Many people switch to diet soda to cut calories, thinking it's a healthier alternative to regular soda, especially for their teeth. While it's true that diet soda is sugar-free, the truth is more complex. This article explores the effects of diet cola on dental health, examining the science behind its impact and offering practical advice on how to protect your teeth.
Understanding Dental Erosion
Dental erosion is defined as the irreversible chemical dissolution of dental hard tissues, including enamel and dentine, through a chemical process. Unfortunately, this damage is irreversible. Most of the population (80%) has some form of dental erosive lesions. When compared with the total sample, people with erosion were more likely to be male (52.5%) and older. People with no erosive lesions were younger (42.3%) and non-Hispanic Black (21.2%). The acids responsible for erosion can be extrinsic, from sources like carbonated drinks or citrus juices, or intrinsic, originating from conditions like acid reflux or eating disorders. Tooth enamel, the hardest structure in the human body, is composed of highly organised crystals arranged in 3D prisms, extending from the amelodentinal junction to the outer surface. These prisms are formed by ameloblasts, with each prism being the product of a single ameloblast. Acidic beverages, such as cola, can disrupt this highly organised structure. Within just five minutes of exposure, the enamel crystals show significant disorder.
The Acidity Factor
One of the key issues with any form of soda is the acids present. The carbonation of soda features acids that can break down the enamel on your teeth. Even though the elimination of sugar is positive, certain dental risks still come with these drinks. It is safe to assume you may not want to totally remove sugary drinks from your diet, but according to the American Dental Association, simply reducing the number of sugary beverages in favor of other options is a great step.
Diet soda is acidic, due to ingredients like citric acid and phosphoric acid. The pH level of diet soda is typically around 3 to 4, which is much more acidic than neutral water, which has a pH of 7. This acidity can erode tooth enamel, which is the hard outer layer of your teeth. Enamel erosion can lead to increased sensitivity, discoloration, and a higher risk of cavities. Acid erosion is a gradual process. It may not be noticeable at first, but over time, it can cause significant damage.
Diet Cola vs. Regular Cola: Which is Worse?
When most patients ask us this question, they're thinking strictly about sugar content - cut out the bacteria-feeding sugar that's present in regular soda by opting for a diet soda and it will be better for your teeth. That seems logical, but there's a bit more to it than that. Regular soda contains sugar. Sugar feeds bacteria in your mouth. These bacteria produce acid, which leads to cavities. Diet soda does not contain sugar, so it does not feed bacteria in the same way.
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While regular cola contains phosphoric acid, the increased erosive potential of diet cola can be attributed to the additional presence of citric acid. Research by Khamverdi et al (2013) shows that it actually causes more dental erosion than regular Coca Cola. This is due to its high content of acidic flavourings like phosphoric and citric acids, which significantly lower the pH in the oral environment, leading to demineralisation. The erosive effect of carbonated drinks is due to their low pH, typically between 2.7 and 3.0, driven by the presence of phosphoric acid and, in diet cola, additional citric acid. While phosphoric acid enhances flavour and shelf life, citric acid increases acidity further, making diet cola even more erosive than regular cola.
Both types of soda can harm your teeth. The choice between them depends on your priorities. If you are concerned about calories and sugar intake, diet soda may seem like a better option. Many people think that switching from regular to diet soda will keep their teeth healthy. Additionally, while the sugar in regular soda and other sweet drinks forms harmful acid in your mouth, diet or sugar-free beverages also contain phosphoric acid, the same found in regular, sugary soda. Citric acid and tartaric acid are just some of the additional ingredients in diet drinks and fruit juices that can damage teeth.
The Role of Artificial Sweeteners
Diet soda is a sugar-free version of regular soda. Manufacturers use artificial sweeteners like aspartame, sucralose, or stevia to mimic the taste of sugar. It tastes sweet but contains no sugar, which appeals to those looking to reduce calorie intake. Despite its low-calorie content, diet soda contains various chemicals and additives. These ingredients contribute to its taste and appearance. However, they can also have effects on your oral health.
Diet soda contains artificial sweeteners. These do not cause cavities like sugar does. However, they do not protect against acid erosion. Artificial sweeteners can still create an environment where bacteria thrive. Some studies have shown that the effects of diet soda are also caused by artificial sweeteners. The sweeteners can make the body feel more hungry and result in more food cravings.
Other Ingredients and Their Impact
Diet soda often contains citric acid and phosphoric acid. These acids can weaken enamel and promote bacteria growth. Citric acid is found in citrus fruits, but in diet soda, it is more concentrated. Other ingredients in diet soda, such as coloring agents and preservatives, may also have effects on your oral health. While these ingredients are generally considered safe, they can still contribute to the overall acidity and impact on your teeth. Many of the traditional dark-colored sodas use the same caramel coloring whether you drink regular soda or diet. The caramel coloring gives the soda its classic look but could present staining issues for your teeth. Similar to coffee, excessive soda consumption could lead to tooth stains in your mouth. Over time, you may notice a general yellowing of your teeth. The white vibrant luster of the teeth could fade over time and result in stains from the soda dyes. One of the main ways stains may accelerate is through the acids present in soda. When the acids weaken the enamel, the dyes reach under layers of the teeth and can result in more permanent stains.
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The Caffeine Connection
One of the main reasons a person may drink diet soda is for the caffeine. Many people rely on a daily dose of caffeine to boost their energy and keep them alert through work or other activities. Unfortunately, whether you drink diet soda or regular soda, the caffeine still impacts the mouth in the same way. Caffeine will often cause dry mouth. Extended periods of dry mouth can cause a lot of dental issues. Without a proper saliva flow, the bacteria in your mouth remains on your teeth and gums. An increase in bacteria could lead to inflamed gums and the eventual formation of gum disease like gingivitis. Without proper treatment, infections could grow and lead to serious problems for your teeth.
