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Iran J Pediatr. In Press(In Press):e85978.
Published online 2019 June 11.
doi: 10.5812/ijp.85978.
Research Article
Impact of Green Vegetables and Green Smoothies on Enamel Mineral
Composition In Vitro
Ines Willershausen 1, Daniel Schulte 2, Brita Willershausen 3,* and Adriano Azaripour4
1Department of Orthodontics and Orofacial Orthopedics, University Hospital of Erlangen, Erlangen, Germany
2Institute of Applied Geosciences, Darmstadt, Germany
3Private Practice, Mediplus, Mainz, Germany
4Department of Operative Dentistry, Johannes Gutenberg University Hospital of Mainz, Mainz, Germany
*Corresponding author: Private Practice, Mediplus, Mainz, Germany. Email: brita.willershausen@gmail.com
Received 2018 November 01; Revised 2019 March 12; Accepted 2019 March 22.
Abstract
Background: Recently, smoothies with a high vegetable content have become very popular, especially among young adults.
Objectives: This in vitro study was conducted to determine the erosive potential of selected green vegetables and green smoothies
on human dental enamel.
Methods: A total of ten green smoothies and eight freshly mixed vegetables were chosen, and pH, calcium and oxalic acid contents
were measured. The enamel specimens were obtained from wisdom teeth and incubated with 3 selected foods (spinach, parsley, or
green smoothie) for 12 and 24 hours (N = 6). Control samples were incubated with a physiological salt solution. An electron probe
microanalyzer (Jeol JXA 8900RL) was utilized to analyze the concentrations of calcium, phosphorus, magnesium and fluorine at
various depths ranging from 5 to 50 µm within the enamel samples. A visual examination of the specimen was carried out with a
digital microscope.
Results: The green smoothies showed pH values ranging from 3.6 to 4.2, and the values of the mixed vegetables ranged from 5.6 to
6.3. Only in the green smoothie group could a time-dependent release of different minerals be observed. After 12 and 24 hours of
incubation, a pronounced loss of calcium and phosphorus was found to a depth of 15 µm. Digital microscopy of the enamel surfaces
confirmed these findings.
Conclusions: In our in vitro study, incubation with the spinach and parsley showed no damage to the enamel specimens; in the
case of the investigated smoothies, a mild loss of minerals to a depth of 25 µm was observed. It must be considered that numerous
factors influence the enamel surface in vivo, translating these results to in vitro conditions must be done with great caution.
Keywords: Green Vegetables, Green Smoothie, Human Dental Enamel
1. Background
A well-balanced modern diet includes cereals, seeds,
vegetables, fruits, dairy products, fish, meat, eggs, oils and
beverages, in particular, water. Over the last 30 years, fast
food cuisine has become established in the diet due to
lifestyle changes. Frequent consumption of this type of
nutrition with high amounts of fat and carbohydrate to-
gether with acidic soft drinks leads to the well-known ef-
fects of overweight and dental problems (1-3). Lifestyle
habits arising from the permanent availability of fast food
products and soft drinks in combination with intensified
oral hygiene measures, chewing habits and bruxism, have
led to an increased prevalence in dental erosion (4-9). In
an in vitro study, Lussi et al. (10) showed that the erosive ef-
fect of modern popular beverages is characterized by a sig-
nificant reduction of the surface hardness of enamel spec-
imens and that in addition to the pH value, the titratable
acidity and other components of the beverages, such as Ca
or F, are also important. Ancient foodstuffs and nutritional
habits vary to a large extent from today’s dietary habits.
In prehistoric times, humans were hunter-gatherers and
had irregular food intake as well as limited food supply. An
explanation for the dental damage was the diet of plant
fibers, hard seeds and foods containing grinding stone
grit. The major plant foods (e.g., agave, yucca, stool, prickly
pear,wild onion, mesquite) are rich in calcium oxalate phy-
toliths. In addition to the erosive effects of oxalic acid,
the presence of phytoliths, which are harder than enamel,
may well have caused loss of dental hard tissue. Currently,
there is an increased awareness of healthy nourishment
Copyright © 2019, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License
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Willershausen I et al.
and a tendency toward a one-sided diet rich in vegetables.
Various types of green vegetables, such as spinach, broc-
coli and parsley, contain high amounts of acidic compo-
nents. Studies have reported that a vegetarian diet can
provoke dental damage, such as abrasion or erosion (11-
13). Consumption of acidic foods and soft drinks has been
linked with the development of dental erosion (3,5,10).
