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Content uploaded by John D Ruby
Author content
All content in this area was uploaded by John D Ruby on Feb 10, 2016
Content may be subject to copyright.
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
Sweetened and flavored beverage consumption
has increased dramatically over the past 35 years
in the United States 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 4.0are potentially damaging to the
dentition.
11
Acids are added to beverages and compose a
flavor profile 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 ª2016 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 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 25C. 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 study’sfindings provide
dental clinicians and auxiliaries with information
regarding the erosive potential of commercially available
beverages. Specific dietary recommendations for the pre-
vention of dental erosion may now be developed based on
the patient’s 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 flavor 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, fortified juices, sports
drinks, and iced teas because it enhances the intrinsic
flavor. Malic acid also is added to artificially sweeten
carbonated beverages to intensify taste and reduce the
amount of other added flavorings. 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 fluorapatite and hydroxy-
apatite crystals after diffusion through plaque-pellicle
biofilm—a process termed proton-promoted dissolu-
tion.
12
Erosion may initially progress through the enamel
TAB L E 1
pH of waters and sports drinks.*
WATERS AN D 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 (flavored water) Kiwi
Strawberry
3.70 (0.01)
Clear American (flavored water) Pomegranate
Blueberry Acai
3.24 (0.01)
Clear American (flavored water) Tropical Fruit 3.07 (0.01)
Clear American (flavored 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 AN D 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
Aquafina 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
2JADA -(-)http://jada.ada.org -2016
TAB L E 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 Strawberry 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)
Barber’s 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 Pineapple 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 Orange 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)
Welch’s 100% Grape Juice 3.38 (0.00)
Welch’s Apple Juice 3.57 (0.01)
Welch’s 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
Campbell’s 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
Barber’s Lemonade 2.69 (0.00)
Barber’s 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)
Welch’s Blueberry Kiwi Blast 2.57 (0.01)
Welch’s Cranberry 2.59 (0.02)
Welch’s Grape Juice Cocktail 2.92 (0.01)
Welch’s 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 2.0from 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 dentin,
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 beverage’s 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 Scientific) to measure the pH of
each beverage in triplicate immediately after opening at a
temperature of 25C. 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). Seventy-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 and 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
Barber’s 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 Guava 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 Orange 3.00 (0.01)
Mondo (Legendary Berry) 3.07 (0.01)
Mondo (Primo Punch) 3.10 (0.01)
Sesame Street Elmo’s 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 Orangearific3.34 (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)
Welch’s Orange Pineapple 3.20 (0.01)
Welch’s Strawberry Kiwi 3.03 (0.01)
ORIGINAL CONTRIBUTIONS
4JADA -(-)http://jada.ada.org -2016
TAB L E 3
pH of sodas.*
SODA pH (STANDARD
DEVIATION)
Extremely Erosive
7UP Cherry 2.98 (0.01)
Boylan’s Black Cherry 2.76 (0.02)
Boylan’s Grape 2.91 (0.01)
Boylan’s 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)
Hansen’s Cane Soda Cherry Vanilla
Crème
2.91 (0.01)
Hansen’s Cane Soda Kiwi Strawberry 2.59 (0.01)
Hansen’s Cane Soda Mandarin Lime 2.57 (0.01)
Hansen’s Cane Soda 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 Ceasefire 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)
Boylan’s Orange Cream 3.59 (0.01)
Boylan’s Orange Soda 3.22 (0.00)
Boylan’s 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 Cherry 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)
Hansen’s Cane Soda Black Cherry Diet 3.47 (0.02)
Hansen’s 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 3.88 (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)
Welch’s 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)
Barq’s Root Beer 4.11 (0.02)
Boylan’s Creme Soda 4.17 (0.02)
Boylan’s Diet Black Cherry 4.00 (0.01)
Boylan’s Diet Root Beer 4.05 (0.02)
Boylan’s 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
TAB L E 4
pH of energy drinks and teas and
coffee.*
ENERGY DRI NKS 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 þPunch) 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 þGuava 3.16 (0.01)
Rockstar Juiced Energy þJuice 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 Tea 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 þGinseng 3.29 (0.01)
Snapple Diet Raspberry Tea 3.39 (0.02)
Snapple Diet Peach Tea 3.32 (0.01)
Minimally Erosive
Milo’s Famous Sweet Tea 4.66 (0.02)
Milo’s 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
6JADA -(-)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 ¼3.0-
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 2.4were lemon juice
(pH ¼2.25), RC Cola (pH ¼2.32), Coca-Cola Classic
(pH ¼2.37), Coca-Cola Cherry (pH ¼2.38), and Pepsi
(pH ¼2.39). 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 consumption.
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 are consistent with reported beverage
pH values 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 capacity—intrinsic to these
acids—does not play as critical a role in dental erosion
as pH because of the limited time exposure the denti-
tion has with ingested 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 potential of
beverages.
Teeth erode in the pH range of 2.0to 4.0, although
surface enamel starts to demineralize as the pH drops to
less than 5.5when 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 4.0is minimal; a
drop of 1unit to 3.0results in a 10-fold increase in apatite
solubility. Moreover, as pH drops from 3.0to 2.0there
is an increase in apatite solubility that approaches 1,000
grams per liter (Figure). Based on the apatite solubility
curve in the figure, we propose that the chemical erosive
potential of beverages be segregated into 3zones:
-
extremely erosive: pH lower than 3.0;
-
erosive: pH 3.0to 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 ¼3.0-3.99), 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
023456
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 3discrete 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 beverages is primarily caused
by phosphoric acid and citric acid; both are triprotic
acids with 3available hydrogen ions, enabling proton-
promoted dissolution.
12
,
37
Chelation or ligand-promoted
dissolution by anionic citrate contributes to enamel
demineralization by the removal of calcium ions at a
higher pH range approaching 6.
12
At the erosive pH of
3, only 3% of citrate ions are appropriately ionized to
chelate calcium ions, indicating their contribution to
the erosive process at this pH is minimal.
38
However, if
anionic citrate were to remain within the oral cavity for
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
reflected by low pH from citric or phosphoric acid results
in undersaturation for both fluor- and hydroxyapatite,
leading to dental erosion. Hence, pH is the controlling
parameter in determining the erosive potential of
beverages.
11,19-24
Knowledge of beverage pH is essential for the devel-
opment of preventive strategies for patients with clinical
erosion.
7,40,41
The elimination of extremely erosive drinks
(pH <3.0), minimizing erosive drinks (pH ¼3.0-3.99),
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 fluorapatite and calcium fluoride.
35,42,43
Xerostomic conditions exacerbate the erosive process
from lack of saliva essential for the dilution and buffering
of hydrogen 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, especially at sleep time when the mouth is
xerostomic. Athletes may have decreased salivary flow
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 vulnerable 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 providing 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 determinant of
beverage erosive potential. We determined the pH of 379
nonalcoholic, nondairy beverages and assessed them for
relative erosivity. 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 ¼3.0-3.99), and 7%(25 of 379)
were considered minimally erosive (pH $4.0). The most
acidic beverages tested with a pH of less than 2.4were
lemon juice (pH ¼2.25), RC Cola (pH ¼2.32), Coca-
Cola Classic (pH ¼2.37), Coca-Cola Cherry (pH ¼2.38),
and Pepsi (pH ¼2.39). Information obtained 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 figure and tables. The authors also thank
Karger AG, Basel, Switzerland, for granting us copyright permission for the
adaptation of the figure.
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