
Sugar, acid and teeth (2009) - jondot
http://www.dbskeptic.com/2009/04/05/sugar-acid-and-teeth/
======
deltaqueue
I wish he would have provided more explanation behind the dentist's algorithm.
Here's an actual study measuring enamel loss, which seems much more
definitive:

[http://faculty.philau.edu/ashleyj/General%20Dentistry%20Arti...](http://faculty.philau.edu/ashleyj/General%20Dentistry%20Article.pdf)

Perhaps the most important snippet:

 _Regression analysis indicated no correlation between enamel dissolution and
beverage pH (r = 0.477, p > 0.05); in addition, the enamel dissolution showed
no difference (p > 0.05) between the regular and diet versions of cola and
non-cola beverages from the same manufacturer (Fig. 2 and 3). It was noted
that the enamel dissolution was similar for all cola drinks over the 14-day
test period (approximately 3.0 mg/cm2)._

And again:

 _The data suggest that enamel aggressivity is determined by beverage
composition rather than by beverage pH._

~~~
nathanb
Or how about experimental science? Get some human teeth (probably not
difficult or expensive for a dentist), weigh them, plunk them in each liquid,
let them sit for a week, see which ones lost the most mass.

Obviously scientific rigor would require several experiments to smooth out the
variances in individual tooth quality and original composition, but it seems
like that would come to a more definitive conclusion.

~~~
splat
I think the presence of saliva has a major effect on inhibiting tooth decay.
I'm not sure how applicable in vitro experiments would be.

~~~
CamperBob2
Exactly, hence the problem with allowing babies to sleep with a bottle. It's
not the milk in the bottle that does the harm, it's the uneven saliva exposure
in the mouth.

In general, people with good salivary coverage get less tooth decay. People
with dry mouths, for whatever reason, get more. This isn't exactly an avant
garde research topic.

While the dentist has impeccable credentials, she seems too reliant on
anecdotes and personal observations, and insufficiently rigorous (to put it
mildly) in justifying the mathematical model she proposes. The reasoning in
this article is a _little_ better than the old science-fair standby of
dropping a tooth in a glass of Coke and gasping with horror when it's gone a
week later, but not much.

------
jws
Where "worst" is defined by a function of pH and sugar content pulled out of
the air by a dentist.

~~~
cmatteri
Their function 10^(5.5-pH) * (mg/cl sugar + 1) does seem to imply that sugar
and acidity have a synergistic effect, where the +1 in the sugar term is a
hack to keep the result from being 0 if the sugar is 0. This doesn't make
sense, as a modest increase in sugar, say from 0 to 1 would double the result
regardless of the pH.

~~~
Royal
Their function also improves the results if the drink is more basic. A drink
with a pH of 13 would have an amazing score on here.

If you normalize the pH above 5.5 since it has "little to no effect" things on
the lower end of the results are better, with milk being worse than water, and
chocolate milk being worse than milk.

~~~
lyso
This shows how bogus it is - you can put lots of sugar in a basic drink and it
would score well.

The key point for me is why is concentration of sugar in mg/cl? Why not mg/l,
or g/l, or oz/gallon? Each one would give a different answer, and all are
equally justifiable. (There is also the weird idea that a decrease in pH of 1,
which is 10 times the concentration of H+, would therefore be 10 times as
bad.)

------
casca
Interesting, but their choice of weighting of sugar and pH is not based on any
evidence.

Also, would the amount of time that the drink is in contact with your teeth
not have an impact? Perhaps wine would have more of an impact because you
might keep it in your mouth longer, offset by the small likelihood you you
drinking as much of it?

~~~
bmelton
Similarly, I read something recently (no link, sorry) that stated something
like the following (poorly paraphrased):

    
    
      Juice is fine to drink as it's generally healthy,
      but if you're going to drink it, do so quickly 
      instead of sipping on it for long periods.  
    

The premise being exactly what you surmised, that chugging a small glass of OJ
is much better for your teeth than sipping it and putting your teeth into
contact with it for so much longer.