In general, dental erosion is primarily chemically induced
by organic or inorganic acids from extrinsic and intrinsic
sources. Tooth structures that are damaged and eroded by
acidic foods are more sensitive to further breakdown by
abrasion and attrition during tooth brushing (14). Recent
health promotion actions recommend consumption of 5
servings of fruit or vegetables per day. Smoothies are pro-
moted as an easy way to consume the necessary amounts
of fruits and vegetables (6). There are only a few publica-
tions that discuss the effects of smoothies, in particular,
fruit smoothies, on human enamel (6,15).
2. Objectives
The aim of our in vitro study was to investigate the
erosive potential of selected green vegetables and green
smoothies on human enamel samples. To quantify the loss
of essential minerals on the enamel surface, we selected
the electron probe microanalyzer, since it is the most sen-
sitive research method.
3. Methods
3.1. Green Vegetables and Green Smoothies
The experimental design was descriptive. For this
study, only green vegetables and green smoothies were se-
lected to determine the possible erosive effect on enamel
surfaces. Green smoothies were selected since they repre-
sent a convenient way to increase children’s fiber and vita-
min intake. Green vegetables were further analyzed as con-
trols to investigate the effect of the unprocessed foodstuff.
Therefore, eight different fresh green vegetables
(spinach, parsley, mangold, broccoli, arugula, kale, leek,
and romaine lettuce hearts) were each homogenized in
a blender for 5 minutes. Next, the vegetable supernatant
was separated from the residue with a centrifuge for 10
minutes (3000 U/min). For all examinations, only the
supernatants of the vegetables were used (Table 1). A
total of ten green smoothies were chosen, which were
mixtures of different vegetables and fruits (Table 2). For
further analyses, the smoothies were also centrifuged for
10 minutes at 3000 U/min. The pH values and concentra-
tions of calcium and oxalic acid were determined from
the vegetable supernatants and the green smoothies.
Among all green vegetables, we selected spinach due to
its high concentration of oxalic acid and parsley because
of its high vitamin C content (Table 1). Within the green
smoothie group, we selected a smoothie with a relatively
high percentage of green vegetables and apple juice as
well as a low pH value (Table 2).
Table 1. Concentrations of Calcium and Oxalic Acid and pH Values in the Super-
natants of Eight Green Vegetables
Green Vegetables Oxalic Acid, mg/mL pH Ca, mg/mL
Spinach 391.3 6.3 0.014
Parsley 83.4 5.6 0.036
Mangold 225.4 6.2 0.025
Broccoli Not detectable 6.2 0.016
Arugula Not detectable 5.8 0.100
Kale Not detectable 6.2 0.018
Leek Not detectable 5.6 0.039
Romaine lettuce Not detectable 6.0 0.171
3.2. Human Enamel Specimen Preparation
For this investigation, twelve fully retained wisdom
teeth from young adult patients were selected. The pa-
tients were informed about the purpose of this investiga-
tion and gave consent for the use of their teeth. Further-
more, the protocol for the experimental analysis of hu-
man samples was approved by the Ethics Commission of
the University Medical Center, Mainz, Germany. The col-
lected teeth were visually examined with a digital micro-
scope, and all teeth with mineralization irregularities or
damage were excluded. The roots were separated from the
crowns, and the enamel surfaces were polished with sili-
con carbide and aluminum oxide discs and sliced horizon-
tally into pieces of approximately 3 mm thickness (16). All
crowns were then divided into up to six slices, resulting in
a total of 52 samples. All samples were washed with and
stored in physiological sodium chloride solution until fur-
ther analysis.
3.3. Physiochemical Measurements
To select characteristic green vegetables, the pH of the
supernatant of the vegetables and of the green smooth-
ies were determined with a microelectrode (Novodirect,
Kehl, Germany). The calcium concentration of the samples
2Iran J Pediatr. In Press(In Press):e85978.
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Willershausen I et al.
