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Q. But even diet soda contains acid from the carbonation (carbonic acid) as
well as citric acid and even other forms of acid added to enhance the flavor.
Since these acids occur in diet soda as well as in sugared soda, why is it that
diet soda doesn't cause decay??
A. All the non sugar related acids in soda (including carbonic acid) are so soluble in
water that they are washed off the teeth almost immediately before they can cause much
decalcification of the tooth structure. On the other hand, the sugar in regular soda is
very sticky and remains on the teeth for a long time. In addition, the bacteria in plaque
use sugar as a raw material to create dextrans which are the molecular units
composing the viscous sticky stuff that makes plaque adhere to the teeth. The dextrans
have the property of absorbing more sugar which is turned into acid by the plaque
bacteria causing the plaque to remain acidic for twenty minutes or more after each
exposure to sugar.
I have never tried to dissolve a nail in a bottle of Coke, but if it did dissolve, it would be
from the prolonged exposure of the iron to the carbonic acid from the carbonation in the
soda, and not from the sugar. If a diet soda is drunk in the ordinary way, the carbonic
acid caused by carbonation does NOT spend enough time in the mouth to damage the
Drinking Diet Coke, Diet Mountain Dew, Diet Pepsi, Diet Kool-Aid or any other
artificially sweetened drink does not cause any decay at all, because artificial sweeteners
are not metabolized into acid by the germs in your mouth.
Finally, it is not just soda that is involved in the sugar habit/tooth decay
syndrome. Below is a short list of some of the surprising habits that I have run into
over the years, and every one of them was the reason that the patient needed a lot of
dental work.
1. Unsweetened fruit juices used in the same way as Coke described above does the
same thing to your teeth. Fruit juices contain natural sugar which is just as
fermentable as table sugar. Many of our patients work in a local juice bottling factory.
They can drink all the juice they want as a perk of the job. Many of them begin to
develop major tooth decay only after beginning work there because of the simple
availability of all that sugar.
2. One woman prided herself on never using sugar, but she needed three very carious
teeth extracted, three root canals and numerous fillings. I kept asking her what type of
foods she ate. "Fresh fruit, vegetables, and other wholesome things. Oh yes, and herbal
tea. " I sweeten it with a tablespoon of HONEY". How often did she drink her tea? "All
day long" she told me. Honey is just concentrated sugar made by bees.
3. Another vegetarian patient came to me with rampant decay. After much indignant
denial about eating or drinking sugared foods, I discovered that she ate RAISINS
throughout the day. Fresh fruit does not stick to the teeth and rarely is involved in the
sugar habit syndrome, but raisins and other dried fruit are very much like gumdrops as
far as the teeth are concerned. The sticky raisin paste remains on the teeth long after the
raisin is eaten, and releases sugar into the saliva for quite a long time.
4. Another older man who I had been treating for years came into the office one day with
cavities starting in almost all of his teeth. He had never had a single cavity for years, but
now he had lots of them. It turns out that he had recently retired and had been spending
a lot of time at the VFW with a bunch of guys who all drank copious amounts of
Mountain Dew. They had all long ago lost their teeth and were wearing dentures. But
my patient had acquired the habit by associating with his new friends, and almost
acquired their dentures as well.
5. A pair of identical twins was brought into Tufts dental clinic while I was there. One
twin had perfect teeth without a single cavity. The other had rampant decay all over his
mouth. Being from the same family, they both ate the same things at each meal (mom
was adamant that she gave them almost no sweets) and being identical twins, they were
genetically identical, so neither one should have been any more susceptible to cavities
than the other. No one could pry out of the twins any differences in their eating habits.
Finally, one of my older professors cornered the two of them and after much prodding
finally discovered that the cavity prone one liked to suck on bread balls. "Bread balls??
What are bread balls?" "Well you take the soft middle out of a slice of bread, ball it up
real tight and suck on it!" Bread is not sweet. How could that cause cavities? Actually,
bread is made of starch which normally does not cause decay, but when kept in the
mouth for a long time, an enzyme in the saliva called amylase begins to break down the
starches into their constituent parts, and those parts are simply sugar. Try it sometime.
If you keep a piece of bread in your mouth for a while it begins to taste sweet. This is not
to imply that bread, potato chips or other starchy foods are major causes of tooth decay.
The sugar is released if the starch is kept in the mouth for a long time without being
swallowed.
6. One elderly woman had a dry mouth, so she began sucking on cough drops all day
long and discovered that within a year of beginning the habit, her teeth, which had
always been a prized possession began turning black and breaking out.
7. One patient liked to reward herself at the end of a long day with a little Claret, a
sweet brandy. She would pour her little shot glass and sip on it all evening until bedtime.
After two years, her formerly good teeth were in need of total reconstruction
8. Nursing bottle syndrome (most recently called early childhood caries) is
characterized by children, generally under the age of 3 who are put to bed with a baby
bottle filled, usually with fruit juice (all natural juices contain lots of fermentable sugars)
or sweetened milk. The pattern is severe decay of the front top teeth. If the bottle
contained only water, or an artificially sweetened drink such as Crystal Lite or artificially
sweetened Kool-Aid, the teeth would not be affected. No mom does this on purpose to
her child, but it is quite common because mom simply doesn't know that the sugar in
the bottle would do this.
Chewing tobacco is cured in sugar! People who chew a lot of tobacco generally
have rampant decay! In areas where chewing tobacco is popular, there is not only a
great deal of decay, but also a lot of badly stained teeth. Chewing tobacco is quite acidic
and tends to etch the surface of the teeth in the same way that the dentist does when he
puts dilute acid on a tooth to etch the surface in preparation for bonding a filling. The
etching process causes a microscopically rough surface on the enamel ideal for allowing
stains to hide out from toothbrushes. Since the tobacco juice is also dark brown, the
stain not only coats the surface of the enamel on the teeth, but it also penetrates into the
nooks and crannies etched into the surface by the acid. This means that the staining
becomes permanent.
10. Honey does cause tooth decay! Honey is considered a refined sugar because
96% of the dry matter in honey is composed of fructose, glucose and sucrose. Honey
also has the highest calorie content of all sugars with 65 calories/tablespoon, compared
to the 48 calories tablespoon found in table sugar. Honey actually decays teeth faster
than table sugar, partly because it is very sweet, and partly because it is sticky and
remains on the teeth longer than other refined sugars.