Can Gum Disease Cause Heart Disease and/or Stroke? By Dr. Jeff Shnall
If your dentist has told you that you have gum disease this is certainly not uplifting news. Gum disease can cause bleeding gums, pain, swelling and lead to tooth loss if untreated. However can gum disease be a direct cause of heart disease or stroke?
If you search this question online you will find that there are many articles suggesting that gum disease is indeed a direct cause of heart disease and stroke.
However there are probably just as many articles and studies online stating that gum disease does not cause heart disease or stroke.
My aim in this article is to provide some clarity to this question.
The short answer is there is no evidence or very weak evidence to support the notion that gum disease causes heart disease and stroke.
However statistics show that fact is that if you do have gum disease you do have a higher chance of also developing heart disease and /or having a stroke.
You may be asking how can this be? I just said that that gum disease not cause heart disease or stroke but now I am saying if you have gum disease you have a higher chance of having heart disease or stroke.
If you are confused that is understandable because a lot of people writing on this topic are also confused.
Medical research has found that that both gum disease and heart disease/stroke have a common cause that leads to both conditions.
A simple everyday example showing the same faulty reasoning in people who claim there is a causal link between gum disease and heart disease/stroke is as follows:
Statistics show that on days when the sale of umbrellas increase there is also an increase in the number of traffic accidents. But can we conclude that buying umbrellas causes car accidents?
Rather, both an increase in umbrella sales and an increase in car accidents have a common cause: they are both more apt to occur on rainy days. (I got this example from the website “The Straight Dope.”)
In the case of gum disease and heart disease/stroke, as I will explain below, the common cause is inflammation. Let's take a closer look at gum disease, heart disease and stroke and to a clearer picture of relationship of these three maladies and see if we can clear up some cause and effect confusion and as well give some advice on how to get your gums and heart healthier.
Figure 1: Gum Disease: red swollen gums
Gum disease is a common condition.
Mild to moderate gum disease affects 30 to 50 percent of adults in the US. The website of the Canadian Dental Association states that gum disease will affect 7 out of 10 Canadians over their lifetime.
Severe gum disease affects an estimated 5 to 15 % of the US adult population and almost one in three elderly. Canadian statistics are likely very similar.
Patients with gum disease may not have pain, at least initially but may notice some of the following:
Symptoms of gum disease:
Swollen, discoloured or bleeding gums especially when brushing or flossing
The teeth may look longer than they use to due to gum recession and bone loss
Development of spacing between the teeth, loose teeth or teeth that are sore to chew on.
Bad breath or bad taste.
Our mouths are home to billions of bacteria of many kinds and when we brush and floss we are trying to remove or brush away the bacteria or plaque form our teeth. However if you don’t brush or floss regularly or carefully bacteria/plaque can build up on the teeth, starting the gum disease process.
Figure 2 The gum disease process
The gum disease process
Figure 2 illustrates the gum disease process:
Part (A) in figure 2 above shows a tooth surrounded by healthy gums.
In part (B) above clumps of bacteria (otherwise known as plaque) have attached and multiplied on the tooth surface and are extending under the gumline.
In (C) the bacteria on the tooth has triggered the neighbouring gums to become inflamed or in other words, has triggered the process of inflammation.
Inflammation is part of our body’s defense system against foreign invaders such as bacteria and also is a mechanism that helps our body heal when our cells become damaged.
In (D) above, blood vessels in our gums release chemicals and white blood cells that attack and try to destroy the bacteria on the tooth.
These blood vessels also get leaky and release more fluid into the affected gums which can cause the gums to swell.
The strong chemicals released by the inflamed gums not only destroy foreign invading bacteria. They also destroy the bone that surrounds and supports the tooth.
If the inflammatory process goes untreated around a tooth the eventual result can be the loss of so much bone that the tooth needs to be removed.
What determines whether you will develop gum disease?
