Sports drinks and gels - understanding tooth deterioration

Mitch Docker - EF Education First - Drapac with the team car, 2018

When we consume carbohydrates and sugars, oral bacteria breaks down the food and leads to the production of acids, which in turn lowers the pH level in the mouth. This creates an acidic environment that can damage tooth enamel and increase the risk of dental issues such as cavities and decay. 

Producing an acidic environment

The process commences when we consume products conatining sugar and carbohydrates, such as sports drinks and gels.

1. Fermentation by Oral Bacteria: Oral bacteria naturally present in the mouth feed on sugars and carbohydrates. They metabolise these sugars and carbohydrates, producing acids as byproducts. This acid production lowers the pH level in the mouth, creating an acidic environment.

2. Acid Production: Specifically, the bacteria ferment sugars and carbohydrates into acids such as lactic acid and acetic acid. These acids can demineralise tooth enamel, leading to tooth decay and the development of cavities.

3. Increased Acidic Environment: Continuous consumption of sugary and starchy foods and beverages, including sports drinks containing sugars and carbohydrates, can lead to a sustained acidic environment in the mouth. This acidic environment promotes the growth of acid-producing bacteria and contributes to dental erosion and decay over time.

Tooth deterioration

Tooth deterioration, particularly due to acid attacks on tooth enamel, is a significant concern for your dental health. Understanding the various processes involved in tooth deterioration can help individuals take proactive steps to prevent or mitigate its effects.

The impact of sports drinks and sports gels on tooth enamel erosion is one of the key contributors to tooth deterioration and tooth loss. 

The Four Methods of Non-Cariogenic Tooth Loss

Before delving into the specifics of tooth enamel erosion, it's essential to understand the broader context of tooth deterioration.

There are four main methods of non-cariogenic tooth loss, that is loss which is not attributed to tooth decay. They are:

a. Abrasion: which can come form activities like brushing too hard 
b. Erosion: occurs when acid attacks softened enamel, it can also contribute to a faster rate of abrasion or attrition.
c. Attrition: grinding of the teeth
d. Trauma, where teeth can be badly damaged by accident or trauma. It can become cracked, chipped or loose. 

Understanding tooth structure: Enamel and Dentine 

To comprehend the effects of acid attacks on tooth enamel, it's crucial to grasp the structure of a tooth. The outermost layer of the tooth is enamel, a highly mineralised tissue that provides protection and strength. Beneath the enamel lies dentine, a less mineralised tissue that comprises the bulk of the tooth structure. When enamel is eroded, exposing dentine, the tooth becomes more vulnerable to further degradation.

The role of acid in enamel demineralisation

Acidic substances, whether from dietary sources or beverages like sports drinks and gels, can initiate a process known as enamel demineralisation. When acids come into contact with outer tooth enamel, they dissolve the mineral content of the enamel matrix which softens the enamel.

This may lead to porosity which is a change in the tiny pores or openings in the tooth structure that are usually evenly distributed throughout the enamel and dentin layers of the tooth.

This leads to the breakdown of teh enamel matrix and become less strong and then it wears away.
If the enamel layer thins out and wears to the point exposing the dentine underneath which unlike the enamel is which 96% inorganic.

Therefore the higher organic component of dentine makes it far less resistant and contributes to a faster rate of erosion, abrasion or attrition.

This process is exacerbated by factors such as low saliva flow, which reduces the mouth's natural buffering capacity against acids.

Chemical changes in enamel

Enamel primarily consists of hydroxyapatite crystals, which are composed of calcium and phosphate ions. When acids attack the enamel, they react with the calcium phosphate mineral, causing dissolution and release of calcium and phosphate ions into the oral environment. This chemical dissolution weakens the enamel structure, making it more susceptible to mechanical wear and tear.

Effects on tooth microstructure

Acid attacks not only cause chemical changes in enamel but also alter its microstructure. Enamel is composed of tightly packed crystalline rods that form a dense outer layer. Acid exposure leads to the dissolution and breakdown of these crystalline structures, resulting in surface roughening and loss of enamel integrity. 

Additionally, acids can penetrate the tubules or tunnels in the dentine layer and the layers of tissue feeding into the tubules can create acid flows creating hydrostatic pressure through these dentine tubeles into the nerve that can become inflamed, see image titled Pulpitis

Overtime this hydrostatic pressure reduces blood flow to the nerves in the tooth, causing nerve damage through chronic inflammation, leading to nerve scaring and eventually the nerve dies, seel last image titled Periodontitis.

Hyper sensitive teeth, the early signs  of enamel demineralisation

The loss of enamel mineral content weakens the tooth structure, making it more susceptible to damage from mechanical forces such as chewing and grinding. Furthermore, demineralised enamel is more prone to staining and discolouration, affecting the tooth's aesthetic appearance. Prolonged acid exposure can also lead to the exposure of dentine, the underlying layer of the tooth, increasing sensitivity to temperature both hot and cold, sugar and an increased risk of decay.

