As dental professionals, it’s always rewarding to see our patients heeding our advice about reducing their sugar intake. However, some popular sugar alternatives can also present a risk to our patients’ oral health in the form of acid erosion.
Acid erosion — are patients swapping one problem for another?
Patients are increasingly aware of the risks of consuming too much sugar, both for their oral and systemic health. As a result, many look for healthier alternatives to their favorite sweet treats and drinks. For example:
Drinking fruit smoothies or juices instead of soda.
Opting for unsweetened tea and coffee.
Switching to sugar-free or “diet” sodas or seltzers.
- Eating fruit instead of candy.
At face value, these changes seem healthy; there are undeniable benefits to be gained from eating more fruit and less candy, of course! However, you will notice that while the popular alternatives we discuss above are lower in sugar/contain no sugar, depending on what is selected they may also be very acidic. In protecting themselves from dental caries and periodontal disease, our patients may unwittingly be putting themselves at risk of acid erosion.
Also referred to as dental erosion (or enamel erosion when it involves only the enamel), acid erosion is the irreversible loss of dental hard tissues caused by non-bacterial acids. These acids may be intrinsic (gastric acid) or extrinsic (acids originating outside the body). Dental erosion caused by repeated and sustained exposure to extrinsic acids most commonly occurs following consumption of acidic foods and drinks, including those mentioned above.
It’s also important to be aware that many popular diets and wellness regimens promote regular consumption of acidic substances like lemon juice (e.g., the “master cleanse”) and apple cider vinegar. Patients reducing their sugar intake as part of a wider effort to improve their health may be especially vulnerable to erosion via this route.
How can we help our patients to make truly healthy choices?
1. Raise awareness
Acid erosion is not as widely known about by patients as dental caries or periodontal disease, which tend to be the main focus of our oral health messaging. One way to raise awareness of acid erosion risk is to incorporate it into those regular caries and perio conversations. As we guide patients away from sugary foods and beverages, we can take the opportunity to steer them towards truly healthier choices by educating them on the risks of acidic alternatives.
2. Frame the topic positively
For patients working hard to make healthier choices, it can be discouraging to hear that some of those choices aren’t quite as healthy as they thought. You can keep your patient motivated by first congratulating them on their efforts and reinforcing the oral health benefits of cutting down on sugar. In this context, you can then frame your recommendations on acidic foods and drinks in a positive way. For example:
“It’s great that you’ve swapped candy for fruit — that’s a major step towards reducing your risk of cavities! Be careful not to have too much of a good thing though, as some fruit is very acidic and too much can still harm your teeth. Moderation is the healthiest way to enjoy it."
Following that, you can suggest non-acidic sugar-free candies as an example, and provide advice on consumption of fruits.
3. Minimize the risk
It’s difficult to avoid acidic foods and drinks altogether, so we can also advise patients on how to minimize the impact. Tips include:
Drinking milk or water with acidic foods and/or instead of acidic drinks (even the occasional swap will make a difference!).
Consuming acidic fruits like berries and citrus fruits in moderation, including in smoothies and juices.
Choosing smoothie ingredients with a higher pH, such as leafy greens, banana, melon, avocado and coconut milk.
Consuming acidic foods and drinks at mealtimes instead of snacking on them, to reduce the frequency of acid exposure.
Drinking juices or smoothies in a single sitting rather than prolonged sipping to avoid “bathing” the teeth in acid for extended periods.
Drinking through a straw to minimize contact with the teeth.
Waiting at least half an hour after consuming acidic foods or drinks before toothbrushing to avoid brushing acid against the teeth.
- Brushing with a toothpaste like Colgate Enamel Health to support enamel remineralization, strengthen enamel and guard against acid attacks.
4. Provide helpful resources
Finally, provide your patient with resources that they can refer back to at home on a regular basis. The following patient-centered resources may be helpful:
Erosion: What You Eat and Drink Can Impact Teeth (Mouth Healthy)
- 4 Non-Acidic Drinks to Help You Avoid Enamel Erosion (Colgate)