There are several factors that will determine whether you develop gum and some may surprise you:
It helps to keep your teeth clean. If you have a lot of plaque buildup on your teeth and don’t spend much effort keeping your teeth clean you are at higher risk of developing gum disease.
However, a big determinant in whether you will develop gum disease is related to how your body responds to bacteria..
We all react to bacteria differently. If you have a normal immune system you may develop a bit of inflammation in response to plaque on your teeth but not much else happens.
However, research has shown that some people are hyper responders to bacteria. A hyper responder can have an exaggerated inflammatory response to bacteria or plaque on the teeth, setting off swelling in the gums, bleeding and loss of bone when there are amounts of plaque that would not cause much of any reaction in a person with a normal inflammatory response.
Hyper responders are found to have signs of chronic inflmmation, that is, inflammation in their body on an ongoing basis.
This explains a strange phenomena that we dentists see in our offices: we can see one patient who always comes in for their dental cleaning with their teeth covered in plaque and hard deposits of calcium yet their gums do not exhibit gum disease while the next patient who comes in may have far less buildup of bacteria/plaque on their teeth yet have red, swollen and bleeding gums.
It is not merely the plaque or bacteria on the teeth that causes gum disease. It is how that individual's immune system (their inflammatory response) reacts to the bacteria that determines whether gum disease will result.
What makes someone a hyper responder?
Hyper responders have an exaggerated inflammatory response to bacteria, irritants and foreign bodies.
There are many factors that make someone a hyper responder:
Genetics can play a role. Some people are simply more prone to inflammation due to their genetic makeup. And they may or may not have any of the other risk factors below.
Other factors that can make some people more prone to stronger inflammatory responses are:
Smoking, excess alcohol use, obesity and stress. These all can increase the inflammatory response in our bodies, including in our gums and can increase the risk of gum disease.
In order to answer our original question regarding the link between gum disease and heart disease and stroke let us now turn our attention towards these latter two conditions.
One leading cause of heart attack and stroke is atherosclerosis, a condition in which the arteries narrow..
Arteries are the blood vessels that carry blood, delivering nutrients and oxygen to all the cells of our body.
Arteries are composed of tissue and are wall of the artery are lined by living cells.
The living cells that line our arteries are in direct contact with our blood inside the artery and it is in this layer of cells that problems can start.
Figure 3 Atherosclerosis
Fig 3 A shows a healthy artery with blood flowing through it unimpeded the way that water flows through a garden hose.
Fig 3 B If irritants make there way into the bloodstream they can lodge into the walls of arteries. One such irritant are small proteins called lipoproteins that carry fats in our bloodstream for use or storage in other parts of the body.
Fig 3 C Irritants such as lipoproteins that penetrate the lining of arteries can trigger an inflammatory response in which the body tries to wall off and contain the irritants.
The walling off of the irritant causes thickening of the artery and narrowing of the artery.
The damaged cells that line the artery can also be plugged up with platelets, fat cells and other blood components that can further clog the artery and cause blood clots in the artery.
Figure 4 Left side: Healthy heart, no blockage in arteries supplying the heart. Right side: Blocked artery in the heart (Large arrow) with damage in heart tissue in are that has lost its blood supply.
If one of these clots should break away in can travel further down the blood vessel and completely block it.
If this occurs in a blood vessel supply the heart it can cause damage to the heart muscle and results in a heart attack. (See figure 4)
If the dislodged clump of cells in the artery flow down stream and block an artery supplying the brain a stroke is the result. A stroke occurs when there is damage to brain cells in a region that have lost their blood supply. (See Figure 5)
Figure 5 Storke: Blockage in an artery in the brain causing damage to nearby brain tissue)
What increases your chance of having a heart attack or stroke?
There are a few factors that increase your chance of heart attack or stroke.
Just like in gum disease, research shows that the more prone you are to inflammation, the higher will be your risk of developing heart disease and stroke.
And the factors that increase the risk of having an exaggerated inflammatory response and therefore an increased your risk of heart disease are:
Genetics : some people have an innate tendency to be hyper inflammatory responders
Smoking, lack of exercise, excess alcohol use, and obesity all increase the chronic inflammatory response in your body and as well increase the risk of heart disease and stroke.