~~~
mtts
Juice is for most intents and purposes no healthier dan soda. It's mostly
sugar and acid. The fact that said sugar and acid used to reside in a piece of
fruit makes no difference at all.

If you want the health benefits of fruit, eat a piece of fruit.

~~~
beagle3
I love the conviction with which you say that.

So, there is no difference between compounds that we've evolved to consume
over millions of years, and ones which were designed in the last 30 to be as
addictive and as cheap to make as possible?

While I do not claim that there is evidence of difference (I cannot provide
any), it is unfounded to claim that there is none, whether based on some
(inherently) limited study of effects, or just based on lack of knowledge
otherwise.

To be clear, I'm NOT talking about "Honest to god freshly squeezed tropicana
juice", which is stretching the definition of what "squeezed orange juice"
means (In case you are not aware - they boil it in vacuum, which gives it a
much longer storage and shelf life, but kills taste and probably also any
nutritional value; flavor is later added with a market-specific artificial
"flavor kit" before packaging to consumers).

I'm talking about actually taking an orange, squeezing that, and drinking it.
Which should be the only acceptable definition for "orange juice", I think.

~~~
ta12121
It may be what you consider the "acceptable definition" of fruit juice, but it
is not the definition in common use.

Also, you are not evolutionarily adapted to eat compounds. You are
evolutionarily adapted to eat foods. And fruit juice is not a food you are
evolutionarily adapted to eat. It is very different, biologically, from eating
an actual fruit.

~~~
eel
For those who might be wondering, one such difference is the presence of fiber
in fruit, but the lack of fiber in fruit juices.

------
barcoder
"To mitigate the effects of pop consumption, only consume it with meals. Brush
soon after eating or drinking anything besides water (including milk or
juices)."

Brushing soon after drinking or eating something sugary is not a good idea.
Best to wait around 30 minutes and let your body clean your teeth during that
time, after the 30 minutes manually clean!

[http://well.blogs.nytimes.com/2012/05/21/really-never-
brush-...](http://well.blogs.nytimes.com/2012/05/21/really-never-brush-your-
teeth-immediately-after-a-meal/)

[http://www.hindustantimes.com/Entertainment/Wellness/Brushin...](http://www.hindustantimes.com/Entertainment/Wellness/Brushing-
within-30-minutes-after-meal-can-damage-teeth/Article1-866236.aspx)

------
steve8918
I have deep grooves in my teeth right above my gums on both sides of my mouth
from drinking 3-6 cokes a day for 10+ years. For some reason, I have a habit
of swishing the drinks on the bottom of my mouth and I think this is the
reason why my teeth are so jacked up. In the past year, I've largely stopped
drinking Coke, partly because of this, and because of the other health
problems associated with drinking so much soft drinks. I've switched to water
and have a sugary drink maybe once or twice a week.

~~~
peterwwillis
Besides being bad for your teeth it's a nightmare on your body. That insulin
dump from the onslaught of sugar will make you much more likely to develop
diabetes, and some studies have shown a long-term metabolic effect where your
body prefers sugars for energy instead of fats. That and the empty calories
will lop-side your diet and make it harder to lose weight or gain muscle.

There are lots of ways you can drink something tasty and not have such a huge
impact on your body. Sometimes i'll buy a two-liter of green tea ginger ale or
cranberry juice, and make a 50/50 or 25/75 mix of the drink and tap water.

You can also just cold-brew tea or coffee and mix in a little sweetener or
other flavor to change it up. It's cheaper than soda and (after you stop
drinking soda every day) tastes much better because you're not getting hit
over the head with truckloads of sugars. Ask a European about how sweet all
our foods and drinks are.

~~~
steve8918
I 100% agree. Actually I have done almost exactly that, switched to tea, or
ice tea. I'm not completely off the sugary drinks, but I'll drink things like
Honest Tea with a lot less sugar than Coke, or just plain Tea.

The thing I'm actually most worried about is pancreatic cancer. I'm not even
sure if there's a link between that and soft drinks, but I read one study
where having 2-3 soft drinks a week doubled your risk of getting it. Well I
was having 20 a week, which scared the crap out of me. And more and more
people appear to be contracting and dying of it, so it's my secret fear.

