Warning – these images below are not pretty.

These are the types of dental decay we as dentists see frequently in people who consume soft drinks regularly. They are easy to spot.  The teeth appear quite shiny and clean due to the constant bathing in acid.  Early white spot lesions (decay) rapidly grow into open cavities, which grow into requiring root canals and extractions.  And yes there is severe pain as they progress into root canals and extractions.  Genuine pain, and pain to the wallet.

coke and tooth decay
coke and tooth decay

The sad thing is so many times as I talk to my young clients about this as they have just wandered into the clinic clutching a soft drink – I can see their eyes glazing over.  And yes they return usually in about 5 years in a state that we either just can’t fix or they can’t afford to fix.

It’s so simple – just don’t do it.  Please.

Several of these images are from Dr Rob Beaglehole – NZDA spokesperson

Images showing dental decay and the extraction of teeth due to drinking sugary drinks.  These are baby teeth.

rotten tooth extraction
rotten tooth extraction

Dental erosion and severe tooth decay related to soft drinks: a case report and literature review*

Soft drinks have many potential health problems. The inherent acids and sugars have both acidogenic and cariogenic potential, resulting in dental caries and potential enamel erosion. In this report we present a 25-year-old man complaining with the severe worn-out of the front teeth during the past 3 years. He had a history of drinking cola for more than 7 years and had a poor oral hygiene. Severe decays were present in the incisors and the canines, while less severe lesions were noted on the premolars and the molars. The review is to show the relationship between dental erosion and caries and soft drinks. Some efforts have been taken to reduce the harmful effect of soft drinks.

In the present case, the lesions of the patient indicated the long-term damage of soft drinks. The white spot lesions confirmed the diagnosis of dental erosion. Severe caries were also found in the upper incisors, making the diagnosis complicated.

Compared with caries, dental erosion seems to have much stronger relationship with soft drinks. The erosive potential of drinks is mainly represented by their pH and the buffering capacity. In previous reports, the initial pH values of some soft drinks and their buffering capacities were determined. Carbonated drinks had lower pH than fruit juices. The buffering capacities are in the following order: fruit juices>fruit-based carbonated drinks>non-fruit-based carbonated drinks (Edwards et al., 1999; Owens, 2007). Carbonated drink could reduce surface hardness of enamel, dentine, microfilled composite, and resin-modified glass ionomer. Sports drink and juices are merely effective to enamel (Wongkhantee et al., 2006). Even the sports drinks have a stronger softening effect than fruit juices (Lussi et al., 1995; Lippert et al., 2004; Jensdottir et al., 2005). Moreover, some supplements of drinks, such as calcium, could reduce the progress of enamel demineralization (Hara and Zero, 2006).

rotten teeth

Toothbrushing is a way to keep a good oral hygiene. Hard tissue loss after erosion and toothbrushing is significantly greater than erosion alone (Rios et al., 2006; Magalhães et al., 2008). However, after intra-oral periods of 30 and 60 min, wear was not significantly higher in toothbrushing than in unbrushed controls. It is concluded that keeping tooth unbrushed for at least 30 min after an erosive attack is necessary for protecting dentin (Attin et al., 2004).

Even some kinds of toothpastes accelerate tooth wear due to the removal of superficial enamel layer (Rios et al., 2006). Non-fluoride toothpaste could increase dentine loss compared with drinks alone (Ponduri et al., 2005). Whitening dentifrice also leads to significantly greater wear of sound enamel and of both eroded and sound dentine (Turssi et al., 2004). On the contrary, fluoride and remineralizing toothpastes (containing NaF, calcium, phosphate, and fluoride ions) are effective in inhibiting enamel erosion.

The fluoride concentration around 1100×10−6 in dentifrices helps to reduce dentin wear by erosion and erosion+abrasion, but the protection does not increase with fluoride concentration (Magalhães et al., 2008). Remineralizing toothpaste is more effective in intact and decalcified enamel (Muñoz et al., 1999; Magalhães et al., 2007). It could improve tooth-surface smoothness and gloss with regular use (Muñoz et al., 2004).

soft drink decay in teeth

In conclusion, excessive intake of soft drinks could cause complex dental consequences including dental erosion and caries. Although the diseases are different in their histological appearance, the two conditions occurring concurrently could be deleterious to dental hard tissues. It is necessary to educate patients about the harmful effects of excessive soft drink consumption and to advise them with the following tips to prevent dental erosion and caries: limiting soft drinks intake, choosing the low erosive soft drinks, improving the drinking habit, toothbrushing at least twice a day, avoiding brushing tooth within 1 h after consuming acidic food, and using fluoride or remineralizing toothpaste.