Too Much Coffee Can Cause Tooth Sensitivity and Tooth Wear By Dr. Jeff Shnall
Coffee is one of the most popular beverages around and a great many people do not feel right until they have had their morning cup. While coffee has been touted to have many positive health effects, if consumed in excess and/or over long periods of time throughout the day, coffee can cause tooth sensitivity, tooth wear and tooth erosion.
In this article I will discuss when coffee consumption can lead to tooth sensitivity, what kind of damage coffee can inflict on our teeth and how you can still enjoy your morning cup without having to worry about coffee harming your teeth.
Drinking a cup or two of coffee a day has been found to have some positive effects. For example, research has shown that having a cup of caffeinated coffee 30 minutes before a workout will boost exercise performance by ten percent.
The caffeine boost from a cup of coffee can help kick start our day and some people rely on coffee to help them get through their work day, giving them a wake-me-up when their energy is low.
When can coffee consumption lead to dental problems?
As the old saying goes, everything in moderation. I have met patients whose excessive coffee drinking has caused tooth sensitivity and tooth wear.
One cause of tooth sensitivity is frequent and /or prolonged exposure of our teeth to acid.
The source of this acid will either be found in the food or drink we consume or from strong acids that rise up from our stomach back into our mouth in conditions such as acid reflux or bulimia.
The acidity of food or drink is rated by its pH score. Tap water is neutral and has a pH of 7. If food or drink has a pH below 7 it is acidic.
Enamel is the hardest mineral in our body but it will start to dissolve if exposed to liquids with a pH of 5.5 or lower.
So if acidic food or drink is taken in amounts that is too excessive or too frequent our teeth can demineralize or dissolve. And once you start to lose tooth structure through dissolution or erosion you cannot grow it back.
If you are prone to enamel wear due to an overly acidic diet your enamel can wear and become thin. A tooth that is undergoing acid erosion can become more fragile, may chip more easily and can also become more sensitive.
Tooth sensitivity is far more common in people with gum recession Gum recession is a fairly common condition in which our gums shrink away from their original position on the tooth leaving an exposed root.
The roots of our teeth are not covered by enamel. Rather they are covered by a material called cementum. Cementum is softer than enamel and can be easily worn away by using a hard toothbrush and/or by brushing the roots of the teeth too aggressively.
Underneath enamel and cementum is a layer of dentin. Dentin is also softer than enamel and more easily eroded by acid.
Dentin and cementum can start to wear if it is exposed to food or drink with a pH of 6.7 or lower. But the most damage to exposed roots will be seen in people who either have dry mouth, who have a diet high in acidic food/drink or who have acid reflux issues.
When the exposed roots of our teeth are exposed to an excessive amount of acid the root surface softens.
For example, if you have gum recession and you drink a lot of acidic beverages (citrus fruit juices, sports drinks, coffee or pop/soda/soft drinks ) or have acid reflux the root surface will soften and erode. This can lead to deep defects in the side of the root and can also cause tooth sensitivity.
Is coffee acidic acidic enough to damage or teeth?
That will depend on the type of coffee you drink.
In an article titled “Low Acid Coffees,” author Kenneth Davids states “Most high grown, medium roasted coffees ….tend to register a pH of around 4.9 to 4.5.” (Source: The website “ Coffee Reviews”).
So if you regularly drink medium roast coffees you are exposing your teeth to an acidic drink.
Here are some other key points from his interesting article:
Acidity can boost the flavour of coffee
The organic acids in coffee are what gives coffee its health positive antioxidant effects.
Acidic coffees can stimulate and worsen acid reflux in people with this condition.
There are coffee companies that make low acid coffees and market them as such. These companies achieve low acidity by either slow roasting their coffee beans or by steaming the waxy outer layer off the green coffee bean before roasting it. These companies also purchase their coffee beans from certain regions of Brazil that grow coffee beans with naturally less acidity.
Other ways of finding a lower acidity coffee are by looking at brands that are dark roasted or very dark roasted, both which will result in lower acidity.
Three low acid brands that the author gave good taste reviews are “Tully’s French Roast” and “Peet’s Sumatra Blue Batak.” These brands were not advertised by their manufacturer as low acid brands but were found to be low in acidity as they are dark roasted.
The author of the article did not like the taste of some low acid coffees so you may want to do some research before you buy a brand just because it is advertised as a low acid coffee. The taste could disappoint you.
Two low acid brands that did get good taste review in the article were were the “Simpatico Nice Coffee” and “Simpatico Espresso Roast.”
The author also states that “ almost any Brazil or Sumatra and many Mexicos, Perus, Guatemala Antiguas and Nicaragua's brought to a darker roast should display relatively low acidity.”
What is the ph of low acid coffee?
