This document discusses the effects of soft drinks on teeth. It notes that soft drinks are highly cariogenic due to their high sugar content, with a typical can containing over 40g of sucrose. The acids in soft drinks also cause dental erosion. Studies have found that children who increased their consumption of soft drinks over time had higher rates of tooth decay. Teenagers are especially at risk due to their immature enamel. While modifications could potentially make soft drinks less harmful, such as removing caffeine and acids or replacing sugar, it is best to minimize soft drink consumption to reduce risks to dental health.

1. Effect Of Soft Drinks
On Teeth

2. Introduction
The high cariogenicity of soft drinks is recognized by
all dental professionals as well as dieticians, and
follows on from the accepted role of refined
carbohydrates, particularly when sucrose, in caries
process

3. Definition
Dental caries is defined as an “irreversible disease
of calcified tissues of teeth, characterized by
demineralization of the inorganic portion and
destruction of the organic substance of the tooth,
which often leads to cavitation”.
-Shafer’s Textbook of Oral Pathology

4. Composition Of Soft Drinks
Components Typical Use Level
Water
Sugars
Carbon Dioxide
Acids
Flavors
Juices
Coloring
Preservative
Foaming Agent
Hydrocolloids
Vitamins/Mineral/
Fibre
up to 95%
7 - 14%
0 - 0.70%
0.05 - 0.35%
0.05 - 0.50%
0 - 20%
0 - 200 ppm
0 - 400 ppm
0 - 200 ppm
0 - 0.25%
variable

6. When sucrose intake exceeds 15 to 20kg per
person per year, such intake is directly associated
with increasing caries prevalence, particularly
when sucrose is consumed between meals
With a sucrose content typically in the range of 10-
12%, a 375ml can contains in excess of 40g of
sucrose, thus one can of sugared soft drink per
day for one year will itself account for 15kg of
sucrose per year

7. Study (Heller KE, Burt BA et al
2001)

8. Caffeine
 Caffeine is added to soft drinks generally to contribute to the
complex flavor

9. Health Issues
The combination of caffeine with erosive acids and
either sucrose or artificial intense sweeteners
raises a number of issues beyond an elevated risk
of dental caries and dental erosion
Caffeine also increases secretion of gastric acid
and increase urine output, giving a diuresis which
can impact negatively on fluid balance and thus
lower resting salivary flow, ph. and buffer capacity,
with consequential effects on oral health

10. It is worth remembering that drinks which are
consumed slowly over a longer time period will
warm from refrigerator temperature to room
temperature and then to body temperature.
As this temperature increase occurs, enamel
mineral loss per unit time will increase, and enamel
hardness will decrease, approximately linearly with
temperature

12. Susceptibility
With the consumption of acidic, carbohydrate rich
soft drinks, teenagers are at high risk for caries
development, which can be quite aggressive. 8 to
17-year-old children are at greatest risk

13. The newly erupted enamel in teenagers is
immature, and the crystalline structure is porous,
chalky, and easily penetrated and dissolved by
acids
Even in the absence of carbohydrates, soft drinks
can be destructive to teeth. These acidic, or low
pH, beverages can contribute to the
demineralization of dental hard tissues

14. Courtesy Pamela R. Erickson et al, 2001

15. Soft drinks have ortho-phosphoric acid while diet
soft drinks contain both ortho-phosphoric acid and
citric acid
Ortho-phosphoric acid will dissolve the protective
pellicle layer deposited by saliva onto teeth, and
will etch both enamel and dentine
Citric acid sequesters calcium ions from saliva,
preventing re-mineralization, etches dentine, and
causes dental erosion. The combination of these
various acids give a low ph.

16. Study (Marshal et al, 2008)
 Trained dentists and interviewers examined a
representative sample of 369 children, aged 3 to 5
years, in 2002-2003 and again two years later. They
assessed caries by using the International Caries
Detection and Assessment System
 Soft drinks, 100 percent fruit juice and milk represented
the sugared beverages consumed. A cluster analysis of
the relative proportion of each drink at baseline and
follow-up revealed four consumption patterns

17. The authors found that children who changed from
being low consumers of soft drinks at baseline to
high consumers after two years had a 1.75 times
higher mean number of new decayed, missing and
filled tooth surfaces compared with low consumers
of soft drinks

19. The Future- Dentally safe
drinks?
Chemical Modifications
Removal of caffeine
Reduction in the levels of acidity
Replacement of sucrose with low glycemic index
non-cariogenic sucrose replacements like
Isomalt
If it is possible to supplement with as much as
40mmol/L calcium and 30mmol/L phosphate ion,
then despite their ph. Being below the critical ph.
threshold they should not erode the enamel and
dentine because the calcium and phosphate will
saturate the drink with respect to apatite mineral

20. To achieve significant concentrations of these ions,
a phosphor-protein stabilizer is essential. Casein
phosphopeptide-stabilized amorphous calcium
phosphate (CPP-ACP) can produce high levels of
bio-available calcium and phosphate
This has already been shown with sports drinks
such as PowerAde, where adding CPP-ACP
reduced beverage’s erosivity without affecting its
taste

21. Precautions
Rinsing with water may help reduce the risk of
decay and erosion as well. If you are very thirsty
after playing sport or working outdoors, drink some
water first. This will replenish your saliva which in
turn will help to dilute and neutralize the acid.
Use a straw where possible
However, it is always best to minimize the amount
and number of times per day you drink soft drinks

22. Conclusion
Soft drinks are potentially cariogenic; however,
young children still can consume them more safely
if the exposure is reduced and dental plaque is
removed regularly with a fluoridated dentifrice
As dental professionals, we need to educate our
patients about the consequences of soft drink
consumption and provide suggestions to minimize
the risk

23. References
Marshall and Amid I. Ismail Anita M et al;
Cariogenicity of Soft Drinks, Milk and Fruit
Juice in Low-Income African-American
Children : A Longitudinal Study; JADA 2008;
139(7): 959-967
Pamela R. Erickson, D.D.S., Ph.D., Deanna
L.Alevizos, D.D.S., M.S. and Darcy J.
Rindelaub, D.D.S.; Soft Drinks: Hard on Teeth
Professor Laurence J. Walsh; Black cola
drinks, oral health and general health: An
evidence based approach; School of dentistry,
University of Queensland