Lessening dental erosive potential by product modification

Abstract

Current interest in dental erosion has led to increasing attention to ways in which potentially erosive products might be modified. Information on how this could be achieved has been hard to gather, and has focused chiefly on possibilities in reformulating soft drinks. The bulk of the work published on this relates to calcium and phosphate supplementation, ranging from early experimentation on saturation of a demineralising medium with tricalcium phosphate, through tests of more soluble phosphates and other calcium salts providing various levels of Ca2+ and PO4(3-), to a calcium citrate malate additive specially formulated to curb erosion by soft drinks. Opinions on the effectiveness of citrate, the practicability of reducing the acidity levels of soft drinks, and the possible applications of fluoride, bicarbonates and certain constituents of milk products are also included. Finally, an attempt has been made to summarize some of the advantages and shortcomings of the different methods, but it is clear that much further work will be needed before firm guidelines on the best routes to product improvement can be laid down.

A laboratory investigation of consumer addition of UHT milk to lessen the erosive potential of fizzy drinks

“…18 The purpose of this in vitro study was to assess the capacity of six brands of carbonated drinks to bring about dental erosion and determine if the addition of milk affected this. It was not the primary aim of this work to make inter-drink brand comparisons.…”

Effect on plaque pH of fruit drinks with reduced carbohydrate content

“…[1][2][3] Most studies have shown that when drinks that contain fermentable carbohydrate are consumed, there is a drop in the pH of the dental plaque in vivo. The production of acid by bacteria in such close proximity to the tooth surface would mean that on consumption enamel demineralisation could occur, hence their cariogenic potential.…”

Prevention. Part 3: Prevention of tooth wear

“…This increases the erosive potential of these drinks, at least when measured in vitro. 40 A successful attempt to reduce the erosive potential of soft drinks by the addition of calcium citrate-malate was reviewed by Grenby 30 but a later in vivo investigation by Rugg-Gunn et al 41 found no difference in the amount of erosion seen in enamel slabs treated with plain or modified orange drinks. One of the potentially most important steps in soft drink modification has been the development and subsequent marketing of Ribena Tooth Kind.…”

“…30 Addition of calcium lactate to Coca Cola® has been shown to reduce the erosive potential of this most international of erosive beverages 39 but this research does not appear to have been taken up by the manufacturer. Rather the reverse trend is seen with the marketing of drinks with added citric acid to drinks such as Pepsi Cola® and to several diet preparations of carbonated drinks.…”

“…A number of animal and in vitro studies suggest that adding fluoride to potentially erosive drinks will reduce the erosive potential of these drinks. [29][30][31] Addition of fluoride to sports drinks has also been shown to reduce the erosive potential of these, otherwise highly erosive, drinks. 32 Amaechi et al, 33 have shown that xylitol and fluoride have an additive effect in reducing the erosive potential of orange juice in in vitro studies.…”