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Acids play an important role in oral health, however when hearing the word ‘acid’ we might be likely to recall the various chemicals we saw in glass bottles in science class at school. We may also think of it as the thing that can cause heartburn and indigestion. 

There are several foods and drinks that are high enough in acid to cause a problem for the health of your teeth. High acidity foods and drinks are the cause of dental erosion and can have serious consequences for the strength of the enamel that surrounds and protects teeth. 

How acid affects the mouth

Acids leave teeth vulnerable to damage by weakening the enamel. Every time we eat or drink anything acidic, the enamel becomes softer for a short while and it loses some of its mineral content. Enamel is the hard, protective coating of our tooth, which protects the sensitive dentine underneath. The dentine underneath is exposed, when the enamel is worn away which may lead to pain and sensitivity.

Naturally, saliva will slowly cancel out this acidity and restore the chemical balance in the mouth. However, if this acid attack happens over and over, it could result in permanent damage to the enamel.

The most common types of acid in food and drink are carbonic acids, citric acids, and phosphoric acids. These are the acids that weaken enamel, leading to dental erosion.

The main culprits when it comes to acidic foods and drinks are the two Fs: Fizz and Fruit.

Fizz

‘Fizziness’ is often a tell-tale sign of an acidic drink. The most common of these are fizzy drinks, sodas, pops, and carbonated drinks. Even the ‘diet’ brands that contain “Fizz” are harmful. 

Some alcohols are also acidic. Beer, cider, prosecco, white wine, and alcopops are all examples of alcoholic drinks that are highly erosive for teeth.

Dr. Nigel Carter OBE, Chief Executive of the Oral Health Foundation says: “The best way for us to avoid the damage caused by fizzy drinks is to simply limit our exposure to them.” Try reducing exposure to acidic drinks by eliminating them outside of mealtimes.

Another tip is to swallow the drink quickly, without holding it in your mouth or ‘swishing’ it around. Again, it’s all about reducing the amount of time the teeth are being exposed to acid. Using a straw helps drinks go to the back of the mouth and avoids additional contact with teeth.

Dr. Soha Dattani, Director Scientific & Professional Affairs at GSK Consumer Healthcare says: “The drinks market is full of products which are high in acidity and that can play havoc on the enamel of our teeth. As consumers, this often makes it difficult for us to make healthy choices when choosing our drinks.” This is true whether we’re in a supermarket, a restaurant, attending events, or socializing.

Plain, still water is the best drink for teeth. Milk is also good because it helps to neutralize acids in the mouth.

Fruit

Fruits form an integral part of a healthy balanced diet. However, fruits can encourage dental decay as they contain citric acid.

Citrus fruits are the worst offenders as they have low pH levels, which means they are acidic. The most acidic fruits are lemons, limes, plums, grapes, grapefruits, blueberries, pineapples, oranges, peaches, and tomatoes.

There are a few things we can do to limit the dental damage caused by fruits.

Dr. Nigel Carter adds: “The first thing we can do, much as with fizzy drinks, is to keep them to mealtimes. Consuming fruit at breakfast, lunch, and dinner should provide the appropriate number of daily portions while not putting teeth under unnecessary strain.

Secondly, always try to consume fruit in its whole form and not as fruit juice. While most fruit contains natural sugar, many fruit juices also have added sugar. This is not good for teeth. Whole fruit is also packed full of vitamins, minerals, and fibre, which is often missing or reduced in concentration in fruit juice.

More tips and advice

Erosion of the enamel from acidic foods can cause sensitivity in your teeth- this may be one of the first signs of dental erosion. If you experience sensitivity to temperature or sweet foods, you should schedule an exam with your dentist.  Sensitivity can be treated with special ‘desensitizing’ products to help relieve the symptoms. This may include fluoride gels, rinses, or varnishes.

The symptoms of dental erosion can also be managed at home, while waiting for a dental appointment, with products like toothpastes designed to reduce sensitivity and strengthen enamel.  Your dentist will be able to advise which type of toothpaste is best for you.

Borthwick, Josh, “ What foods and drinks contain acid and why it spells trouble for our oral health”. Oral Health Foundation. https://www.dentalhealth.org/blog/what-foods-and-drinks-contain-acid-and-why-it-spells-trouble-for-our-oral-health

Certain medications can influence dental treatment decisions and it’s important to let your dentist know about all the medications that you take. 