Table2. List of Ingredients of Ten Different Green Smoothies, Which Are Available in German Supermarkets
Name of Green Smoothies Ingredients pH Ca, mg/mL
Saftig smoothie; Fresco y Zumos, S. A. Spain Apple juice 48%, apple puree 25%, cucumber puree 12%, banana puree
10%, lemon juice 4%, spinach and nettle extract
3.69 0.05
Bio-Alnavit Grüner Held, Alnavit GmbH; Bickenbach, Germany Pear puree 47%, kiwi puree 25%, acerola puree, broccoli puree 9.5%, bell
pepper puree, dandelion juice 2%, stinging juice 2%, spirulina 0.1%,
matcha powder 0.1%
3.77 0.28
Voelkel fair to go; 100% direct juice; Demeter e.V.; Germany Tomato juice 66%, carrot juice 13%, sauerkraut juice 6%, beetroot juice
5%, celery juice 4%, cucumber juice 2%, bell pepper paste 2%, onion
juice, bean juice, dill juice, herbal sea salt
4.18 0.11
Truefruits green smoothie; spinach; Bonn, Germany Apple juice 54.9%, banana puree 21%, organic spinach puree 11%, pear
puree 8%, organic kale puree 4%, ginger puree 1%, organic matcha tea
0.1%; percentage of organic ingredients: 15.1%
3.86 0.03
Truefruits green smoothie; arugula; Bonn, Germany Apple juice 48.9%, mango puree 19%, arrugula puree 15%, pear puree
11%, carrot puree 5%, mint 1%, chlorella 0.1%
3.85 0.21
Grüner Smoothie Voelkel; orange; Demeter Germany Apple juice 20%, orange juice 20%, pear juice 19%, banana puree 4%,
kale 8%, peach pulp 7%, spinach 5%, acerola pulp 5%, wheatgrass,
matcha
4.10 0.12
Grüner Smoothie Voelkela; Demeter Germany Apple juice 52.5%, mango pulp 17.5%, beetroot juice 16%, spinach 8%,
kale 6%
3.89 0.05
Grüner Smoothie Voelkel, mango; Höhbeck, Germany Apple juice 48%, mango pulp 15%, banana puree 13%, kale 6%, ginger
juice 6%, ginger, mineral water, lemon juice concentrate, acerola pulp
5%, spinach 8%,
3.96 0.18
Voelkel vegan to go; Kraftprotz gluten frei Demeter e.V.;
Germany
Cucumber juice 35%, apple juice 20.5%, mango pulp 10%, orange juice
10%, spinach 6.5%, kale 6.5%, banana puree 6%, quinoa 2.5%, wheatgrass
juice, lemon juice, acerola pulp, spirulina powder,matcha 0.1%
4.19 0.14
Innocent smoothie-; Innocent Alps; Salzburg, Austria Apple juice 48%, pineapple juice, kiwi puree 16%, grape juice, lime
juice 1.2%, spinach and stinging nettle extract
3.58 0.10
aThe marked smoothie was selected for the in vitro study.
was determined spectrophotometrically using a colori-
metric assay (Randox Laboratories, Krefeld, Germany). The
concentration of oxalic acid was measured spectrophoto-
metrically using a colorimetric assay test kit (Enzytec, R-
Biopharm AG, Darmstadt, Germany).
3.4. Exposure to Selected Green Vegetables and Green Smooth-
ies
Exposure to selected green vegetables and green
smoothies for the specific and sensitive analysis of the
elements Ca, Mg, F, and P with the electron probe micro-
analyzer was repeated in six independent experiments.
For each test solution (spinach, parsley, green
smoothie), one sample per tooth served as the enamel
control and was incubated with 3 mL of the physiological
salt solution.
This in vitro study aimed to investigate the maximal
erosive potential of selected vegetables and smoothies on
dental enamel without further possibility of remineraliza-
tion. Therefore, we consciously incubated our samples for
up to 24 hours and abstained from employing a further in-
cubation period with artificial saliva solution.
The selected enamel slices (N = 48) were placed into
multiwell plates (Greiner, Frickenhausen, Germany) and
then incubated with 3 mL of the respective test super-
natants at 37ºC in a humidified atmosphere in a gas incu-
bator (Heraeus, type Function Line, Hanau, Germany) for
12 hours and 24 hours. After exposure, the supernatants
were removed, and the enamel samples were thoroughly
washed in sterile distilled water, air-dried and prepared for
electron probe microanalysis.
3.5. Electron Probe Microanalyses
The quantitative measurement of the elements Ca, F, P
and Mg in the enamel surfaces was conducted with an elec-
tron probe microanalyzer (JEOL JXA 8900 RL, JEOL, Eching,
Germany). For this analysis, the dental slices were embed-
ded in epoxy resin and processed according to a previously
published protocol (16).