Note: It was previously thought that a diet high in fat/cholesterol would result in cholesterol being digested and carried to the lining of the heart by small proteins in our blood. These cholesterol laden proteins were thought to enter the wall of arteries of the heart.
Current thinking suggests that it is not a diet high in cholesterol but instead, one high in highly refined carbohydrates such as sugar, high fructose corn syrup, white flour and even white rice that are the culprit in atherosclerosis.
These sugars and simple starches are digested, converted into triglycerides and then carried by small proteins (lipoproteins) through the circulation where they can lodge into the lining of arteries in the heart.
So What about the link between gum disease , heart disease and stroke?
Well, we have now discussed that these three health problems are found in people who have exaggerated inflammatory responses. In gum disease the hyper inflammatory response causes gum disease and in the case of heart disease the hyperinflammatory response occurs in the arteries supplying the heart..
Given the fact that these three diseases have a common cause, inflammation, it is easy to confuse cause and effect when discussing the link between gum disease and heart disease.
I should note that some websites include claims that it is bacteria in gum disease that travels to the heart and causes blockages or plaques to build up in arteries. However research shows that the plaques or blockages found in arthersclerotic arteries do not contain bacteria found in infected gums.
It is important to treat gum disease. Managing and treating gum disease has many benefits. It can help save your teeth. Loss of teeth can affect your ability to chew, can affect your appearance and can make you self conscious when you smile. It can affect your ability to eat anything you like rather than softer foods that denture wearers sometimes have to settle for. It can also help allow diabetics to have better control over their blood sugar levels. Diseased gums has been shown to raise blood sugar levels.
However treating gum disease is not going to reduce your risk of heart disease or stroke.
In order to prevent heart disease and stroke you need to get the the cause of the problem. Someone predisposed to heart disease will benefit from reducing the inflammatory response in their body This can be done through diet, exercise, quitting smoking and reducing alcohol consumption, weight loss and managing stress.
In the following section I will provide a summary of research articles that point to the role of inflammation in the development of heart disease, stroke and gum disease and how researchers, and physicians and dentists are trying to treat these diseases by combatting inflammation .
Article #1: C-Reactive Protein Test to Screen for Heart Disease: Why Do We Need Another Test?
Appeared in Harvard Health Publishing March 2017, Harvard Medical School
This article discusses how measuring inflammation in the body can be a better predictor regarding our risk of developing heart disease or stroke than knowing our LDL cholesterol levels.
When you go for your annual physical your doctor may ask for a blood test to measure your cholesterol levels, including LDL and HDL cholesterol in order to assess your heart health. However only 50 % of people who have heart attacks have high levels of LDL cholesterol in their blood, so the theory that is high cholesterol levels that lead to heart disease does not seem to adequately explain heart disease.
The article supports the belief that high levels of inflammation appear to be causative in heart disease and that trying to reduce inflammation is one way of trying to prevent heart disease.
C- reactive Protein (CRP) is a protein found in higher amounts in the blood in people who have higher levels of chronic inflammation (hyper inflammatory responders). By measuring your CRP predictions can be made regarding your risk of developing gum disease and heart disease. (High CRP blood test results may put you in a higher risk category for inflammatory diseases).
This article makes the following key points: “Chronic, low-grade inflammation is closely linked to all stages of atherosclerosis.”The author discusses the process of atherosclerosis: damage to the lining of arteries in people with abnormally strong inflammatory reactions can lead to eventual narrowing or blockage of the artery which can lead to heart attack or stroke if this occurs in arteries supplying oxygen to the heart or to the brain. A link to the article:
Article: # 5: Clinical And Systemic Implications Of Periodontal Disease Susceptibility: The Importance Of IL-6 Polymorphism
Author: Herbert I Bader DDS, FACD, m FICD Clinical Associate, Harvard School of Dental Medicine Published : January 02, 2014 in the journal Dentistry
This article discusses patients with a hyper inflammatory reaction to bacteria on the teeth are more likely to develop gum disease than normal inflammatory responders. This article discusses a saliva test that can spot people with the genetic tendency to a hyper inflammatory response so that preventive measures can be employed before the patient develops gum disease or heart disease Here is the link:
This is a link to a few paragraphs from a popular textbook on gum disease that explains the relationship between hyper inflammatory responders and gum disease and , heart disease. Textbook: Clinical Periodontology 10th edition By Dr. Michael Newman (et al. chapter 18).
