2.61 (0.01)
180 Blue Orange Citrus Blast 2.82 (0.00)
180 Blue With Acai 2.82 (0.01)
5-Hour Energy Berry 2.81 (0.03)
5-Hour Energy Extra Strength 2.82 (0.00)
5-Hour Energy Lemon-Lime 2.81 (0.00)
Amp Energy Elevate 2.79 (0.01)
Amp Energy Overdrive 2.78 (0.01)
Amp Energy regular 2.81 (0.01)
Amp Energy Sugar Free 2.86 (0.01)
Jolt Blue Bolt 2.96 (0.00)
Jolt Passion Fruit 2.82 (0.01)
Jolt Power Cola 2.47 (0.01)
Meltdown Energy Peach Mango 2.77 (0.00)
No Fear regular 2.97 (0.02)
Orange County Choppers 2.78 (0.02)
Purple Stuff Lean 2.87 (0.01)
Redline Peach Mango 2.74 (0.02)
Redline Princess Exotic Fruit 2.85 (0.01)
Redline Triple Berry 2.77 (0.01)
Rockstar Energy Drink 2.74 (0.01)
Rockstar Punched (Energy þ Punch) 2.83 (0.01)
Rockstar Recovery 2.84 (0.01)
Erosive
Crunk Citrus 3.20 (0.01)
Crunk Energy Drink 3.31 (0.01)
Crunk Grape Acai Energy Drink 3.30 (0.01)
Crunk Low Carb Sugar Free 3.34 (0.00)
Drank 3.09 (0.01)
Fuel Energy Shots Lemon Lime 3.97 (0.01)
Fuel Energy Shots Orange 3.44 (0.01)
Full Throttle Blue Agave 3.10 (0.01)
Full Throttle Citrus 3.09 (0.01)
Full Throttle Red Berry 3.08 (0.01)
Hydrive Blue Raspberry 3.45 (0.01)
Hydrive Citrus Burst 3.03 (0.01)
Hydrive Lemon Lime 3.42 (0.01)
Hydrive Triple Berry 3.15 (0.01)
Jolt Ultra Sugar Free 3.14 (0.00)
Killer Buzz 3.23 (0.01)
Killer Buzz Sugar Free 3.36 (0.00)
Monster Assault 3.58 (0.01)
Monster Energy 3.48 (0.01)
Monster Hitman Energy Shot 3.44 (0.01)
Monster Khaos 3.47 (0.01)
* For manufacturer information, please see the Appendix (available
online at the end of this article).
TABLE 4 (CONTINUED)
ENERGY DRINKS pH (STANDARD
DEVIATION)
Monster Low Carb 3.60 (0.01)
Monster M-80 3.29 (0.00)
Monster MIXXD 3.35 (0.00)
Nitrous Monster Anti-Gravity 3.64 (0.01)
Nitrous Monster Killer B 3.31 (0.00)
Nitrous Monster Super Dry 3.46 (0.00)
No Fear Sugar Free 3.06 (0.01)
NOS Fruit Punch 3.32 (0.00)
NOS Grape 3.27 (0.01)
NOS High Performance Energy Drink 3.31 (0.01)
NOS Power Shot 3.03 (0.02)
Redbull regular 3.43 (0.01)
Redbull Shot 3.25 (0.03)
Redbull Sugar Free 3.39 (0.00)
Redbull Sugar Free Shot 3.28 (0.02)
Redline Xtreme Grape 3.23 (0.01)
Redline Xtreme Triple Berry 3.24 (0.01)
Redline Xtreme Watermelon 3.41 (0.00)
Rhinos Energy Drink 3.51 (0.01)
Rhinos Sugar Free Energy Drink 3.32 (0.01)
Rockstar Energy Cola 3.14 (0.01)
Rockstar Juiced Energy þ Guava 3.16 (0.01)
Rockstar Juiced Energy þ Juice Mango
Orange Passion
3.05 (0.01)
Rockstar Sugar Free 3.15 (0.03)
TEAS AND COFFEE pH (STANDARD
DEVIATION)
Extremely Erosive
Admiral Iced Tea Raspberry 2.94 (0.00)
Arizona Iced Tea 2.85 (0.03)
Lipton Green Tea With Citrus 2.93 (0.00)
Lipton Green Tea With Citrus Diet 2.92 (0.00)
Nestea Iced Te a With Natural Lemon
Flavor
2.94 (0.01)
Nestea Red Tea Pomegranate and Passion
Fruit
2.87 (0.01)
Snapple Peach Tea 2.94 (0.01)
Snapple Raspberry Tea 2.92 (0.00)
Erosive
Admiral Iced Tea Green Tea 3.72 (0.01)
Admiral Iced Tea Mango 3.41 (0.00)
Admiral Iced Tea Sweet Tea 3.76 (0.01)