A yellowish colour may be observed where the gums meet the teeth and on the biting surfaces of the teeth as the enamel is quite white in colour and as it starts to thin out the dentine is visible which is more yellow.

Worse case scenario

If left untreated, the tooth can fracture as the tooth is weakened and under load the tooth can break, exposing the nerve. The nerve can also become inflamed leading to a dental abscess which will require a root canal.
If no further action is taken, the nerve dies. The infection in the nerve spreads from inside the tooth to the surrounding bone and the tooth becomes mobile and can lead to potentially losing the tooth.

Carry 2 water bottles, sports drink and plain water

Saliva is a natural buffer against acid attacks. When you are dehydrated there isn't as much saliva, so when you rehydrate with an acidic drink it creates an even lower pH level in the mouth.

Whereas if you are flushing or rising you mouth with water, it creates a buffer against the acids from the sports drinks. It's important to make sure the pH level stops the calcium from being removed form the enamel.

Protective Measures Against Acid Erosion

To mitigate the effects of acid erosion on tooth structure, individuals can take several preventive measures. Limiting the consumption of acidic foods and beverages, including sports drinks and gels, can reduce acid exposure. 

Additionally, maintaining good oral hygiene practices, such as regular brushing with fluoride toothpaste and using fluoride mouthwash, can help strengthen enamel and remineralise damaged areas. A product called tooth moose helps to add calcium that strengthens the enamel by making the enamel matrix more rich in calcium and less porous therefore more resistant to erosion, attrition and abrasion. 

Dentists may also recommend dental sealants or fluoride treatments to provide additional protection against acid attacks.

Treatment Options for Enamel Erosion

In cases where enamel erosion has already occurred, various treatment options are available to restore tooth structure and prevent further damage. These may include dental bonding or veneers to cover exposed enamel surfaces, dental crowns to strengthen weakened teeth, or in severe cases, root canal therapy to address nerve damage.

Dentists may also prescribe fluoride supplements or remineralising agents to promote enamel repair and regeneration.

Preventive mindset rather than a reactive mindset

Acid erosion poses a significant threat to the tooth structure, leading to enamel demineralisation and subsequent degradation. By understanding the mechanisms through which acid affects enamel and implementing preventive measures, individuals can protect their teeth from the damaging effects of acid erosion. 

Through good oral hygiene, regular dental hygiene visits and reviews, dietary choices, and timely dental intervention, individuals can maintain optimal dental health and preserve their tooth integrity.

To quote Dr Tilley-Keynes "a stitch in time saves nine', that is: address a problem early to prevent further harms.

The information presented in this article is for informational purposes only and should not be considered as medical advice. It is not intended to be relied upon nor replace consultation with a qualified healthcare professional.
 

Mitch Docker, a journey to Improved dental health and advocacy

Photo credit: Zac Williams/SWpix

Professional cyclist Mitch Docker's recent dental consultation provided valuable insights into the detrimental effects of sports drinks on his dental health.

He recalls that the onset of dental issues began around the age of 18, which coincided with the commencement of his cycling career. He acknowledged a lack of dental hygiene, coupled with the consumption of sports drinks and gels during races as contributing factors to his dental deterioration which ended up involving many fillings.

Early racing career

He was a new cyclists and consuming a large amount of volume of these products, with no experience in what was required to adequately fuel for races and training. In retrospect Mitch acknowledging that he didn't have enough saliva in the mouth to clear the sugar sitting on his teeth when he was riding, and also after the races, right up until brushing his teeth at night.

Despite sporadic attempts to prioritise dental care, the demands of professional cycling often took precedence, leading to neglect of his personal health. It wasn't until a serious crash in 2016 which necessitated extensive dental treatment that he realised the importance of regular dental maintenance and hygiene. This lead to chewing gum for half the ride/race to maintain the saliva levels and using tooth moose at the end of the day.

A change in thinking

The financial implications and long-term consequences of neglecting dental health prompted him to advocate for better oral hygiene practices, not only for himself but also for future athletes.

Within the cycling community, the lack of awareness surrounding dental care highlighted the need for a paradigm shift towards holistic health and wellbeing. Some coaches prioritise performance over personal health, while others are focused on the athletes wellbeing. We now recognise that both physical and mental health is of the most importance to continually perform well as athletes.

Ultimately, Mitch's journey towards improved dental health underscored the importance of consistency, discipline, and proactive measures to mitigate the adverse effects of sports drinks on his dental wellbeing.

The next generation

Mitch continues to instil the importance of good dental health to his children and now leads by example. He encourages cyclists to make dental health a priority in your life and part of your daily routine and to not ignore the signs of decay and deterioration as it will have a long-term negative effect on your health.

References

Dr Adam N Keyes-Tilley

BDSc (Melb), FRACDS, FICCDE, General Dentist
Ground Floor, 468 St Kilda Road
Melbourne, Victoria 3004
https://cdc.net.au

Mitch Docker
www.lifeinthepeloton.com