~~~
kokey
For sweetness, try rotating between non-fructuse sweeteners. like saccharin,
aspartame, stevia, etc. I also find that Coke Zero is a nice way to cut down
on sugar but still keep the Coke taste, and it's a lot less acidic than Diet
Coke. However I don't find vending machines stocking it as often as I'd like.
That's assuming you are not buying into the aspartame myths. I've got diabetes
in my family, so to me the risks of sugar far outweighs the less than slight
risk of aspartame.

~~~
peterwwillis
Or, you know, stop drinking sweet things =) I know that's heretical in our
society, but once you cut out sweet things your palate will change and you'll
find things like unsweetened teas (cold Oolong is fucking amazing) and
juice/water mixes are cheap, simple, tasty and healthy.

~~~
tallanvor
I love unsweetened iced tea and drink it as often as I can get it when I'm
visiting home in the States, but it's so hard to get good iced tea in Europe,
and since it's hard to keep enough ice on hand, it's a pain to try and make it
here as well. So I end up drinking stuff like Pepsi Max (Can't get Diet Pepsi
in Norway) or other diet sodas.

------
hnriot
This should not be so much surprise to anyone really. It's pretty widely known
that sugar and acids are bad for your teeth. The degree to which any drink
with these contributes to dental damage is probably more complicated but
everyone knows that its best to drink water. Not only will it not ruin your
teeth but it will also not make you fat, like sodas and juice boxes.

------
rcxb
With "skeptic" in the name, I was expecting much, much better. It's a pretty
bland application of some rule-of-thumb (perhaps, dogmatic) beliefs about
tooth decay, which doesn't hold up to reality.

One of the problems which comes to mind is that mouth wash has NEVER proven
effective in preventing tooth decay (and companies that make Scope, Listerene
and others would really LOVE to be able to say that it does). Meanwhile, this
article blindly asserts that they will work quite well.

This issue throws every other claim into doubt, too, since the bacteria is
claimed be be the sole cause of decay, and a mouth wash certainly _could_
kill-off bacteria in the mouth. It seems tooth decay is a far more complex
activity than the model used in this discussion.

------
Detrus
I never drink any sugary juices or candy. Eat lots of fruits and veggies, also
bread, milk and nuts.

And I have terrible tooth decay.

Seems a bit silly to compare pHs of various junk foods. Drinking a better pH
won't make much difference. The problem is a tad more complicated.

~~~
beagle3
I had terrible tooth decay when I was younger (I have 16 fillings from ages
10-20). And then, all of a sudden - nothing. I haven't had a hole or a problem
since (except for a filling that broke and had to be replaced). There was
nothing that I'm aware of that I changed around that time -- I stopped
drinking sodas and eating junk food around age 30.

But I have recently read claims (and testimonials) that what you need for
healthy teeth is Vitamin D (make sure you take it in the morning if you do!)
and Vitamin K2, see e.g.
[http://www.thedentalessentials.com/The_role_of_vitamin_k2_on...](http://www.thedentalessentials.com/The_role_of_vitamin_k2_on_tooth_decay_s/29.htm)
; If you find this interesting, you'll find a lot more similar stuff on the
bulletproof executive forums.

------
njs12345
There's some effort underway to develop a vaccine against dental caries:
<http://en.wikipedia.org/wiki/Caries_vaccine>

~~~
nemo1618
Indeed, there are some very exciting prospects here. The replacement therapy
seems most promising. I developed a number of cavities out of the blue after I
began aggressively using mouthwash - my theory is that I had a mostly
benevolent strain of bacteria and accidentally killed them off, and they were
eventually replaced with a nastier strain. If a harmless strain could be
administered through vaccine or chewing gum, the societal effects would be
enormous. Seems like the largest problem left (as usual, sadly) is getting it
out of the lab.