To conclude, the scientific evidence available points to a common cause for both gum disease, heart disease and stroke. These diseases are more likely to be caused by other factors such as a genetic tendency to be a hyper responder to bacteria, or other shared causes such as smoking and poor dietary and exercise practices.
Taking steps to reduce inflammation can be an important way to prevent gum disease and heart disease/stroke.
How is gum disease traditionally treated?
The aim is to eliminate inflammation in the gums and to heal diseased gum tissue and bone. Here are some of the ways gum disease is treated:
Professional cleanings by a dentist or dental hygienist to remove the bacterial coating and calcium deposits above and below the gum line.
Teaching pts to keep their teeth as bacteria-free as possible through proper brushing and flossing technique
Antibacterial rinses, antibiotics, gum surgery or sometimes extraction of one or more teeth is needed.
Research has proven that if patients can keep their teeth very clean at home, and if they see their dentist regularly this can help prevent or reduce the severity of gum disease.
Also, as discussed in this article, reducing generalized inflammation in the body can also play a role in controlling gum disease, especially reducing or eliminating smoking. A future article in this series will explore ways of reducing inflammationan as it relates to dental and overall health.
Some additional sources:
The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease, July 2009, Vol. 80, No. 7, Pages 1021-1032Vincent E. Friedewald,* Kenneth S. Kornman, et al. The link to this highly technical article is: http://www.joponline.org/doi/full/10.1902/jop.2009.097001
An interesting article was published by the the Royal College of Dental Surgeons of Ontario, in 2005, entitled: Is there a link between periodontitis (gum disease) and cardiovascular disease? This article is written for dentists but it has very important information that is consistent with the information that I have presented.
Cavities are preventable. Here are some of the products I recommend to my patients that can prevent or in some cases reverse cavities that are starting.
Some of these products can be purchased at supermarkets, selected pharmacies, online or from your dentist. In Toronto, Canada where I practise, dentists are not allowed to sell dental products to their patients at a markup, so buying through your dentist can save you money but may not be a convenient option.
So here is the list:
1. REMIN Toothpaste
This toothpaste contains calcium and phosphate. When brushed onto the teeth the calcium and phosphate get absorbed into the enamel and other parts of the tooth surface.
When a tooth starts to develop a cavity it loses calcium and phosphate so REMIN toothpaste can replace lost calcium and phosphate in the tooth and reverse early decay.
REMIN toothpaste can also rebuild and strengthen enamel that has been weakened by acid erosion from drinking excessive amounts of fruit juices, pop/soda or from acid reflux.
The active ingredient in REMIN toothpaste is called nanohydroxyapatite (nanoHA) which was invented by NASA’s laboratories in 1970.
NanoHA (composed of small particles of calcium and phosphorous) also seals up sensitive roots helping to decrease tooth sensitivity.
REMIN has only been available in CANADA since 2015 however it has been a popular toothpaste in Japan for the past 35 years and has been extensively researched. In Japan it was marked under the name “Sangi’s Medical Hydroxyapatite toothpaste.”
Remin does not contain fluoride. This may be a benefit to those who are reluctant to use fluoride products although as you will see in this article, there are many fluoride containing products that I do recommend to my patients.
2. X-Pur Xylitol Gum and Pastilles (Lozenge)
If you like to pop a mint in your mouth to freshen your breath do yourself a favour. Try a xylitol containing piece of gum or lozenge instead.