In the case of antiresorptive agents—medicines that help strengthen bones—these medications have been associated with a rare but serious condition called osteonecrosis (OSS-tee-oh-ne-KRO-sis) of the jaw (ONJ) that can cause severe damage to the jawbone.

Some bone strengthening medicines, such as Fosamax, Actonel, Atelvia, Didronel, and Boniva, are taken orally to help prevent or treat osteoporosis (thinning of bone) and Paget’s disease of the bone, a disorder that involves abnormal bone destruction and regrowth, which can result in deformity. Others, such as Boniva IV, Reclast or Prolia, are administered by injection. Higher and more frequent dosing of these medications are given as part of cancer therapy to reduce bone pain and hypercalcemia of malignancy (abnormally high calcium levels in the blood) associated with metastatic breast cancer, prostate cancer, and multiple myeloma.

How do these medications affect dental treatment plans?

While osteonecrosis of the jaw can occur spontaneously, it more commonly occurs after dental procedures that affect the bone or associated tissues (for example, pulling a tooth). Be sure to tell your dentist if you are taking any medications for bone health so he or she can take that into account when developing your treatment plan.

It’s not possible to say who will develop osteonecrosis and who will not. Most people (more than 90 percent) diagnosed with ONJ associated with these medications are patients with cancer who are receiving or have received repeated high doses of antiresorptive agents through an infusion. The other 10 percent (of people with ONJ) were receiving much lower doses of these medications for the treatment of osteoporosis. It may be beneficial for anyone who will be starting osteoporosis treatment with antiresorptive agents to see their dentist before beginning treatment or shortly after. This way, you and your dentist can ensure that you have good oral health going into treatment and develop a plan that will keep your mouth healthy during treatment.

Continue regular dental visits

If you are taking antiresorptive agents for the treatment of osteoporosis, you typically do not need to avoid or postpone dental treatment. The risk of developing osteonecrosis of the jaw is very low. By contrast, untreated dental disease can progress to become more serious, perhaps even involving the bone and associated tissues, increasing the chances that you might need more invasive treatment. People who are taking antiresorptive agents for cancer treatment should avoid invasive dental treatments, if possible. Ideally, these patients should have a dental examination before beginning therapy with antiresorptive agents so that any oral disease can be treated. Let your dentist know that you will be starting therapy with these drugs. Likewise, let your physician know if you recently have had dental treatment.

Talk to your physician before ending medications

It is not generally recommended that patients stop taking their osteoporosis medications. The risk of developing bone weakness and a possible fracture is higher than those of developing osteonecrosis.

Talk to your physician before you stop taking any medication.

Symptoms of osteonecrosis of the jaw include, but are not limited to:

• pain, swelling, or infection of the gums or jaw
• injured or recently treated gums that are not healing
• loose teeth
• numbness or a feeling of heaviness in the jaw
• exposed bone

Contact your dentist, general physician or oncologist right away if you develop any of these symptoms after dental treatment.

“Osteoporosis and Oral Health”. Mouth Healthy

https://www.mouthhealthy.org/en/az-topics/o/osteoporosis-and-oral-health

Good oral health involves more than having a beautiful smile; it is key if we are to enjoy food, feel confident about interacting with others and avoid oral pain. Statistics however show that many Americans could improve in this department. Over 90% of Americans have had at least one cavity, and one in four has untreated tooth decay. Meanwhile, around half of all adults above the age of 30 have gum disease – according to the Center for Disease Control and Prevention’s Oral Health report. Dentists recommend brushing and flossing twice daily, but for those with gum disease and frequent plaque build-up, one gadget that should be present on your bathroom countertop is a water flosser.

How does a Water Flosser Work?

Water flossers usually consist of a small nozzle that sprays pressurized water, connected to a water reservoir by a tube. Water flossers  clean teeth and gums through a combination of water pressure and pulsations, which remove food residue and plaque from teeth. They work similarly to dental floss, but the pressure means that tiny pieces of food you don’t even notice can be efficiently removed. Water flossers can reach areas that floss cannot get into; for instance, beneath the gum line at the front of teeth. Users can alter the pressure according to their needs. Therefore, those with sensitive gums may use a lower setting, while those after a power clean can set their flosser on high pressure.

Are Water Flossers Effective?