I was not able to get good data on this. One brand of low acid coffee called "Trucup" states the following on their website:
"According to our test results, Trücup Born To Be Mild (Light Roast) clocked in at an impressive 5.74 pH level – making it 1.7 to 4.6 times less acidic than light roasts from some of the leading national coffee brands."
I have never tasted Trucup coffee. It does come in at a pH higher than 5.5 so that it means that it will not erode enamel and could be kinder to sensitive stomachs but a pH of 5.74 means that it still acidic enough to potentially cause root sensitivity if you have gum recession and drink it in excess.
When can coffee consumption cause sensitivity and tooth wear?
This depends on your consumption pattern: How much coffee do you drink? How many cups a day? How long does it take you to have your cup of coffee?
It takes me about 15 minutes to drink my morning coffee. I drink my cup of coffee at lunchtime in about 10 minutes or less. Drinking one or two cups of coffee a day in mere minutes does not bathe my teeth in an acidic liquid long enough to cause any tooth sensitivity or enamel wear, especially since I am also eating food as well with the coffee.
Having the coffee at a meal time boosts my saliva flow and means the acid of the coffee will be washed off my teeth at a faster rate. The bicarbonate, found inmy (and your) saliva will also buffer the acid found in the coffee further lessening the chance of damage to the enamel or dentin of my teeth.
However, I have patients who do have tooth sensitivity and do show signs of tooth erosion and it is likely coming at least in part from the coffee they drink.
What do these patients have in common?
They have longer periods of coffee exposure to their teeth.
They can take 45 mins to an hour to have a single cup of coffee, taking small sips.
They often have several cups of coffee a day
I have patients who tell me they have 3 cups of coffee per day, taking one hour to drink each cup.
Another patient recently told me she drinks 6 cups of coffee per day, taking an hour to drink each cup.
These patients are exposing their teeth to potentially acidic brands of coffee for 3 to 6 hours per day respectively (practically all day long at work).
It is no surprise that these patients complain of tooth sensitivity and show signs of enamel wear.
Tips to reduce tooth sensitivity and wear from excess coffee consumption
1. Limit the amount of coffee you you drink each day. Can you get by with 1 to 2 cups instead of 3 or more?
2. Limit the time it takes you to drink a cup of coffee. 10 to 15 minutes per cup is better than an hour per cup and and will expose your teeth to less acid.
3. Substitute coffee with tap water or milk if you feel you need to drink in between meals during the day. These latte two beverages are non-acidic, however do not sip on milk for long periods of time as milk does contain lactose, a natural sugar that can cause cavities if milk is sipped at for hours on end.
4. Try chewing sugarless gum to keep your mouth moist and occupied to help wean you off of an excessive coffee consumption.
5. Have coffee with a meal rather than as a stand alone beverage.
6. Get enough sleep at night! If you can get 8 hours of sleep each night you may not need as much caffeine to get you through the day.
7. Do some research on low acid coffees or check out some brands of dark roast coffees and see if there is available information on the pH / acidity of the brand. Searching the brand online is a way to start.
8. Some habits are hard to break. Some patients who do drink /sip on high amounts of coffee that I have in my practice can find it hard to cut back on their coffee consumption even if they know it is not a healthy habit.
How toothpastes for sensitive teeth work: (A) shows a magnified view of small openings on the side of the tooth root (brown dots) The openings are caused by acid stripping away the protective coating of the root. If cold water or sweets contact these opened tubules on the root, pain in the tooth can result. (B) If you brush with a desensitizing toothpaste i.e. Sensodyne chemicals such as potassium nitrate shown as yellow dots can plug up the microscopic openings on the root. (C) The root openings are plugged up, eliminating the root sensitivity.
For these patients a desensitizing toothpaste like Sensodyne, Colgate Pro Relief or others can seal up roots exposed by excess coffee consumption and give some relief from tooth sensitivity.
Another Low Acid Coffee Option:
By using a technique called Cold water brewing one can also lower the acidity of coffee.
Cold brew coffee is made by letting medium to coarse ground coffee sit (steep) in cold or room temperature water for 12 to 24 hours. Hot water is not used in the process. After at least 12 hours, the grounds are filtered out of the water leaving the finished cold brew coffee. You could filter the grounds out by pouring the coffee through a coffee filter or you could use a French press for the entire steeping and filtering process.
During the steeping process the oils,caffeine and sugars of the coffee are released out of the coffee grounds and into the water. The result is smooth, rich coffee that is of less acidity than regularly brewed or iced coffee.