Sugar promotes cavities however xylitol is a natural sweetener that can actually help prevent cavities. Xylitol is a naturally occurring “sugar alcohol” that is found in small amounts in most plant material and in the fibres of various fruits and vegetables such as berries, oats and mushrooms and corn cobs.
Products that are sweetened with xylitol such as sugarless gum and sugarless candies have been show to actually reduce the number of cavities people get and also can help stimulate the flow of saliva in people with dry mouth.
Xylitol prevents cavities by interfering with the way that bacteria produce acid on the surface of our teeth. The bacteria on our teeth usually feed on sugar and other carbohydrates and produce acid as a byproduct, which then can lead to cavities.
However when this same bacteria is exposed to xylitol it cannot use the xylitol as a food source. When the bacteria consumes xylitol it cannot convert it to acid and because the bacteria cannot derive energy from the xylitol the bacteria starves, resulting in reduced amount of bacteria on the teeth. This further reduces the chance of a cavity forming on our teeth.
The effect that xylitol has on bacteria is unique and not other sugar substitutes such as sorbitol and aspartame, so if you chose a mint or gum sweetened with xylitol you get the cavity reducing properties.
If you have one piece of X-Pur gum or a few x-Pur lozenges after a meal or when your mouth feels dry and let it dissolve in you mouth can be beneficial, whereas having a mint that contains sugar will increase the chance of a cavity developing.
There are other xylitol containing gum and candies on the market. You want to be sure they contain a sufficient amount of xylitol to be effective in reducing cavities. For comparison Each piece of X-Pur gum contains 1 gram of xylitol.
As with most things, use moderation in the amount of xylitol you consume since consuming more than 30 more 40 grams of xylitol per day can lead to diarrhea or gas.
X-Pur products are available through your dentist (if they stock them) or can be purchased at Shopper’s Drug Mart and other pharmacies outside of Toronto. See additional information at the end of this article regarding sourcing X-Pur products.
One caution: Xylitol is very toxic to dogs in even small amounts so keep any xylitol containing products out of their reach.
3. Xylimelts: For people who suffer from dry mouth while they sleep
When we sleep our saliva glands produce less saliva. As well, some people take medications that dry the mouth so as a result some people complain of their mouth getting very dry during sleep.
A dry mouth during sleep can result in an increased amount of bacteria/plaque on the teeth as saliva washes our teeth and as well bathes our teeth in minerals such as calcium and phosphate. Dry mouth can result in cavities.
Xylimelts are a small lozenge that you can “glue” to a spot in your mouth (i.e. the side of a tooth or gums) so it can slowly dissolve in your mouth while you sleep.
The lozenge releases xylitol into the mouth which stimulates your saliva glands to produce more saliva during sleep. The xylitol also interferes with the production of acid by bacteria/plaque in the mouth which can reduce cavities.
Xylimelts are actually a small adhesive disc that sticks to your gums or teeth.
The disc stays in places while the xylitol slowly dissolves over several hours.
You can either attach the xylimelt disc to the side of a molar or to your gums. I was a little skeptical when I first heard about this product and was wondering if it would actually stay in place. However if applied properly it does stick and I have had good feedback about this product from my patients who have tried it.
Where to buy it: Dentists who stock it or participating pharmacies ie Shopper’s Drug Mart.
4. Sodium Fluoride Rinse (.05%)
I recommend this fluoride containing rinse to patients who are cavity prone (especially older patients who are getting cavities on the roots of their teeth), to patients who have a lot of dental work in their mouths (crowns, bridges), or to patients that are not doing an optimum job at removing plaque when they brush.
A one minute swish and spit, once a day can strengthen roots and prevent cavities. After use be sure not to drink or eat anything (including water) for 30 minutes so the fluoride has a chance to penetrate your tooth surface.
Where to buy it: Dentists who stock it or participating pharmacies ie Shopper’s Drug Mart.