Arizona Diet Green Tea þ Ginseng 3.29 (0.01)
Snapple Diet Raspberry Tea 3.39 (0.02)
Snapple Diet Peach Tea 3.32 (0.01)
Minimally Erosive
Milos Famous Sweet Tea 4.66 (0.02)
Milos No Calorie Famous Sweet Tea 5.18 (0.03)
Red Diamond Tea Fresh Brewed Sweet
Tea
5.04 (0.02)
Starbucks Medium Roast 5.11 (0.05)
ORIGINAL CONTRIBUTIONS
6 JADA -(-) http://jada.ada.org - 2016
of 2.47 to 3.97 and a mean (SD) value of 3.13 (0.29)
(Table 4). Seventeen teas had a pH range of 2.85 to 5.18
and a mean (SD) value of 3.48 (0.77); coffee had a pH of
5.11 (Table 4). Most beverages tested had a pH lower than
4.0 (354 of 379; 93%) (Tables 1-4). Relative beverage
erosivity zones based on data from studies of apatite
solubility in acid indicated 39%(149 of 379) of the bev-
erages tested were considered extremely erosive (pH <
3.0), 54%(205 of 379) were considered erosive (pH ¼ 3.0-
3.99), and 7%(25 of 379) were considered minimally
erosive (pH $ 4.0)(Figure
25
). The most acidic beverages
tested with a pH lower than 2.4 were lemon juice
(pH ¼ 2.25), RC Cola (pH ¼ 2.32), Coca-Cola Classic
(pH ¼ 2.37), Coca-Cola Cherry (pH ¼ 2.38), and Pepsi
(pH ¼ 2.39). Citric acid, followed by phosphoric acid,
and then malic acid were the most frequently added
acids to the drinks tested.
DISCUSSION
Laboratory studies have determined the pH of beverages
for human consum ption.
6,10,22,24,26-29
Our study deter-
mined the pH of 379 beverages available to the US
consumer and is the most comprehensive in terms of
beverage numbers and diversity. An increase in beverage
diversity in the marketplace probably accounts for the
large number of beverages procured.
Our results ar e consistent with reported beverage
pH valu es by other investigators. For example, we
determined the pH of Coca-Cola was 2.37 (Table 3)as
compared with 2.46 ,
21
2.45,
24
2.48,
26
2.53,
30
2.39,
22
2.40,
25
2.49,
31
and 2.53
28
; the pH of Schweppes Tonic Water was
2.54 (Table 3) as compared with 2.50
6
and 2.48
25
; the pH
of Gatorade Lemon-Lime was 2.97 (Table 1) as compared
with 2.93,
31
2.95,
27
3.01,
21
2.90,
10
3.08,
29
3.17,
24
and 3.29
22
;
the pH of Pepsi was 2.39 (Table 3) as compared with
2.53,
25
2.36,
22
2.39,
24
2.30,
10
2.46,
26
and 2.53
28
; and the pH
of apple juice was 3.57 and 3.66 (Table 2) as compared
with 3.60,
10
3.41,
24
and 3.60.
32
The pH of extrinsic solutions (dietary beverages)
coming into contact with the dentition appears to be
the main determinant of dental erosion; the hydrogen
ion concentration or acidity, as measured in pH, is
primarily responsible for the immediate dissolution
and softening of surface tooth structure (erosive po-
tential) by acidic beverages composed of weak acids,
for example, citric and phosphoric acid.
10,12,19-24
The
titratable acidity or buffer capacityintrinsic to t hese
acidsdoes not play a s critical a role in dental erosion
as pH because of the limited time exposure the denti-
tion has with i ngested liquids during each drinking
and swallowing episode.