The effectiveness of water flossers was put to the test in a study published in the Journal of Clinical Dentistry. Participants in the study were assigned to one of two groups. Group One used a manual toothbrush plus a water flosser, while Group Two used a manual toothbrush and waxed dental floss to clean between teeth. The results showed that the water floss group had a 74.4% reduction in whole mouth plaque and an 81.6% reduction in plaque between teeth. The dental floss group meanwhile, had a 57.7% and 63.45% reduction in plaque in these respective areas. The scientists noted that the water flosser was, therefore, a superior way to keep plaque at bay. It also indicates that dental floss is still a good way to improve oral health, even though it was less effective than the water flosser. 

When Might Your Dentist Recommend a Water Flosser?

Your dentist may recommend this method of daily cleaning if you have frequent plaque build-up or if your gums tend to become inflamed. If you have a condition like gingivitis, you may be recommended to wait until bleeding has stopped to use a water floss. However, a water flosser is not enough to treat more serious periodontal disease, and you should always consult with your dentist. You may be recommended a root scaling and planing treatment and perhaps later, a water flosser can play a role in the maintenance of your gum health. Water flossers also work well for teeth that are difficult to clean. For instance, if you have wisdom teeth that have not been removed, then teeth may be very tight and it may be very difficult to get dental floss in between then, but a water flosser may be a good alternative.

Because a water flosser cleans plaque and removes trapped food so effectively, it is ideal for teeth in odd positions, but it can also form part of a daily oral health routine for anyone wishing to obtain an optimal clean. Studies have shown that it is more effective than standard brushing and flossing, so if you are worried about decay and gum inflammation and disease, ask your dentist if a flosser is suitable for you. Flossers have removable tips, so one machine can be used by more than one family member.

Fallon, Jacqueline. “Is Water Flossing the Perfect Tool for Better Oral Health?”. The Dental Greek, 11 Dec 2018

Maintaining great personal hygiene has never been more important, given the current pandemic situation that many of us across the world find ourselves in.

Advice around how to do this is something that we all should take note of. Especially, regular handwashing with soap for at least 20 seconds or using hand sanitizer gel when this is not possible.

It is important to remember that being as hygienic as possible doesn’t just help protect you, but it also protects those around you.

The Oral Health Foundation has provided the following advice to help avoid catching or spreading the coronavirus (COVID-19).

Do not share a toothbrush

You should never share your toothbrush with anybody else, no matter how close you are to them.

This is one way that viruses and blood-borne diseases can be caught from other people.

You should make sure that toothbrush heads are also kept apart from each other wherever you and the rest of your household store your toothbrushes.

Keep the toilet lid closed before you flush

If you store your toothbrush anywhere near your toilet, every time someone flushes, some of the toilet sprays will fly out and land on your toothbrush.

There has already been research conducted that suggests that the virus can be spread via faecal matter (poo).

Make sure you close the lid before you flush and keep your brush at a safe distance away from the toilet.

Change your toothbrush regularly

It’s important to change your toothbrush, or brush head, at least every three months. Perhaps even earlier if the bristles become frayed.

This helps to ensure you are brushing your teeth effectively. A worn brush can’t do the job it needs to.

Changing your brush regularly also helps prevent the spread of bacteria. 

Clean your bathroom regularly

Many of us store our toothbrushes, towels, flannels and other intimate items in our bathrooms.

Due to this reason, it is important to keep the bathroom clean at all times to ensure that there is no spreading of germs and viruses. 

Visiting the dentist

It is important to maintain regular visits to your dental team. It’s best to always call ahead before any appointments, especially during this period of uncertainty. You can ask about any special check-in procedures your dental office may have, or if they have any paperwork you can complete online before your visit.

Be prepared for your appointment to either be delayed or canceled. This is for the safety of both staff and patients. Emergency treatment may still be available but other, more routine procedures, may be postponed for the foreseeable future. Communicate with your dentist about your needs to make sure you receive essential care, without putting yourself or others at unnecessary risk.

Don’t forget the basics

Our oral health should always be a priority. In addition to visiting your local dental team when possible, don’t forget the simple day-to-day habits that will help you keep a healthy mouth.

Brush daily with a fluoride toothpaste last thing at night and at least one other time during the day.

Cut down on how much and how often you have sugary foods and drinks and drink plenty of water. 

Consider using a mouthwash and clean between your teeth every day with interdental brushes or floss. 

Bushel, George. “COVID-19: our guide to looking after yourselves and others through better oral hygiene”. Oral Health Foundation, 23 Mar 2020 https://www.dentalhealth.org/blog/covid-19-our-guide-to-looking-after-yourselves-and-others-through-better-oral-hygiene