5. Plaque HD Plaque Identifying toothpaste
This is an interesting product. It does everything that a normal fluoride containing toothpaste does with the added benefit of staining any bacteria/plaque that you miss when you brush . You simply brush with it, spit out thoroughly and look in the mirror. Any plaque that you missed will be stained blue. Simply go back and brush some more until the blue stained plaque is gone.
This is a product can be used for young children that are old enough to spit out, teenagers (especially those with braces who may be missing spots when they brush), adults and as well as the elderly who may need a help detecting spots they are missing when they brush.
This product is more expensive than standard toothpaste so you can either use it as a once off educational tool or use it as a regular toothpaste. Because it promotes better, more thorough brushing if it even prevents one cavity HD toothpaste will pay for itself many times over.
Where to buy it: Dentists who stock it, or see below.
very product I mentioned in this article is manufactured and/or distributed by the company “Oral Science.” You can visit the online sales site: https://x-pur.com/ and check them out. I don’t get a commission from Oral Science but I do like their products and recommend many of them to my patients.
I hope this article has provided you with some useful information.
If you have any questions, comments or ideas for other topics you would like me to discuss in this blog please feel to fill out the form below or email me at BeechDental@gmail.com
Dr. Jeff Shnall
Dr. Jeff Shnall is a dentist providing general, cosmetic and implant dentistry in the Beach neighbourhood of Toronto. For an appointment please either email us at BeechDental@gmail.com or call our office at 416-691-2886.
Dentally speaking we are living in good times. People are keeping their teeth longer and if an adult tooth is lost it can often be replaced in ways not even dreamed of a few generations ago (i.e. dental implants).
However tooth decay is still a disease that affects humans and it is likely to be with us for the foreseeable future.
In my dental practise I have patients that have never developed a cavity while others are cavity prone.
A cure to eradicate tooth decay has not been found however as a dentist my job is not only to treat dental diseases such as a cavities but to also to help prevent dental disease, especially cavities.
In this article I will give an overview of how cavities form and ways to prevent cavities that will help save your teeth. Before we jump in consider a few interesting facts:
Our teeth are covered by an outer protective layer, enamel, which is the hardest substance in the human body. Yes, it is harder than bone. Yet our teeth is the only part of our body that rots.
Once we die our teeth are indestructible. Proof of that latter point is an article you can easily search online; “French archaeology students find 560,000-year-old tooth.”
However during our lives our teeth are anything but indestructible.
Our teeth are covered with a hard outer enamel layer. Beneath that layer is a less hard layer called dentin.
Our teeth are in large part made up of the minerals calcium and phosphate.
Although enamel is the hardest biological material in our bodies it can be dissolved by acids found in certain foods and drinks as well as acid produced by bacteria that cling to our teeth.
The decay process
Our mouths are full of bacteria. Some of these types of bacteria cause tooth decay/cavities.
The bacteria found on our teeth is also called plaque and it likes to grow in the deep grooves that some people have in their teeth, in between the teeth where a toothbrush doesn’t reach as well as along the gum line.
Some species of bacteria/plaque that grow on our teeth ingest sugar and starches from food and drink we consume and convert them into acid.
If the acid that is produced remains on your tooth long enough the acid will start to dissolve the calcium and phosphate in the tooth and a white spot will develop, a process called demineralization.
These white spots in teeth can be reversed.
If we can stop or minimize the acid attack on the tooth by keeping bacteria/plaque off the teeth and re-expose the tooth to enough calcium and phosphate the white spot can harden and the enamel will return to its normal appearance. The hardening of the tooth is called remineralization. Later I will explain how dentists can help you remineralize or repair white spots forming on your teeth.
If the white spot on a tooth does not regain the calcium and phosphate and the enamel continues to be dissolved by acid produced by bacterial plaque, the white spot will progress beyond the point of no return and become a cavity.
On the diagram labelled "Stages of Caries Development" caries is another term for cavity. In the above diagram the "white spot" actually has progressed to become a darker area of decay which has gone untreated to the point where the decay has infected the nerve or root canal of the tooth.