3.6. Data Analysis
The statistical analysis was carried out with the SPSS
software (version 23.0; SPSS Inc., Chicago, IL, USA). For the
measurement of the concentrations of the various ele-
ments in the enamel slices, only descriptive analyses were
Iran J Pediatr. In Press(In Press):e85978. 3
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Willershausen I et al.
performed, which are expressed as the means ±SD (stan-
dard deviations).
4. Results
The ten selected green smoothies showed pH values
ranging from 3.6 to 4.2 and calcium concentrations rang-
ing from 0.03 to 0.28 mg/mL (Table 2). For all smooth-
ies, the oxalic acid concentration was lower than the de-
tection limit. The pH values of the eight green vegetables
ranged from 5.6 (parsley) to 6.3 (spinach), and the con-
centration of free calcium in the supernatants was low for
all vegetables (Table 1). Oxalic acid was only detectable
in spinach (391.3 mg/L), mangold (255.4 mg/L) and parsley
(83.4 mg/L). Since qualitative and quantitative erosive dam-
ages can be detected by the Electron Probe Microanalyzer,
which allows the detection of characteristic elements, we
purposely abstained from the unspecific investigation of
the surface roughness.
With the electron beam microprobe analyzer, the el-
emental concentrations of Ca, P, Mg and F in the enamel
samples were measured at depths of up to 50 µm (Figure
1). The incubation of the enamel samples with spinach and
parsley showed no erosive potential over the incubation
time of 24 hours. In contrast, the incubation of the dental
samples with the green smoothie showed, in comparison
to the controls, a mild erosive potential. The incubation
time of 12 hours showed a loss of Ca and P at a depth of 20
µm, while the longer exposure time demonstrated a loss
of minerals up to 25 µm. The fluorine content showed con-
siderable variation at all depths and in all specimens. The
visual examination of the enamel samples with the digital
microscope showed only a slight alteration of the surface
topography for the specimens incubated for 24 hours with
the green smoothie (Figure 2).
5. Discussion
Nutritional habits can influence dental health. In par-
ticular, frequent consumption of diets rich in sugar or
acids can lead to dental decay or dental erosion (4,8,17). Re-
cently, increased health awareness has evoked increasing
popularity of fruit smoothies (6,15) and so-called super-
foods such as chia seeds or goji berries. Green smoothies, a
blended mixture of fruits and vegetables, are viscous fruit
juices with high fiber content [10% - 19%], and these bev-
erages are very popular for adolescents and young adults.
Our in vitro study aimed to elucidate the possible erosive
effects of green smoothies and, in particular, green vegeta-
bles as a major component of these modern beverages.
The etiology of erosive tooth wear is a complex process
with different causative and individual factors (18); it is im-
portant to recognize initial changes and to assess possi-
ble erosive processes with sensitive techniques. We investi-
gated parsley and spinach as representative green vegeta-
bles, which are also known for being especially healthy be-
cause they contain numerous minerals and are rich in vi-
tamin C. Spinach also has high oxalic acid content, which
binds especially effectively to calcium as a chelator. How-
ever, Hannig et al. (19) showed in an in vitro study that in-
cubation of bovine enamel specimens with oxalic acid did
not have a pronounced erosive effect. The present study
showed that a green smoothie with a high content of green
vegetables and apple juice led to a notable loss of the essen-
tial minerals calcium, phosphate and magnesium. Oxalic
acid was not detectable in this smoothie and therefore can-
not be responsible for the mineral loss. However, the low
pH and considerable titratable acidity reflect the content
of other acidic fruit components. In contrast, the super-
natants of spinach and parsley induced only a slight loss
of calcium and phosphate on the enamel surface.