------
brianbreslin
My uncle who is a dentist told me i got loads of cavities from gatorade. His
rationale aside from the high sugar content was that because I was exercising,
my mouth was drying out w/the gatorade residue in it. So the sugars eat away
at your teeth faster. So there is that factor to weigh in as well (how your
mouth is reacting at the time of the liquid consumption, or post consumption
residue).

------
nealabq
One hears that Bulimia and certain drug addictions (Crack, Meth) are very bad
for your teeth. Bulimia because of the strong acid, and drugs because they
interfere with the mouth's self-cleaning instinct.

I'd guess the best teeth live in a mouth with: 1\. Active high-volume saliva
glands 2\. A population of healthy bacteria

How do you encourage that?

~~~
Alex3917
The reason why amphetamines are bad for your teeth is that they prevent your
mouth from making saliva, which allows bacteria to multiply and causes other
bad things to happen as well. Obviously it's probably not a good idea to be
using meth in the first place, but if you're going to use any sort of drug
that causes dry mouth then at the very least you should brush, floss, and use
mouthwash and flouride rinse beforehand.

------
stuaxo
Hm, but what about the effect of the bacteria consuming said drinks; surely
this will change the results ?

------
humdumb
Bacteria vs. Human body^1.

1\. Specifically, teeth and saliva, but you must always consider the whole
organism.

Drink soda pop --> Advantage, Bacteria.

Don't drink soda pop. --> What do you think?

Bacteria need acidic conditions and they are happy to have plenty of sugar.
Preserving your teeth means giving your body the best possible chance against
bacteria, slowing the process of decay as much as you can. But in the end, on
every front, bacteria will always win. It's just a matter of time. If they
don't consume you while you're alive, they will after you're dead.

With respect to tooth decay, drinking soft drinks surely helps bacteria, not
the human body. But then, maybe people derive other benefits from drinking
these concoctions. (Jolt?) Maybe preserving their teeth is not their number
one priority?

Factoid: George Washington had wooden teeth?

------
eaurouge
Interested in hearing what people think of Xylitol and its positive effects on
saliva pH.

~~~
beagle3
Xylitol's major positive effects on teeth health come from a different path:
The bacteria responsible for cavities will try to eat it (cause it's close
enough to sugar) but fail to digest it (cause it isn't), which will interfere
with their ability to prosper and even kill them.

(Unfortunately, that's also true for dogs: DO NOT feed your dog xylitol. It is
toxic for them: two xylitol-swettened gums are potentially enough to kill a
small dog, and cause irreversible damage to larger dogs!)

<https://en.wikipedia.org/wiki/Xylitol> is a treasure trove

~~~
ericd
That sounds like something I don't want to be eating either, if it's so toxic
to both bacteria and fairly similar mammals. Have there been any long term
xylitol studies? It seems likely that it would screw with the bacteria in
one's gut.

~~~
beagle3
I don't know specifically about bacteria in one's gut, and hadn't thought of
that. However, studies of xylitol in both humans and rats all show
overwhelming positive (and mostly unexpected) results related to immunity to
diseases like respiratory infections and ear infections.

> something I don't want to be eating either, if it's so toxic to both
> bacteria and fairly similar mammals.

FYI: Chocolate is toxic to dogs as well; a 70% chocolate bar can kill a small
dog. Are you going to abstain from chocolate and recommend everyone else does
too?

Also: some humans are deathly allergic to nuts, and others to strawberries,
and yet others to wheat gluten. These people are a lot closer to you
genetically than a dog.

Enough research has been done on xylitol to deem it safe for human use -- much
more so than e.g. sucralose (Splenda), acesulfame-K (SweetOne), Aspartame
(NutraSweet) and High Fructose Corn Syrup. And while Xylitol does not form
naturally, it is a sugar alochol like e.g. Sorbitol (also found in plums and
apples), and shares the vast majority of its properties.

Really, do read the wikipedia entry.

------
tocomment
I've never understood if sugar affects gum disease. Does anyone know? Does the
gum disease bacteria eat sugar or directly eat your teeth and gums?

