Wednesday, April 07, 1999
Tooth decay and the soda factor
As consumption of sweet drinks grows by big gulps, cavities go crazy
BY SUE MacDONALD
The Cincinnati Enquirer
A picture is worth a thousand words, especially when taken by Dr. Paul Staubitz inside the mouth of a 20-year-old patient.
“Look here at the base of the teeth,” the Western Hills dentist says, pointing to places where the enamel — the hard outer coating of the teeth — has been eaten away, leaving tooth surfaces looking flaky, crusty and almost chalky.
Some teeth have tiny holes at the gum line.
“We see this all the time,” Dr. Staubitz says. “The kids don't know they have a problem, and this is what happens. They don't find out about it until it's too late.”
The problem is cavities and dental decay, the likes of which some dentists haven't seen in years.
Dentists think they have a pretty good idea of the culprit: a steady rise in the amount of sugary drinks guzzled every day by so many U.S. children. They're doing the Dew, sipping cola, firing up on sports drinks and downing gallons of fruity punches and “thirst-ades” — all at the expense of plain old water and calcium-rich milk.
All things being equal, fluoride toothpastes, high-tech toothbrushes, tooth sealants and public education campaigns have made it easier for American children and their parents tokeep healthy.
But the variable amid those dental-care advances has been a steady, and to some an alarming, rise in the amount of sugary drinks consumed each day by U.S. children.
“We've had a number of kids who have gone away to college, and their first checkup back is horrible,” says Dr. David M. Sullivan, a Monfort Heights pediatric dentist. “They end up with six, eight, 10 cavities in places they never had trouble before.”
These patients may brush and floss regularly but admit to drinking several cans of pop or a two-liter container a day.
Dr. Sullivan says children who drink lots of sugary fluids are bathing their teeth in a medium that, over time and despite good dental care, can break down the hard enamel that protects each tooth, leaching out essential minerals and allowing decay to set in.
It's not necessarily how much sugar is consumed but how frequently, Dr. Sullivan says. A quickly consumed cup of Coke, for example, is less of a problem than a 64-ounce Big Gulp that's sipped continuously for hours.
“You'd be surprised how many kids will drink at least a two-liter container of pop a day,” he says. “That's a lot, and you can't drink that much sitting down and gulping it in five minutes. It's an all-day adventure, and that's where the frequency issue comes into play.”
The tiny bacteria that gather on, in between and around teeth and inside the mouth thrive on sugar, he says. When the bacteria are exposed to sugar, they metabolize it immediately, producing an acid for 20-40 minutes from the first sugary encounter. The acid can't be stored, so it lingers on the tooth and forms a sticky substance called plaque, holding the acid in contact with the tooth until it's brushed, flossed or cleaned away.
With longtime exposure, “it's like high-octane fuel,” Dr. Sullivan says, and the higher the sugar content, the stronger the acid that's produced.
Even if enamel has been brushed regularly and treated with hardening fluoride, it eventually will weaken and begin to lose calcium under the assault of too much sugar, Dr. Sullivan says. One sugary sip every half hour, he says, “is constantly refueling the bacteria.”
Older teens and young adults sometimes have severe problems because they get out of the habit of regular dental visits and might not be as diligent about fluoride treatments, brushing and flossing properly, getting enough calcium and eating right.
Sugary drinks are especially hard on the teeth of children who wear braces, dentists say. The brackets that hold the wires in place cover part of the tooth, leaving surfaces between the bracket and gum line exposed and likely to capture food particles — and harder to clean.
When the brackets are removed, some teens have noticeable areas of decay in places where the brackets did not protect the teeth.
Moreover, the cavities and decay are occuring in between and around the base of the teeth, making them difficult to treat because they cannot be filled easily. Some young adults end up getting crowns or caps — artificial coverings for the tooth to prevent further decay.
The issue recently attracted the attention of Dr. Lawrence Meskin, a University of Colorado dentist and editor of the Journal of the American Dental Association. In a March JADA editorial, he decried the prevalence of soda and sugary drinks in children's lives and rapped particularly hard at exclusive soft-drink contracts now being negotiated with schools and colleges by Coca-Cola and Pepsi.