When assessing the concentration of different ele-
ments in human teeth, it must be taken into consideration
that even within the same tooth, greater variability in ele-
ments exists. The concentrations of magnesium and fluo-
ride, e.g., as opposed to calcium and phosphate, are more
likely to be influenced by environmental factors such as
nutrition or fluoride supplementation (20,21). Both the
pH value and other factors, such as acid type, buffer ca-
pacity and mineral components, must be taken into con-
sideration. For example, soft drinks contain considerable
amounts of fruit acids, whereas green vegetables very of-
ten contain high amounts of vitamin C and considerable
quantities of oxalic acid (22). Vegetarian or vegan diets that
are naturally rich in raw fruits and vegetables can partic-
ularly damage teeth by erosion or abrasion (11). Linkos-
alo and Markkanen (12) found in Finnish vegetarians a 77%
prevalence of erosion of teeth when compared to individ-
uals consuming a balanced diet. On the other hand, Her-
man et al. (11) observed erosive changes in teeth in 39% of
vegetarians compared to 24% in the control group. Similar
results were reported by Staufenbiel et al. (23), who exam-
ined the oral health of 100 vegetarians and used a question-
naire concerning nutritional and eating habits. The vege-
tarians showed a significantly higher number of teeth with
dental erosion. To study the erosive effects of green vegeta-
bles, we selected wisdom teeth of young adults, whereas
4Iran J Pediatr. In Press(In Press):e85978.
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Willershausen I et al.
Figure 1. Concentrations of the minerals calcium, phosphorus, magnesium and fluorine (determined as CaO, P2O5, MgO, and F) in human enamel specimens (N = 6; mean,
SD) after an incubation time of 12 and 24 hours with different green vegetable or green smoothie supernatants (spinach: pH = 6.3; parsley: pH = 5.6 and green smoothie: pH =
3.9)
previous studies were performed on bovine teeth, as they
are larger and easier to obtain but do not necessarily reflect
the human situation (3,19,24).
5.1. Conclusions
Our in vitro study demonstrated that green smoothies
containing a high percentage of acidic fruit induced a loss
of calcium and phosphate from enamel, whereas the se-
lected green vegetables alone had no substantial effect on
Iran J Pediatr. In Press(In Press):e85978. 5
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Willershausen I et al.
Figure 2. Digital microscopy of human enamel surfaces. A, control sample, B, enamel sample after incubation with a green smoothie for 24 hours (Magnification 500 ×)
the enamel surface.
Since multiple factors, such as remineralization, re-
duce the erosive effect within the oral cavity, green smooth-
ies can be considered a tooth-friendly beverage when con-
sumed in moderation.
Acknowledgments
The authors wish to thank Claudia Darmstadt for excel-
lent technical assistance.
Footnotes
Authors’ Contribution: Conception or design: Ines
Willershausen and Adriano Azaripour. Acquisition and
analysis: Daniel Schulte and Brita Willershausen. Draft-
ing the work: Ines Willershausen, Daniel Schulte, Brita
Willershausen, and Adriano Azaripour. Final approval:
Ines Willershausen, Daniel Schulte, Brita Willershausen,
and Adriano Azaripour.
Conflict of Interests: The authors declare that there is no
conflict of interests.
Ethical Considerations: For this in vitro study, no ethical
considerations were required.
Financial Disclosure: The authors do not have any finan-
cial interest in the companies that produce the materials
included in this article.
Funding/Support: No funding from sources other than
the Department of Operative Dentistry and Periodontol-
ogy of the University Medical Center Mainz has to be re-
ported.
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Article
Full-text available
Introduction Dissolution of the enamel in the form of erosion has increased due to shift in eating habits toward carbonated drinks like soft drink and chocolates. Aim The purpose of this study was to evaluate changes in the salivary pH after intake of different eatables and beverages in children at different time intervals. Study design Using standard salivary tests, this study was conducted as a case-control study. Fifty children between ages of 8 and 12 years having strict vegetarian diet were included in the study. Materials and methods Oral prophylaxis was done and salivary buffer capacity for stimulated saliva was measured. Before the saliva collection, each of the children was informed not to eat or drink anything for up to 2 hours just before the appointment. Results On pairwise evaluation, all the differences were found to be significant statistically except between baseline vs 30 minutes. Maximum mean difference was calculated and observed between baseline and immediately after intake of fruit juice and immediate after 30 minutes, 0.953 and 0.963 respectively, while minimum difference was calculated and observed between baseline and 30 minutes after intake of fruit juice (0.010). Conclusion Maximum drop was seen in cold drink when compared with fruit juice. The maximum pH increase was observed in cream biscuits with 7.63 ± 0.20. It was observed that in all the groups, the pH gradually got back to near normal levels due to the buffering mechanism of saliva. How to cite this article: Pachori A, Kambalimath H, Maran S, Niranjan B, Bhambhani G, Malhotra G. Evaluation of Changes in Salivary pH after Intake of Different Eatables and Beverages in Children at Different Time Intervals. Int J Clin Pediatr Dent 2018;11(3):177-182.
