Foods can be very acidic and can also contribute to enamel erosion. Healthy foods as well as junk food can be equally destructive. Ironically, the adage that an apple a day keeps the doctor (or dentist) away isn’t true when it comes to enamel erosion. Tart apples are very acidic and most apples are acidic enough to dissolve tooth enamel. Of course this doesn’t mean that one should not eat apples in order to minimize enamel erosion, but it should factor in on how to eat them. Incising an apple or any acidic food for that matter will greatly increase the contact of tooth enamel with the acid in the food. Incising is using your front teeth to bite into something in order to break off a piece. This can be avoided by cutting the apple into smaller pieces and not using the front teeth at all. Also, the acidity of any food is only a significant problem when that food is consumed frequently. A person who eats one or two apples a week isn’t going to have an issue with enamel erosion. But consuming them daily and using the front teeth to bite them can significantly erode tooth enamel over time.
When talking about acidic foods, probably the most obvious one is lemons. Some people like to eat lemons so much that they will eat them plain or with salt. I’ve repaired many teeth that have been severely damaged because of frequently eating lemons. Citric foods are all acidic and so care must be used when eating it. As with the apples, do not incise citric foods and avoid developing an addictive eating habit with them. Most people who damage their teeth because of eating lemons, eat them daily. The bottom line with all acidic foods is moderation. Like apples, many acidic foods are very healthy to eat and they should not be avoided. The acidity of foods like green apples and lemons is actually what attracts people to them and what drives the chronic eating of them. This behavior should be recognized and controlled.
Another acidic food that has become popular in recent years is tart and sour candies. When I was in dental school, we had an in-depth lecture on bulimia and specifically the damage it does to teeth which I will discuss later. Our professor had some very good slides he showed us of the pattern of acid erosion that bulimics have. A few days later, one of my classmates had a patient who had teeth that exhibited the same characteristics as those in the slides. Naturally he assumed she was suffering from bulimia and so he confronted her about it. She was surprised by what he said and assured him she didn’t have bulimia. He then told her she was in denial and that he knew she was bulimic by the severe enamel erosion of her teeth. She argued with him until he eventually got an instructor and told him about the conversation he had with the patient. The instructor looked at her teeth and told the student that the erosion could be from other things as well. They decided to do a dietary diary for a week where the patient kept track of everything she put in her mouth. It turned out that she was consuming a candy called “Sweet-Tarts” multiple times a day. Rather than chew them, she would place them on her tongue, against her front teeth and suck on them. My classmate decided to test the PH of the candy and it turned out that it was just below 3. This was what was causing the severe loss of tooth enamel.
Sour candy can be as acidic as 1.6. This is approaching the PH of sulfuric acid found in car batteries. Add sugar to these candies and you have a very destructive recipe for teeth. Tooth decay occurs because of acid that bacteria makes by metabolizing sugars and starches that people eat. The sugar in these acidic candies feeds the bacteria causing more acid. Consuming candies like this can be devastating to teeth.
Earlier I talked about soda and energy drinks being highly acidic. Fruit juices as well can be acidic and can cause enamel erosion. Grape juice is acidic enough to dissolve tooth enamel and likewise so are some kinds of wine. I mention this because a dentist I know had a patient that was involved in wine tasting. He would swish the wine over the front of his teeth which would cause the erosion of the enamel of his teeth. He had damaged his teeth enough to need porcelain veneers. Like soda and energy drinks, frequent consumption of fruit juices can cause enamel erosion. Using a straw can minimize the contact the juice has with tooth enamel.
Keep in mind that I’m not recommending avoiding such foods and beverages. Many of these foods are healthy and good to eat. But the way they are consumed and the extent to which they are eaten may cause severe enamel erosion.
In Part 3 I will talk about other sources of acid erosion of tooth enamel.