Cold brew coffee is different from iced coffee, the latter being hot coffee that has been allowed to cool and then poured over ice. Iced coffee has the same acidity (pH) of hot coffee. (Source: .What is the Difference Between Cold-Brewed Coffee and Iced Coffee? By Amy Sowder | Published on Thursday, September 29, 2016 on the website Chowhound)
I am not about to give up drinking coffee and I am not suggesting you do either. However due to its acidic nature it should be consumed in reasonable amounts and is best not sipped over long periods on a daily basis. When our teeth are sensitive they may be are telling us that they are being exposed to too much acid.
Excess coffee drinking can cause severe tooth sensitivity. A patient of mine recently told me that she has been drinking many cups of coffee throughout the day for several years. Her teeth were so sensitive that she would require freezing of all of her teeth before they could be cleaned by a hygienist.
After explaining the acidity of coffee consumption she agreed to cut back on her consumption and also started to use a toothpaste for sensitive teeth. Her tooth sensitivity decreased significantly and she was able to have her teeth cleaned without local anaesthetic, although we did use a little nitrous oxide sedation. She felt it was a definite improvement though compared to previous cleanings.
Questions? Comments? Feel free to contact our office :) Jeff Shnall May 2018
What you need to know about tooth erosion to prevent premature wear or loss of your teeth.
By Dr. Jeff Shnall
The following article and diagrams cannot be reproduced without written consent.
Most everyone knows that if you eat too much sugar you risk getting a cavity. However, cavities or tooth decay are not the only way that our teeth can deteriorate. Tooth erosion is a very common yet underappreciated cause of tooth wear.
In this series of articles I will discuss what tooth erosion is, how it is different from tooth decay and how erosion can be prevented.
First let’s discuss what a cavity is and how it starts by way of some pictures.
Fig 1 Tooth anatomy
Figure 1 shows a typical tooth, covered by a layer of enamel. Enamel is the hardest tissue in the human body, harder than bone. Under the enamel layer is a softer layer of tissue called dentin. Once you get below the gum line the tooth is covered by a layer of cementum, which is similar to dentin in strength, both being softer and more porous than enamel.
Fig 2a Enamel rods
Figure 2a shows that the enamel layer of our tooth is made up of rods that run from the outer surface of the tooth to the inner dentin layer. These rods in turn are made up of minerals: mainly calcium and phosphate (I only illustrated rods on one half of the tooth).
Enamel rods can be visualized like the metal rods in fig 2b. Enamel rods run alongside each other but there are gaps between each rod.
Figure 3 Plaque (shown in yellow) clinging to the tooth
Figure 3 shows a layer of plaque is sitting on the surface of the enamel. Plaque is actually made up of clumps of bacteria that live on the surface of our teeth.
Figure 4 Plaque on the tooth
Fig 4 shows a white coating of plaque at the gum line of the teeth.
Figure 5 Acid produced by plaque travels in between enamel rods beneath the enamel surface
Figure 5 shows how when we eat or drink sugary food, the bacteria ( plaque) turns this sugar into acid. The acid and bacteria then travels down crevices between the enamel rods into the undersurface of the enamel. Interestingly, the acid being produced by the bacteria does not damage the outer surface of the enamel.
Figure 6 Inner enamel has broken down (decalcified area shown in blue)
In Fig 6 acid and bacteria has penetrated the inner part of the enamel layer, causing the inner enamel to break down.
The enamel is decalcifying, that is, the calcium and phosphate in the enamel is breaking down.
Fig 7 The outer enamel is still left intact. The bacteria in the plaque produce acids that travel through small microchannels in the enamel, which starts the next step: the destruction or demineralization of the inner enamel.
Fig 8 Rebuilding or remineralization of the tooth.
When a Cavity Starts Can it be Reversed?
Under the right conditions, the process described above can be reversed.
Figure 8 shows that if a tooth is exposed to phosphate, calcium or fluoride these minerals can travel down the same microchannels that the acid and bacteria travelled, into the inner surface of the enamel and remineralize or reharden the broken down enamel. The fact that these minerals travel down microchannels is important. They don’t rebuild the surface of the tooth. They rebuild the inner tooth.
In Fig 9 The inner enamel has remineralized and the tooth surface is left intact.
Special repairative toothpastes and creams containing calcium, phosphate and fluoride can deliver these minerals into the tooth and repair the demineralized enamel.
Another key point is that in the early decay process, the enamel rods are not completely destroyed. They can serve as a scaffold to rebuild the enamel.
As well, this reversal of decay can only occur if the bacteria has not reached the inner dentin layer. If that has occurred the tooth will not remineralize and the decay will go on to infect the entire tooth unless the decay is removed and a filling is placed.
Now that you are an expert in how cavities start, let's compare this to another type of damage we see in teeth, as mentioned early, tooth erosion and we will discuss how it is different from tooth decay.