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Aims: To investigate the prevalence and risk factors of dental erosion (DE) among a group of adolescents in Stockholm County. Materials and methods: This cross sectional cohort study was conducted at three clinics of the Public Dental Service in Stockholm County. Fifteen and 17 year old adolescents (1335) who scheduled their regular dental health examination were asked to participate. After drop-outs a sample of 1071 individuals, 547 males and 524 females were enrolled in the study. Presence of erosive wear was diagnosed (yes/no) on marker teeth by trained dentists/dental hygienists and photographs were taken. The adolescents answered a questionnaire regarding oral symptoms, dietary and behavioural factors. Two calibrated specialist dentists performed evaluation of the photographs for severity of DE using a modified version of the Simplified Erosion Partial Recording System (SEPRS). Results: DE was clinically diagnosed in 28.3% of 15 years old and 34.3% of 17 years old. Severe erosive wear (grade 3 and 4 according to SEPRS) was found in 18.3% of the adolescents based upon the intra-oral photographs. DE was more prevalent and severe among males than females. Clinically diagnosed erosive lesions correlated significantly with soft drink consumption (p < 0.001), the use of juice or sport drinks as a thirst quencher after exercise (p = 0.006) and tooth hypersensitivity when eating and drinking (p = 0.012). Furthermore, self-assessed gastric reflux was a factor strongly associated with DE (p < 0.001). Conclusion: The study indicated that DE was common among adolescents in Stockholm County and associated with both internal and external risk factors.
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Material & methods: We have analyzed the loss of enamel and dentine after exposure to different non-alcoholic drinks with a simple new method using bovine teeth. 100 enamel and 100 dentine specimens from freshly extracted bovine incisors were randomly attributed to 10 groups (n=10 for enamel and dentine each). Prior to the start of the experiment all specimens were weighed using a precision balance. The mean initial masses (SD) were 35.8 mg (7.2) for enamel and 24.7 mg (7.0) for dentine. No statistically significant differences were found between groups for initial masses (p>0.05, ANOVA with Bonferroni post hoc test). Thereafter, all specimens of one group were simultaneously placed in 200 ml of the following fluids: Coca-Cola, Coca-Cola light, Sprite, apple juice, Red Bull, orange juice, Bonaqua Fruits (Mango-Acai), tap water, chlorinated swimming pool water, and lemon juice. Fluids were continuously ventilated at 37° C for 7 days. Thereafter the specimens were weighed again and the mean mass loss was calculated. Results: The values were (enamel/dentine): Coca-Cola 7.5 mg/6.6 mg; Coca-Cola light 5.2 mg/3.5 mg, Sprite 26.1 mg/17.7 mg, apple juice 27.1 mg/15.2 mg, Red Bull 16.6 mg/17.0 mg, orange juice 24.3 mg/20.2 mg, Bonaqua Fruits (Mango-Acai) 17.8 mg/16.2 mg, tap water -0.2 mg/-0.3 mg, swimming pool water -0.3 mg/-0.2 mg, and lemon juice 32.0 mg/28.3 mg. From all drinks, Cola and Cola light showed the least erosivity (p<0.001, ANOVA with Bonferroni post hoc test) whereas lemon juice showed statistically significant higher erosivity than all other drinks except Sprite and apple juice (p<0.01, ANOVA with Bonferroni post hoc test). Conclusions: In conclusion, erosivity of common non-alcoholic drinks varies widely. For example, Sprite, apple juice, and orange juice are about five times more erosive than Coca-Cola light. The findings from the present study should be taken into account in choosing a diet that provides satisfactory nutrition while minimizing tooth erosion.