Frequency and Duration of Consumption
The key risk for dental health arises when beverage pH falls below the critical threshold of 4.0, causing enamel to become more soluble and prone to erosion. Studies by Lutovac et al (2017) show that those consuming soft drinks more than twice daily are four times more likely to experience enamel loss - up to 1µm per day. The problems caused by both diet and regular soda is exacerbated when you sip on them throughout the day. The best time for drinking sugar-free drinks is with meals, whereas continuously sipping during the day will cause the most damage.
Psychological Effects
Knowing that you’re drinking something with zero calories could have a big impact on your psychological state of mind. When you have drinks with no calories, you may feel like you could make up those calories with other food options. The “diet” effect could lead to more unhealthy food choices. You could consume more sugars or carbohydrates, which could break down enamel and eventually form cavities. Instead of just focusing on the diet aspect of a drink, try to make better healthy food choices all around.
Statistical Findings
Adult dietary and dental data were analyzed from the 2003-2004 cycle of the National Health and Nutrition Examination Survey. Erosion was measured with a modified tooth wear index and was analyzed as a dichotomous variable. Cluster analysis was performed, and the cluster number was based on having a separate diet drink cluster and the R2 values. Cluster analysis resulted in 4 distinct clusters: high water, high diet drinks, high coffee/tea, and high soda. The respective percentage of individuals in each cluster who had erosion was 78.9%, 85%, 83.9%, and 76.2%, where the "high diet drinks" cluster showed the highest erosion (P = 0.28). High diet drinks consumption slightly increased the odds of dental erosion among US adults, although this relationship was not statistically significant. The findings of this study are suggestive, though not significantly, that diet drinks may increase risk for dental erosion.
Practical Tips to Protect Your Teeth
Sugar-free drinks may cause dental erosion, but there are simple ways you can help protect your teeth. Dental professionals can play a significant role by conducting dietary analysis, enabling them to promote preventive education and collaborate with patients in making informed choices. By assisting patients in selecting beverages with a pH above 4 and advising them to gradually eliminate acid consumption, we can empower patients to make impactful dietary adjustments to help maintain the integrity of enamel.
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Here are some practical tips to minimize the impact of diet cola on your teeth:
- Drink in Moderation: Frequent Diet Coke consumption increases the risk of enamel erosion. Try to limit the amount of diet soda you consume on a daily basis.
- Use a Straw: For best results, position the straw toward the back of your mouth instead of letting the liquid wash over your teeth.
- Rinse with Water: If you choose to drink diet soda, rinse your mouth out with water afterward or brush your teeth. If you’re on the go, then stick with some fresh water to keep your mouth clean. After acidic meals or beverages, rinse your mouth with water, drink milk, or enjoy a little cheese.
- Wait Before Brushing: Brushing immediately after consuming an acidic drink can actually do more harm than good. Acid softens enamel, and brushing can erode it further. As the Oral Health CRC reports, brushing your teeth twice a day with fluoride toothpaste helps limit the effect these beverages have on your oral health, but it is recommended to wait one hour before brushing.
- Chew Sugar-Free Gum: Chewing gum stimulates saliva production, which naturally neutralizes acid and washes away harmful particles.
- Consider Fluoride: Fluoride helps remineralize enamel and strengthen teeth.
- Maintain Regular Dental Check-ups: A dentist in Cheshire, CT can monitor your enamel health and provide professional treatments if early signs of erosion appear. A dentist can evaluate the dryness of your mouth and will see any signs of swollen gums or teeth issues.
The Importance of Saliva
When exposure is short, saliva plays a crucial role in remineralising the demineralised enamel and restoring the pH to neutral (around 7.0). However, prolonged or continuous acid exposure hampers saliva’s ability to remineralise enamel, leading to irreversible loss of tooth structure. Without a proper saliva flow, the bacteria in your mouth remains on your teeth and gums.
The Impact on Oral Health-Related Quality of Life
Al-Omiri et al (2006) have observed that patients with enamel wear are nine times more likely to report discontent with their teeth when compared to the control group. Furthermore, higher levels of enamel wear have also been associated with a lower oral health related quality of life and satisfaction (Mehta et al, 2020). As a result, it is vital that the dental team can appropriately manage tooth wear, particularly dental erosion.
The Broader Context of Soft Drink Consumption
Soft drink consumption is one of several leading causes of tooth decay. Over the past few decades, the consumption of these beverages has significantly increased. In 2004, Public interests reports indicated that around 37 gallons of soft drinks were produced per person annually (Jacobson, 2004). Additionally, studies show that nearly 66% of children and 77% of adolescents consume sugary beverages daily. This rise in soft drink consumption has become a leading cause of dental erosion. Carbonation, sugar and acids in soft drinks weaken tooth enamel and encourage the growth of bacteria that contribute to tooth decay. This acid, plus the extra acid from soft drinks, attacks the teeth. Each acid attack lasts about 20 minutes, and acid attacks start over again with every sip. Ongoing acid attacks weaken tooth enamel. Cavities begin when tooth enamel is damaged. Remember, diet or "sugar-free" soda still has acid that can harm your teeth. Although fruit drinks aren't carbonated like soda, they too have acid and sugar that can cause decay. Give infants and toddlers these beverages in a regular cup.