Tooth erosion is the dissolving or breakdown of tooth structure (enamel and sometimes dentin) caused by exposure of the teeth to acid either from the diet (extrinsic erosion) or from our own stomach acids (intrinsic erosion).
The acid that causes tooth erosion is not produced by the bacterial plaque on our teeth. Instead it is caused by the acid found in soft drinks/pop, many kinds of fruit juices,some sports drinks and citrus fruits. In fact, many people who people whose teeth wear down due to acid erosion often keep their teeth very clean so it is not a plaque related issue.
Figure 10 Enamel and Dentin
Figure 10 shows the appearance of a normal tooth. It has a hard enamel outer coating and softer dentin inner layer.
Fig 11 Tooth exposed to acid. If a tooth is exposed to a strong enough acid the outer enamel layer can breakdown or dissolve.
Fig 11 shows this same tooth exposed to acid. If a tooth is exposed to a strong enough acid the outer enamel layer can breakdown or dissolve.
Although enamel is the hardest tissue in our body, food or drink that has a pH below 5.5 can dissolve enamel.
Almost every brand of pop/soft drink contains acid. Citrus juices are acidic as are most sports drinks. Lemons and other citrus fruits and even some brands of coffee and tea are acidic, below the critical ph of 5.5. If our teeth are exposed to large volumes of acidic food/drink or exposed to small amounts but over long duration erosion or breakdown of the enamel and other tooth structure can occur.
Some people develop tooth erosion due to stomach acids entering the mouth in conditions such as acid reflux or in eating disorders such as bulimia. The mineral that composes our teeth will also erode and dissolve due to the strong acidity of stomach acids.
Key differences between tooth erosion and tooth decay (cavity formation)
Above we discussed how in cavity formation, the outer enamel of the tooth is left intact while the inner enamel layer breaks down or demineralizes (see figures 6 and 7).
Figure 12 Tooth erosion
Fig. 12 In tooth erosion, the loss of tooth structure occurs at the surface of the tooth and works its way down into deeper areas of the tooth.
When a tooth is exposed to acid a certain amount of tooth material dissolves into the saliva.
Our saliva contains the buffering agent bicarbonate which can reduce the acidity at the tooth surface and limit erosion. The saliva also contains calcium and phosphate which if it is high enough amounts can limit the amount of calcium and phosphate that dissolves from the surface of the tooth. This is all happening on a microscopic level.
However if the amount of acid the tooth exposed to overwhelms the buffering and rebuilding ability of the saliva them loss of tooth material (erosion) will occur and once surface enamel or dentin is lost through erosion it cannot be regrown,, no matter how much you bathe the tooth in saliva, calcium, phosphate or fluoride. This is why it is important to avoid the loss of enamel and other tooth material from erosion in the first place. This means managing diet and treating underlying conditions that lead to tooth erosion before erosion occurs.
Why can’t you rebuild loss enamel and dentin through tooth erosion while a tooth developing an early cavity can reharden or remineralize? Let me explain.
Fig 13 shows a tooth that has just been brushed. It has a clean surface. All of the plaque/bacteria has been removed.
ig 14 shows this same tooth a few seconds after it has been brushed. After we brush our teeth, within seconds a thin film of called the dental pellicle forms on the tooth, shown as a blue thin coating in figure 15). The pellicle is thinner than the diameter of a human hair and is formed when proteins found in saliva coat the tooth.
The pellicle layer acts as a barrier to calcium, phosphate and fluoride and preevents these materials from binding or attaching to damaged enamel or dentin. So if your tooth loses enamel after drinking 2 cans of cola you cannot rebuild the lost enamel by applying a medicated calcium phosphate toothpaste. The pellicle coating prevents the tooth surface from rebuilding.
If it were not for the pellicle layer our teeth would continue to add layers of calcium phosphate from our saliva to our enamel and our teeth would become thickened.
This is also a reminder of how once our tooth surface is eroded the damaged tooth surface can not be regrown (although it can be filled or replaced with dental materials as needed).
It is the pellicle layer attracts bacteria/plaque to the surface of our teeth. In the situation where a tooth is developing a cavity, the pellicle layer does allow calcium, phosphate and fluoride to enter the dental plaque and these minerals can still heal or remineralize inner layers of demineralized enamel as we had discussed above. The pellicle does not play a disturbing factor in the repair of a tooth developing a cavity.
So it is important to know the causes of tooth erosion, namely the teeth being exposed to either dietary acids and/or stomach acids on an ongoing basis. Drinking one can of pop is not going to cause permanent loss of enamel, however if you sip on a can of cola each day for an hour or two while at work or while watching tv you almost assuredly will lose a noticeable amount of tooth enamel and or dentin, which will have consequences.
In my next article I will discuss other types of tooth wear related to erosion and also how to prevent and manage tooth erosion.