19,20,22,33,34
Therefore, pH or
hydrogen ion concentration (acidity) at the time of
dental exposure is the important chemical parameter
to assess when determining the erosive p otential of
beverages.
Teeth erode in the pH range of 2.0 to 4.0, although
surface enamel starts to demineralize as the pH drops to
less than 5.5 when the external milieu of the oral cavity
becomes undersaturated for hydroxyapatite.
35
Apatite
solubility studies indicate a logarithmic increase in
apatite solubility as pH drops under laboratory equilib-
rium conditions as can be seen in the solubility curve
(Figure).
25,36
Apatite solubility above pH 4.0 is minimal; a
drop of 1 unit to 3.0 results in a 10-fold increase in apatite
solubility. Moreover, as pH drops from 3.0 to 2.0 there
is an increase in apatite solubility that approaches 1,000
grams per liter (Figure). Based on the apatite solubility
curve in the gure, we propose that the chemical erosive
potential of beverages be segregated into 3 zones:
-
extremely erosive: pH lower than 3.0;
-
erosive: pH 3.0 to 3.99;
-
minimally erosive: pH more than or equal to 4.0.
Furthermore, the relative erosivity zones (extremely
erosive, erosive, minimally erosive) of 379 beverages as
determined by pH testing indicated 39%(149 of 379) were
extremely erosive (pH < 3.0), 54%(205 of 379) were
erosive (pH ¼ 3.0-3.99), and 7%(25 of 379) were mini-
mally erosive (pH $ 4.0). Although apatite solubility as a
function of pH is on a continuum, the segregation of
300
400
500
600
700
800
900
1,000
200
100
0
23456
pH
SOLUBILITY (g/L)
Extremely Erosive
Erosive
Minimally Erosive
Figure. Erosion zones based on theoretical solubility of apatite as a
function of pH. g: Grams. L: Liters. Adapted with permission of S. Karger
AG from Larsen and Nyvad.
25
ORIGINAL CONTRIBUTIONS
JADA -(-) http://jada.ada.org - 2016 7
erosive potential into 3 discrete zones would be helpful to
the dental clinician when providing a dietary guide of
relative beverage erosivity to the patient. The prevailing
paradigm for dental erosion remains: as the pH of the
oral milieu decreases, the solubility of apatite on the
tooth surface increases logarithmically.
11
Dental erosion from beverag es is primarily caused
by phosphoric acid and citric acid; both are triprotic
acids with 3 available hydrogen ions, enabling proton-
promoted dissolutio n.
12
,
37
Chelat ion or ligand-promoted
dissolution by anionic citrate contributes to enamel
demineralization by the removal of calcium ions at a
higher pH range ap proaching 6.
12
At the erosive pH of
3, only 3% of citrate ions are ap propriately ionized to
chelate calcium ions, indicating their contribution to
the erosive process at this pH is minim al.
38
However, if
anionic citrate were to remain within the oral cavity fo r
extended time intervals, allowing the pH to rise to 6,
chelation could play a contributing role in the erosive
process. For example, the eating of citrus fruits more than
twice a day has been associated with dental erosion.
39
Nevertheless, high concentrations of hydrogen ions
reected by low pH from citric or phosphoric acid results
in undersa turation for both uo r- and hydroxyapatite,
leading to dental erosion. Hence, pH is the contr olling
parameter in determining the erosive potential of
beverages.
11,19-24
Knowledge of beverage pH is essential for the devel-
opment of preventive strate gies for patients with clinical
erosion.
7,40,41
The elimination of extremely erosive drinks
(pH < 3.0), minimizing erosive drinks (pH ¼ 3.0-3.99),
and substituting drinks with a (pH $ 4.0) would be
prudent advice for the prevention of erosion. Fluoride
does not prevent erosion because highly acidic environ-
ments solubilize uorapatite and calcium uoride.
35,42,43
Xerostomic conditions exacerbate the erosive process
from lack of saliva essential for the dilution a nd buffering
of hydrog en ions in the oral cavity.