What factors make it more likely you will develop a cavity?
Not brushing carefully enough, long enough or often enough and not flossing regularly.
If you leave plaque on your teeth you are increasing the chance of getting a cavity. I am always amazed at the number of patients I see who only brush once a day. Unfortunately I also see patients who don’t even manage that. Aim to brush 2 to 3 times daily. I am less amazed at the number of patients who don’t floss regularly even though once daily flossing should be your goal.
The bacteria in plaque not only feed on sugar; they also can feed on carbohydrates found in bread, crackers, cookies, pretzels and potato chips. Yes, even bread and potato chips can cause cavities, especially if the foods we snack on get stuck in the deep grooves of our teeth or in between our teeth.
Brushing after a sugary or starchy snack or chewing a piece of sugarless gum after such a snack can stimulate saliva and wash the sugars and starches off our teeth.
Nuts and seeds do not contain sugars and carbohydrates that fuel acid production on your teeth so choosing them as a snack over chips or candies can reduce cavities.
Fresh fruit does contain natural sugars but the sugars are bound up in fibre and are less easily accessed by bacterial plaque so are less likely to cause decay . This does not hold true for dried fruit such as raisins, which are sticky and soft and whose residue can cling long enough to our teeth after we eat them to allow the bacteria to feed on their sugar content. Eating too much dried fruit can lead to cavities.
3.The amount of acid your teeth are exposed to can determine whether or not you will develop cavities. There are several reasons for this.
Bacteria/plaque found on our teeth become greater in number in an acidic environment and these same bacteria diminish in number if your mouth is not acidic.
If your mouth/saliva is acidic you risk getting larger amounts of bacteria/plaque on your teeth hence more cavities.
As well, enamel and other tooth structures (i.e. dentin) will gradually wear down due acid erosion if exposed to acidic foods or drinks.
What determines if your mouth is acidic or not?
If you expose your teeth to acidic food or drink many times a day or for long periods of time a day your mouth, tooth surfaces and the bacteria /plaque on your teeth will stay acidic.
The acidity of any food or drink can be measured. Iced tea and lemonade are examples of two drinks that are acidic. If you drink too much of either of theses beverages, you could erode your enamel and also could develop white spots and subsequent cavities.
Acidic drinks,like lemonade and iced tea for example, make plaque/bacteria more abundant for the reason that bacteria function better if surrounded by acid, as stated earlier. This higher number of bacteria on our teeth can lead to an even greater amount of acid production on our teeth if this more abundant bacteria is fed a sugary diet.
The chart below shows the amount of acidity of some common foods and drinks and other substances.
Any foods on the left hand side of the chart are acidic and support bacterial growth in the mouth and directly break down enamel and dentin.
As seen on the chart our enamel will start to dissolve if exposed to liquids that are a pH of 5.5 or less. So any foods or drinks below 5.5 will promote enamel demineralization.
From the pH chart some points to consider:
Any citrus juices or fruits such as orange, lemonade, grapefruit juice and most soft drinks (i.e.colas, root beer, mountain dew) are acidic drinks and have a pH value in the 2 to 3 range. These drinks can dissolve enamel and promote the growth of cavity causing bacteria.
If you check the label of your favourite soft drink/soda you will see citric, carbonic or phosphoric acid or even all three. Citric acid is also known as Vitamin C. Carbonic acid results from the carbonatation or adding bubbles to the soft drink. Phosphoric acid is added to some soft drinks as a preservative.
Tea and coffee have a pH of 2 to 3 and also provide an environment that supports cavity causing bacteria and tooth demineralization.
4.Exposing your teeth to sugars and certain carbohydrates or acid many times during the day and / or for long durations can cause cavities.
For example someone who carries around a bottle of juice, pop or an energy drink and takes sips from it during the day, or someone who has their morning coffee with a teaspoon of sugar but sips on it for an hour or more hour each morning is keeping their mouth acidic for long stretches of time. This supplies the bacteria on our teeth with a constant supply of sugar which leads to a continual production of acid that sits on their teeth.