I tried looking it up once but I only found information about sugar and
cavities.

~~~
artemus
Bacteria consume sugar, which produces acid as a waste-product, which erodes
enamel. Gum disease is primarily an inflammatory response to the presence of
external irritants like dental plaque (which contains bacteria as well).

~~~
tocomment
So there's no specific gum disease bacteria? It's just the same bacteria that
causes cavities?

~~~
artemus
According to Feng & Weinberg:

Approximately 500 bacterial species reside in the oral cavity. Of these, 415
species are estimated to be present in subgingival plaque. Specifically:

"A. actinomycetemcomitans has been strongly implicated in localized aggressive
(juvenile) periodontitis Likewise, bacteria such as P. gingivalis, A.
actinomycetemcomitans, Tannerella forsythia (formerly, Bacteroides forsythus),
Treponema denticola, and Eikenella corrodens have been associated with chronic
(adult) periodontitis."

Ref:
[http://www.perioimplantelsalvador.com/Informacion/bibliograf...](http://www.perioimplantelsalvador.com/Informacion/bibliografia/periodontal_tissues_role_bact.pdf)

------
solox3
To couple pH with 'badness', you need to couple it with volume. It takes less
effort to neutralize 1L of pH3 stuff than 10L of pH4 stuff.

------
kokey
From a very basic investigation by myself, I have found whiskey and water to
be the alcoholic drink that's the least acidic.

------
nsxwolf
As a child, my dentist also warned me about Mountain Dew and gave a specific
reason - the presence of ethylenediaminetetraacetic acid (EDTA), used as a
stabilizer.

His theory was that it would chelate the calcium out of your tooth enamel.

Sounds like a bit of dentist lore that gets passed around. Maybe because they
use EDTA during root canals to prep the area.

------
shalmanese
Have there been any studies on whether drinking with a straw is better than
drinking from a cup/bottle?

------
dhughes
I can't see how second best sorbitol and the best being Xylitol are any better
than sugar they're sugar alcohols which have the effects of a laxitive.

How about just not eating so much sugar, and if you're diabetic try stevia
that's what my mother, a diabetic, chooses.

------
JabavuAdams
So a cookie should be much worse than any sugary drink.

Basically, if you eat more than 0 sweets per day, it seems ridiculous to worry
about sugary drinks.

If you get a raspberry seed stuck between your teeth, it should be much worse
than a sugary drink.

Is there some coating effect I'm missing?

------
tocomment
Hmm, this makes me wonder; should a low carb diet help cure gum disease and
prevent cavities since you're providing so little sugar to the bacteria?

In fact do you need to brush and floss when on a low carb diet?

Has this been studied?

------
davidw
I didn't get the impression they looked at serving size. In other words, the
Merlot's average serving size is smaller than that of the Guiness, even though
the latter is "better".

~~~
pre
I wonder how much serving size would even matter? I'm told the damage comes
_after_ the drink really, when your teeth sit around covered in it.

I'm sure it'd make some difference, it takes longer to drink a pint than a
shot there'll be a bigger concentration there during those initial minutes,
but I doubt it'd be linearly proportional.

I'd guessed a red-wine. My dentist certainly goes on about my drinking booze
more than me downing Ribena by the pint. I wonder if alcohol can have some
unmeasured effect apart from sugar content and PH.

------
jtlienws
If you must drinks harmful to teeth, It would make sense to me to use a straw,
and put the straw deep in you mouth so that the liquid does not come in
contact with the teeth.

------
dollarpizza
So where do coffee, espresso, & teas (black, green) fit into his Harm Matrix?

~~~
jarek
Depends how much sugar you put into them.

------
magoon
Root beer is the best soda (pop) for your teeth because it isn't acidic.

------
gdw2
My dentist explained it this way: Bacteria eats sugar and pees acid.

------
myhf
Wow, I never realized Diet Coke was less acidic than Diet Dr Pepper.

------
baseh
Thats it. I am switching to Spartan Lower 1/2% milk

------
photorized
Genetics.