“Kids are replacing a good part of their diet with inadequate nutrition,” Dr. Meskin says, noting that excess sugar consumption can lead not only to tooth decay but to obesity, calcium-robbed bones, kidney stones and overall poor nutrition.
Consumer trends reflect the increase:
• In 1947, soft-drink production in the U.S. averaged about 100 12-ounce cans for every American. By 1997, it reached nearly 575 cans, according to the National Soft Drink Association.
• Daily consumption of non-diet soft drinks for 12- to 19-year-olds rose between 1977 and 1994 from 7 ounces to 19 ounces a day for boys, 6 ounces to 12 ounces a day for girls.
• By one government estimate, 20 percent of 1- and 2-year-olds consume about a cup a day of soft drinks.
And part of that increase is directly linked to serving sizes, according to the Center for Science in the Public Interest, a nonprofit consumer watchdog group in Washington. Cokes that started out in quaint little 6-ounce glass bottles have grown to 12-ounce cans, 20-ounce plastic bottles and 64-ounce fast-food and convenience store cups.
Screw-off caps and pop-up squirt-sip lids make it possible for one container to last for hours.
Dr. Meskin agrees that clinical studies need to be done on what happens to human teeth exposed to large amounts of sugary drinks. In test tubes, sugary sodas eat away at tooth enamel, and dentists would like to know what happens inside the mouth, where saliva can act as a diluter and protectant.
He'd also like to see schools refuse to sign exclusive soft-drink company contracts that pay quota-based fees based on how much is consumed in a given time period.
“I would hope that schools are a place for education, not a place for corporate America to be selling its wares,” he says.
“Like anything else, I don't think there's anything wrong with the occasional soda. But to be pushing it to students because you have to make your quotas, or extolling its virtues by having teachers allow it in the class, doesn't make sense from an education or a health standpoint.”
TOOTH-SAVING TIPS
To protect the teeth as much as possible from the eroding effects of sugar in soft drinks, sports drinks and sugary fruit drinks, dentists urge parents to:
• Limit the amount of soda pop and sugary drinks a child and teen consumes each day. Make sugary drinks a treat, not a staple of the child's diet. Limit serving sizes. This is especially true for children wearing braces or orthodontic appliances.
• Consider using a battery-operated toothbrush, especially for children wearing braces. “It's difficult to manipulate the head of a toothbrush to remove plaque yourself, but if you use one of the electronic toothbrushes, all you have to do is get it close,” says Dr. David M. Sullivan, pediatric dentist in Monfort Heights.
• Substitute healthier drinks for children, including milk and water. Read ingredient labels to weed out high-sugar drinks. Sugar can be listed as high-fructose corn syrup or any ingredient ending in -ose (fructose, sucrose, glucose, dextrose).
• Ask your dentist if your child or teen needs a prescription fluoridated toothpaste (Prevident 5000 and Phos-flu are common brands) to strengthen tooth enamel.
No shortage of opinions on stadium
Net predator gets jail time, probation
Cincinnati Public Schools struggle to graduate freshmen
Church schools violate codes
Exercise plan for kids costly, critics say
Ex-Chiquita lawyer sought revenge, prosecutors say
Exhibit offers glimpse of future
N.Ky. area code may be split
Arson fires hit 2 middle schools
Cameras 'watch' school halls
Ohio romance writers rendezvous in Sharonville
Tooth decay and the soda factor
'ER' actress dreams about having it all
Author connects to aging parents
CCM to raise curtain on new space, offers free shows
The CCM 'campus village'
Bishop tells jail inmates: 'God is here'
Condos to be built in Monroe
Court: Miami must allow mentally disabled workers
Dispute between dispatchers, county reaches board
Families struggle despite working parent
Kenton commission nears jail decision
Kids, adults to formulate battle plan for drug war
Middletown picks mall liaisons
Part of road closes to stop erosion, slide
Probe continues into hot-tub shooting
Talawanda considers tax, bond issue
Technology center will help people with disabilities
TRISTATE DIGEST
Two firefighters die in Boone National Forest blaze
Warren to promote full returns in census
Wyoming building new water plant