If the tooth has periods of time when it is not being bathed in cola or juice or the bacteria is not being fed sugary drinks or candy, the tooth surface will have a chance to remineralize.
The reminerilization process occurs naturally if our saliva is able to bathe damaged enamel and dentin in calcium and phosphorous. These minerals can be deposited back into the injured enamel/dentin and the tooth can harden or remineralize. Fluoride can also help remineralize a softened, demineralized tooth.
Sticky candy like gummy bears or sour keys or long lasting candy such as lollipops also expose the teeth to a longer sugar and acid attack, which can overwhelm the ability of the tooth to repair and rebuild.
5. Dry mouth and cavities
People who have chronically dry mouths are at a very high risk for developing cavities. Saliva washes bacteria off our teeth, and buffers our teeth (makes them less acidic) and delivers calcium and phosphorous to help rebuild demineralized enamel and tooth structure.
If you do not produce enough saliva you will get:
More bacteria buildup on your teeth due to less washing of saliva.
And less rebuilding of damaged tooth as fewer minerals are being delivered to damaged tooth structure
Dental disaster strikes in patients with dry mouth who make the unfortunate choice of sucking on candies that contain sugar to keep the mouth moist or who sip on pop, juice, coffee or tea with sugar to keep the mouth lubricated.
The patient with dry mouth already has more plaque or bacteria on their teeth. The sugar will cause decay, the pop or juice provides an acidic environment in the dry mouth and the result can be devastating.
I have seen patients with dry mouth issues develop cavities in many of their teeth, under fillings and under other kinds of dental work.
Some Good News About Cavities
The good news is that cavities are not inevitable and our goal in dentistry is to prevent cavities from developing, repairing ones that start and also allow you to eat foods you enjoy without destroying your teeth.
It's about keeping the amount of acid your teeth are exposed to to a reasonable level and also promoting remineralization.
So here are some tips to prevent cavities based on our discussion above:
Limit acidic drinks (soft drinks, citrus juices) to meal times and limit the amount you drink.
If you are going to have acidic foods, sweets or other cavity causing carbs limit them to when you are eating breakfast, lunch or dinner; try not to have these cavity causing/demineralizing foods spread over many small meals and / or snacks throughout the day. This allows your mouth and tooth surface to recover from the acidic conditions created by the acidic foods or drinks.
Milk is a better choice than soft drinks/soda and citrus juices as it is not as acidic but you should limit milk to snack time or meal time and do not sip on it for hours at a time as milk does contain natural sugars that promote cavitities.
If you must drink juice, dilute it with water. You may not like it at first but once you get use to it you won’t even notice the difference in taste. At least that has been my personal experience.. I dilute my orange juice: one part orange to three or more parts water. This is less acidic and less sweet. Fewer calories as well. It is an acquired taste but if I can get used to it you likely can too.
Avoid soft drinks/soda, again for the reason that pop/soft drinks/soda contain acids and sugar. Diet soft drinks do not contain sugar but they do contain acid.
If you like to carry a drink with you to sip at during the day tap water is best….it is fluoridated and is neutral i.e. is not acidic.
Whereas, believe it or not some brands of bottled water are actually acidic. There are some brands of bottled water that have a pH in the range of 3.5 to 5.0 ; remember: enamel demineralizes at a pH of 5.6
If you are a bottled water fan search the name of the bottled water you normally like to drink online and check the acidity/pH of that brand. You may be surprised to see the amount of acidity of certain brands of bottled water.
Limit sweets and avoid the sticky ones (i.e. caramels, toffees,fruit roll ups) and definitely no lollipops (unless they are sugar-free)
Choose healthy snack: nuts, seeds, fruit, cheese
In my next article I will discuss products that dentists use in the office to remineralize white spots starting in teeth as well as dental products you can use at home to help prevent cavities. If you have any questions or comments on this post please free to leave a message below.