39,44
The primary
dentition of children is highly susceptible to the erosive
process and low pH beverages should not be placed in a
baby bottle, especia lly at sleep time when the mouth is
xerostomic. Athletes may have decreased salivary ow
rates due to dehydration from profuse sweating after
prolonged, intense physical activity and should rehydrate
with water.
45
Geriatric patients taking medications with
xerostomic side effects are vulne rable to erosion, and the
exposure of cementum and dentin due to gingival
recession allow for root demineralization and hyper-
sensitivity from contact with erosive drinks.
7,14,46
Obvi-
ously, saliva is an important ameliorating milieu for the
abrogation of dental erosion by not only diluting and
buffering extrinsic acids, but also provi ding the source of
glycoproteins that coat the tooth surface as the protective
acquired pellicle.
20,43,44
However, when acidic beverage
consumption is excessive, saliva provides the dentition
limited protection from erosion.
47
CONCLUSIONS
Studies suggest that pH is the primary determ inant of
beverage erosive potential. We determined the pH of 379
nonalcoholic, nondairy beverages and assessed them for
relative erosi vity. Relative beverage erosivity zones based
on previous studies of apatite solubility in acid indicated
39%(149 of 379) of the beverages tested were considered
extremely erosive (pH < 3.0), 54%(205 of 379) were
considered erosive (pH ¼ 3.0-3.99), and 7%(25 of 379)
were considered minimally erosive (pH $ 4.0). The most
acidic beverages tested with a pH of less than 2.4 were
lemon juice (pH ¼ 2.25), RC Cola (pH ¼ 2.32), Coca-
Cola Classic (pH ¼ 2.37), Coca-Cola Cherry (pH ¼ 2.38),
and Pepsi (pH ¼ 2.39). Information obt ained from this
study will enable dental care practitioners to make
appropriate dietary suggestions when counseling patients
about the damaging dental effects of acids in the bever-
ages they drink.
n
SUPPLEMENTAL DATA
Supplemental data related to this article can be found at:
http://dx.doi.org/10.1016/j.adaj.2015.10.019.
Dr. Reddy is a resident, Department of Pediatric Dentistry, School of
Dentistry, The University of Alabama at Birmingham, Birmingham, AL.
Dr. Norris is a resident, Department of Orthodontics, School of Dentistry,
The University of Alabama at Birmingham, Birmingham, AL.
Ms. Momeni is a graduate student, Department of Pediatric Dentistry,
School of Dentistry, The University of Alabama at Birmingham, LHRB
Room 238, 1720 2nd Avenue South, Birmingham, AL 35294-0007, e-mail
sks@uab.edu. Address correspondence to Dr. Momeni.
Dr. Waldo is an assistant professor, Department of General Dentistry,
School of Dentistry, The University of Alabama at Birmingham, Birming-
ham, AL.
Dr. Ruby is a professor, Department of Pediatric Dentistry, School of
Dentistry, The University of Alabama at Birmingham, Birmingham, AL
Disclosure. None of the authors reported any disclosures.
This study was supported by Mary MacDougall, PhD, associate dean for
research and professor, director, Institute of Oral Health Research, Bir-
mingham, AL, and training grant T32-DE017607 from the National Institute
of Dental and Craniofacial Research (NIDCR). Ms. Momeni is a Dental
Academic Research Training Predoctoral Fellow under NIDCR institutional
grant T-90 DE022736.
The authors thank Mr. David Fisher, Medical Education and Design
Services, The University of Alabama at Birmingham, Birmingham, AL, for
the design and production of the gure and tables. The authors also thank
Karger AG, Basel, Switzerland, for granting us copy right permission for the
adaptation of the gure.
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... The pH values of groups 3, 4, and 6 were slightly lower than Reddy's findings. 11 Group 2 had a higher pH compared to Reddy's findings. 11 The mean pH of the groups ranged from 4.96 to 2.79. ...
... 11 Group 2 had a higher pH compared to Reddy's findings. 11 The mean pH of the groups ranged from 4.96 to 2.79. A paired t-test comparing the T 0 to T 1 measurements, as shown in Table 1, concluded that there was a statistically significant difference in the mean from T 0 Canary numbers to T 1 Canary numbers for groups 1 (P = 0.0002), 2 (P = 0.0015), 3 (P < 0.0001), 4 (P < 0.0001), 5 (P = 0.0002), 6 (P < 0.001), and 7 (P < 0.05). ...