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This prospective, randomised in vitro study was to investigate the pH and titratable acidity of fruit smoothie drinks and to assess the effect of these drinks on enamel erosion. Fifty enamel slabs were divided into five groups which were allocated to the sample solutions groups: Innocent(®) smoothie strawberries and bananas (SB), Innocent(®) smoothie mangoes and passion fruit (MP) and Diet Coke. Distilled deionised water (DD) was used as negative control and citric acid 0.3 % as positive control. All the slabs were subjected to a 21-day pH cycling regime involving 2 min of immersions, five times a day with appropriate remineralization periods in between. Measurement of surface loss was assessed using profilometry. Independent sample t tests were used to compare mean. The titratable acidity for both test smoothies were 3.5-4 times more than that needed to neutralise Diet Coke and citric acid 0.3 %. The pH of SB, MP smoothie and Diet Coke was found to be 3.73, 3.59 and 2.95, respectively. MP smoothie caused the greatest amount of surface loss followed by Diet Coke. Both smoothies were found to cause significant surface loss. MP smoothie resulted in significantly higher surface loss compared with MB smoothie and citric acid 3 %. The smoothies tested were acidic and had high titratable acidity. They produced a significant erosion of enamel in vitro. The results of this study suggest that there should be increased awareness of the erosive effects of smoothies especially as their consumption seems to be on the increase.
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To measure, in vitro, the pH and titratable acidity (TA) of various soft drinks and to assess the erosive effect of smoothies using an in situ model. The in vitro phase of this study included measuring the inherent pH of six different commercially available smoothies, diet coke, and citric acid 0.3% (positive control) using a pH meter. The TA was determined by titration with NaOH. In the second part of the study, an in situ model was used. An upper removable appliance capable of retaining two enamel slabs was constructed and worn by 14 volunteers. The drinks under test were Innocent(®) strawberries and banana smoothie and citric acid. Volunteers were instructed to dip the appliance in the test solutions extra-orally five times daily for 2 min each time for 21 days. Measurements of enamel loss were made by surface profilometry and microhardness. Diet Coke was found to be the most acidic drink (pH 2.61), whereas Innocent(®) mangoes and passion fruit smoothie showed to be the least (pH 3.9). With regard to TA, Innocent(®) blackberries, strawberries, and blackcurrant smoothie had the highest TA requiring 10.8 mol of NaOH to reach pH 7.0, whereas citric acid required only 3.1 mol of NaOH to reach the same pH value. Surface profilometry and microhardness testing revealed that citric acid caused a statistically significantly greater tooth surface loss compared with smoothie after 21-day pH cycling protocol. Smoothies are acidic and have high TA levels. Innocent(®) strawberries and banana smoothie had an erosive potential to the teeth. However, its erosive effect was significantly less compared with citric acid after 21-day pH cycling protocol using an in situ model.
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AimTo identify potential risk indicators of dental erosion (DE) among 12- to 14-year-old Jordanian school children. DesignA random cross-sectional sample was selected from Amman, Irbid, and Al-Karak governorates. A weighted multistage random sampling system was used to yield 3812, 12- to 14-year-old school children from 81 schools. The study utilized a self-reported questionnaire of factors reported in the literature and thought to be associated with DE. Full mouth recording using the tooth wear index modified by Millward etal. (1994) was performed by a single calibrated examiner. ResultsLogistic regression analysis defined the risk indicators that were simultaneously associated with DE with geographical location, medical condition including frequent mouth dryness, and having frequent bouts of vomiting or using a cortisol inhaler, dietary habits including consumption of carbonated beverages, lemon, sour candies, and sports drinks, keeping soft drinks in the mouth for a long time, brushing teeth following soft beverages or drinking lemon juice at bed time. Conclusions Dental erosion is a multifactorial condition in which mouth dryness, vomiting, cortisol inhaler use, keeping soft drinks in the mouth, drinking beverages at bed time, consumption of lemon, sour candies, and having confectionary as snacks are risk indicators, and area of residence are all potential factors.
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Tooth erosion is a growing dental problem; however, the role of diet in the aetiology of tooth erosion is unclear. A cross-sectional study was conducted to determine the association between tooth erosion occurrence and the consumption of acidic foods and drinks among undergraduate university students. A total of 150 undergraduate students (33 males and 117 females) aged 19 to 24 years at Universiti Kebangsaan Malaysia participated in this study. The Basic Erosive Wear Examination was used to assess the occurrence of tooth erosion. Information regarding dental hygiene practices, usual dietary habits, and consumption of acidic foods and drinks was obtained through a structured questionnaire. In all, 68% of subjects had tooth erosion. Subjects who reported having received information about healthy eating were less likely to have tooth erosion (χ(2) [1, N = 150] = 7.328, P = 0.007). The frequencies of milk (OR = 0.29, 95% CI = 0.13-0.67) and tea/coffee (adjusted OR = 0.42, 95% CI = 0.19-0.95) consumption were negatively associated with tooth erosion. Dental hygiene practice, the frequency and amount of acidic food and drink intake, and body mass index classification were not significantly associated with the risk of tooth erosion (P > 0.05). A high prevalence of tooth erosion was observed among this group of students. Preventive measures, such as dietary advice and increased consumption of milk at a younger age, may reduce the occurrence of tooth erosion among this age group.
