Energy Drink and Dental Erosion
Case report For french version click here
A young patient of 28 years old consults for dental treatments. She reports drinking 8 to 10 cans of 480 ml energy drink Redbull per day since the age of 17, which means a minimum daily dose of 1.5 g of caffeine per day. Note that at 1 gram per day, we are in the level of toxic doses.
This young person ended up in emrgency at the hospital and had to be operated for appendicitis (apendicectomy). The doctor who received her quickly made the connection with the excessive consumption of energy drink and warned her to stop immediately consumption given the cardiac risks it incurred. In short, she was lucky that it was appendicitis and not a cardiac warning.
In order to make up for her need for sugar, Madame has been eating countless sweet treats from 2017 to 2019.
The damage to his teeth as you can see is huge. The consumption of Redbull caused a dissolution of the enamel of her teeth to such a point that one can speak of destruction. The consumption of sweet treats that ensued during the next 2 years favored the development of dental caries.
Dental Erosion with Redbull
Dental Erosion and Energy Drink
Dental erosion is the irreversible acidic dissolution of surface tooth structure by chemical means in the absence of microorganisms. It primarily occurs when hydrogen ions [H ] interact with the surface flluoroapatite and hydroxyapatite crystals after diffusion through plaque-pellicle biofilm—a process termed proton-promoted dissolution.
Erosion may initially progress through the enamel lamellae exposing dentinal tubules leading to dentinal sensitivity, however, with continuous erosive insult to the surface enamel, larger areas of the enameldentin junction will eventually become exposed, leading to enhanced sensitivity
As the oral cavity pH drops below 4.0, the tooth surface erodes and with each unit of decrease in pH there is a ten-fold increase in enamel solubility resulting in a 100 fold increase in enamel
demineralization as the pH approaches 2.0 from 4.0. Apatite solubility studies indicate a logarithmic increase in apatite solubility as pH drops under laboratory equilibrium conditions as can be seen in the solubility curve.
The pH energy drink like Monster (low carb, M-80 et MIXXD0) varies from 3,29 to 3,60. The pH of Redbull (shot, regular, sugar free et sugar free shot) varies from 3,25 to 3,43.
The most acidic beverages tested with a pH < 2.4 were: lemon juice (pH 2.25), RC Cola (pH 2.32), Coca-Cola Classic (2.37), Coca-Cola Cherry (pH 2.38), Pepsi (pH 2.39). Citric > phosphoric > malic acids were the most frequently added acids to the drinks.
The primary dentition of children is highly susceptible to the erosive process and low pH beverages should not be placed in a baby bottle, especially at sleep time when the mouth is xerostomic.
Natural saliva has a buffer effect to reduce the acidity of these products. But energy drinks contain caffeine, which reduces salivary flow. If the salivary flow is reduced, the mouth is drier and there is no longer any protective effect against tooth decay and erosion.
Cardiac rhythm disorder
Energy drinks contain high concentrations of caffeine, guarana, taurine and sugar. The typical dose of caffeine added is 7 to 32 mg / 100ml which means a dose of 35 to 150 mg of caffeine for a 500 ml can. This is combined with guarana (extracted from Paullinia cupana) which increases from 40 to 80 mg of caffeine per gram of guarana and each can contains about 10 mg of guarana, which represents an additional dose of 400 to 800 μg of caffeine.
Guarana also contains stimulants such as theobromine and theophylline.
Taurine is another active ingredient known to modulate muscle contraction.
Caffeine is an antagonist of adenosine and benzodiaspine receptors. Caffeine binds with the G protein receptors coupled on the surface of the heart muscle. The toxic dose of caffeine is 1 g. The lethal dose is 5 to 10 g.
Side effects of high caffeine intake include increased heart rate, palpitations, increased blood pressure, anxiety, insomnia, nervousness, irritability.
Recent studies demonstrate that energy drinks can reveal cardiac arrhythmia problems such as Brugada syndrome and the long QT syndrome. It is a cause of sudden death in people at risk of arrhythmia. Other patients had supraventricular tachycardia problems and cardiac arrest caused by coronary vasospam in a patient who had consumed 8 cans of energy drinks.
Other causes of Dental Erosion
Here are the teeth of a 28-year-old woman who has been suffering from bulimia for about ten years.
Exaggerated consumption of soda (Pepsi or Cola)
pH of Pepsi® est de 2,39; Pepsi®-Wild Cherry = 2,4; Pepsi Diet® =3,02
pH of Coca-Cola® Classic = 2,37; Coca-Cola Diet = 3.1; Coca-Cola® Cherry = 2,38
ph of 7up® = 3,24; 7up® Diet = 3,24
The most acidic beverages tested with a pH < 2.4 were: lemon juice (pH 2.25), RC Cola (pH 2.32), Coca-Cola Classic (2.37), Coca-Cola Cherry (pH 2.38), Pepsi (pH 2.39).
Dental Decalcification dentaire: Apple Juice and Aligners
A young patient wanted treatment with Invisalign aligners. Two problems occurred.
1- Despite reminders at each visit and repeated demonstrations of hygiene method, she has never managed to obtain an adequate quality of oral hygiene.
2- I noticed decalcifications on the surface of her teeth and I informed her that it was related to her bad brushing.
On the other hand, the day I took the pictures that follow, I asked more questions because I said that decalcifications could not be explained only by poor hygiene. That’s how I discovered that in her gourd she was constantly hanging out, she was putting apple juice. She drank apple juice continuously during the day. Apple juice infiltrated her aligners and caused an acidic environment that trigger decalcification.
Clapp, O., et al. (2019). “The top five selling UK energy drinks: implications for dental and general health.” Br Dent J 226(7): 493-497.
De Sanctis, V., et al. (2017). “Caffeinated energy drink consumption among adolescents and potential health consequences associated with their use: a significant public health hazard.” Acta Biomed 88(2): 222-231.
Gray, B., et al. (2012). “Consumption of energy drinks: a new provocation test for primary arrhythmogenic diseases?” Int J Cardiol 159(1): 77-78.
Sanaei-Zadeh, H. (2013). “Overuse of energy drinks: why death?” Am J Emerg Med 31(12): 1713-1714.