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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.
... In this study, we utilized an inverse logarithmic relationship reported by Larsen and Nyvad [28] to determine beverages' pH and erosive potential. This method has also been employed by other researchers [35]. Beverage manufacturing companies do not usually print pH information on their product labels. ...
... Although the pH and resultant erosive potential of beverages have widely been reported in previous studies [21,33,35,36], it is difficult to compare these data with beverages available in Pakistan due to gross variations in manufacturing processes, temperature and equipment accuracy. For instance, beverages tested at a higher temperature exhibited lower pH values [37]. ...
Article
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The objectives of this study were to investigate the pH of common beverages and to evaluate the effects of common acidic beverages on the surface hardness and weight loss of human tooth specimens. A total of 106 beverages were conveniently purchased from supermarkets in Karachi, Pakistan. Prior to evaluation, beverages were refrigerated or stored at room temperature in accordance with the manufacturers’ recommendations. Beverages were categorized into six groups: ‘Sports and Energy drinks’, ‘Water’, ‘Fruit Juices and Drinks’, ‘Sodas’, ‘Milk and Flavored Milk’ and ‘Teas and Coffee’. Using a pH meter, the pH of each beverage was measured in triplicate at room temperature. In addition, the influence of five highly acidic beverages on the weight loss and surface hardness of human tooth specimens was evaluated using gravimetric analysis and the Vickers hardness tester, respectively. ‘Sports and Energy drinks’, ‘Fruits Juices and Drinks’ and ‘Sodas’ were the most acidic beverage categories, with a pH range of 3.00–5.00. A total of 33% of beverages tested in this study were highly acidic (pH less than 4.00), 29% of beverages were moderately acidic (pH 4.00–4.99) and 31% were mildly acidic (pH 5.00–6.99). Significant weight loss was observed in all immersed specimens compared to control counterparts (p < 0.05). Similarly, for surface hardness, five highly acidic beverages (Red Bull, Pepsi, Apple Cidra, Tang Mosambi and Tang Orange) significantly decreased the surface hardness of specimens (p < 0.05). The pH levels of commonly available beverages in Pakistan are highly acidic, which may encourage loss of minerals from teeth; hence, affecting their surface hardness.
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Several developments in Western Europe may have contributed to the increased prevalence of dental erosion during the last decades. Exposing children to sour taste at an early age increases the preference for acidic food and drinks later in life. Acidic fruits and beverages became widely available due to economic prosperity. New types of acidic candies were developed, some of which are kept in the mouth for very long times. Children are exposed to intense marketing of these acidic products, which are widely available in supermarkets and school canteens. In the meantime, much less attention has been paid to the development and marketing of less erosive food products.
Chapter
Dental erosion is caused by repeated short episodes of exposure to acids. Dental minerals are calcium-defi- cient, carbonated hydroxyapatites containing impurity ions such as Na+, Mg2+ and Cl-. The rate of dissolution, which is crucial to the progression of erosion, is influ- enced by solubility and also by other factors. After out- lining principles of solubility and acid dissolution, this chapter describes the factors related to the dental tis- sues on the one hand and to the erosive solution on the other. The impurities in the dental mineral introduce crystal strain and increase solubility, so dentine mineral is more soluble than enamel mineral and both are more soluble than hydroxyapatite. The considerable differ- ences in structure and porosity between dentine and enamel influence interactions of the tissues with acid solutions, so the relative rates of dissolution do not nec- essarily reflect the respective solubilities. The rate of dis- solution is further influenced strongly by physical fac- tors (temperature, flow rate) and chemical factors (degree of saturation, presence of inhibitors, buffering, pH, fluoride). Temperature and flow rate, as determined by the method of consumption of a product, strongly influence erosion in vivo. The net effect of the solution factors determines the overall erosive potential of differ- ent products. Prospects for remineralization of erosive lesions are evaluated. © 2014 by S. Karger AG, P.O. Box, CH-4009 Basel (Switzerland). All rights reserved..