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Caries and erosion are common diseases of the dental hard tissues. The influence of vegetarianism on the development of caries and erosion has scarcely been investigated in the past. The aim of the present study was to evaluate the influence of fruit consumption and topical fluoride application on the prevalence of caries and erosion in vegetarians. In 100 vegetarians and 100 nonvegetarians, a dental examination was performed. The indices for decayed, missing, filled teeth (DMFT) and surfaces (DMFS) were determined. DMFT and DMFS were subdivided into decayed teeth (DT), filled teeth (FT), decayed surfaces (DS) and filled surfaces (FS). In addition, the hygiene index and the number of teeth with dental erosion (DE), root caries (RC) and overhanging restoration margins (ORM) were recorded. A questionnaire assessed patients' eating habits, frequency of oral hygiene, dentist visits and topical fluoride application. For statistical analysis, unpaired t-test, Mann-Whitney test and Pearson's chi-square test were applied. Vegetarians had significantly more DT (P<0.001), DS (P<0.001), more teeth with DE (P=0.026), RC (P=0.002) and ORM (P<0.001) than nonvegetarians. Daily consumption of fruits was significantly more prevalent (P<0.001), and topical fluoride application was less prevalent (P<0.001) in vegetarians compared with nonvegetarians. In particular, fluoride-containing toothpaste (P<0.001) and table salt (P=0.039) were less frequently used in vegetarians. The presented data suggest that vegetarians have an increased risk for caries and erosion. Topical fluoride application was shown to be effective in preventing caries, but not in preventing erosion.European Journal of Clinical Nutrition advance online publication, 18 March 2015; doi:10.1038/ejcn.2015.20.
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Dental erosion is often described solely as a surface phenomenon, unlike caries where it has been established that the destructive effects involve both the surface and the subsurface region. However, besides removal of the surface, erosion shows dissolution of mineral within the softened layer - beneath the surface. In order to distinguish this process from the carious process it is now called 'near surface demineralization'. Erosion occurs in low pH, but there is no fixed critical pH value concerning dental erosion. The critical pH value for enamel concerning caries (pH 5.5-5.7) has to be calculated from calcium and phosphate concentrations of plaque fluid. In the context of dental erosion, the critical pH value is calculated from the calcium and phosphate concentrations in the erosive solution itself. Thus, critical pH for enamel with regard to erosion will vary according to the erosive solution. Erosive tooth wear is becoming increasingly significant in the management of the long-term health of the dentition. What is considered as an acceptable amount of wear is dependent on the anticipated lifespan of the dentition and is, therefore, different for deciduous compared to permanent teeth. However, erosive damage to the teeth may compromise the patient's dentition for their entire lifetime and may require repeated and increasingly complex and expensive restorations. Therefore, it is important that diagnosis of the tooth wear process in children and adults is made early and that adequate preventive measures are undertaken. These measures can only be initiated when the risk factors are known and interactions between them are present. © 2014 S. Karger AG, Basel.
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Oxalic acid and its salts occur as end products of metabolism in a number of plant tissues. When these plants are eaten they may have an adverse effect because oxalates bind calcium and other minerals. While oxalic acid is a normal end product of mammalian metabolism, the consumption of additional oxalic acid may cause stone formation in the urinary tract when the acid is excreted in the urine. Soaking and cooking of foodstuffs high in oxalate will reduce the oxalate content by leaching. The mean daily intake of oxalate in English diets has been calculated to be 70-150 mg, with tea appearing to contribute the greatest proportion of oxalate in these diets; rhubarb, spinach and beet are other common high oxalate-content foods. Vegetarians who consume greater amounts of vegetables will have a higher intake of oxalates, which may reduce calcium availability. This may be an increased risk factor for women, who require greater amounts of calcium in the diet. In humans, diets low in calcium and high in oxalates are not recommended but the occasional consumption of high oxalate foods as part of a nuritious diet does not pose any particular problem.