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Erosive tooth wear in children is a common condition. Besides the anatomical differences between deciduous and permanent teeth, additional histological differences may influence their susceptibility to dissolution. Considering laboratory studies alone, it is not clear whether deciduous teeth are more liable to erosive wear than permanent teeth. However, results from epidemiological studies imply that the primary dentition is less wear resistant than permanent teeth, possibly due to the overlapping of erosion with mechanical forces (like attrition or abrasion). Although low severity of tooth wear in children does not cause a significant impact on their quality of life, early erosive damage to their permanent teeth may compromise their dentition for their entire lifetime and require extensive restorative procedures. Therefore, early diagnosis of erosive wear and adequate preventive measures are important. Knowledge on the aetiological factors of erosive wear is a prerequisite for preventive strategies. Like in adults, extrinsic and intrinsic factors, or a combination of them, are possible reasons for erosive tooth wear in children and adolescents. Several factors directly related to erosive tooth wear in children are presently discussed, such as socio-economic aspects, gastroesophageal reflux or vomiting, and intake of some medicaments, as well as behavioural factors such as unusual eating and drinking habits. Additionally, frequent and excessive consumption of erosive foodstuffs and drinks are of importance. © 2014 S. Karger AG, Basel.
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When considering the erosive potential of a food or drink, a number of factors must be taken into account. pH is arguably the single most important parameter in determining the rate of erosive tissue dissolution. There is no clear-cut critical pH for erosion as there is for caries. At low pH, it is possible that other factors are sufficiently protective to prevent erosion, but equally erosion can progress in acid of a relatively high pH in the absence of mitigating factors. Calcium and phosphate concentration, in combination with pH, determine the degree of saturation with respect to tooth minerals. Solutions supersaturated with respect to enamel or dentine will not cause them to dissolve, meaning that given sufficient common ion concentrations erosion will not proceed, even if the pH is low. Interestingly, the addition of calcium is more effective than phosphate at reducing erosion in acid solutions. Today, several calcium-enriched soft drinks are on the market, and acidic products with high concentrations of calcium and phosphorus are available (such as yoghurt), which do not soften the dental hard tissues. The greater the buffering capacity of the drink or food, the longer it will take for the saliva to neutralize the acid. A higher buffer capacity of a drink or foodstuff will enhance the processes of dissolution because more release of ions from the tooth mineral is required to render the acid inactive for further demineralization. Temperature is also a significant physical factor; for a given acidic solution, erosion proceeds more rapidly the higher the temperature of that solution. In recent years, a number of interesting potentially erosion-reducing drink and food additives have been investigated. © 2014 S. Karger AG, Basel.
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Saliva is the most relevant biological factor for the prevention of dental erosion. It starts acting even before the acid attack, with an increase of the salivary flow rate as a response to the acidic stimuli. This creates a more favorable scenario, improving the buffering system of saliva and effectively diluting and clearing acids that come in contact with dental surfaces during the erosive challenge. Saliva plays a role in the formation of the acquired dental pellicle, a perm-selective membrane that prevents the contact of the acid with the tooth surfaces. Due to its mineral content, saliva can prevent demineralization as well as enhance remineralization. These protective properties may become more evident in hyposalivatory patients. Finally, saliva may also represent the biological expression of an individual's risk for developing erosive lesions; therefore, some of the saliva components as well as of the acquired dental pellicle can serve as potential biomarkers for dental erosion. © 2014 S. Karger AG, Basel.
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Dentine hypersensitivity is a common oral pain condition affecting many individuals. The aetiology is multifactorial; however, over recent years the importance of erosion has become more evident. For dentine hypersensitivity to occur, the lesion must first be localised on the tooth surface and then initiated to exposed dentine tubules which are patent to the pulp. The short, sharp pain symptom is thought to be derived from the hydrodynamic pain theory and, although transient, is arresting, affecting quality of life. This episodic pain condition is likely to become a more frequent dental complaint in the future due to the increase in longevity of the dentition and the rise in tooth wear, particularly amongst young adults. Many efficacious treatment regimens are now available, in particular a number of over-the-counter home use products. The basic principles of treatment are altering fluid flow in the dentinal tubules with tubule occlusion or modifying or chemically blocking the pulpal nerve. © 2014 S. Karger AG, Basel.