Secret enemy destroying Marines' teeth

Local dental hygienist Erika Feltham recently discovered that some Marines returning from overseas “appear to be suffering from an unusually high and rapid loss of tooth enamel with larger aggressive cavities.” According to Feltham, the increased enamel erosion and decay are caused by an increased intake of dietary acid which is found in foods and beverages.

She defined the effects of the acid as dental erosion or demineralization by a chemical process which results in permanent loss of dental hard tissue (enamel and/or root surfaces).

A common source of these acids is energy drinks. Frequent and excessive consumption of any dietary acid can be devastating she said, adding, “I am deeply disturbed by these findings because our brave soldiers are risking their lives only to return home to find they may have to save their teeth. Many may have to combat extensive and permanent dental problems associated with the consumption of a variety of popular energy drinks.”

In the past year, the private dental office Feltham works in has treated active duty Marines for the first time. This is because Camp Pendleton’s dental clinics are currently swamped and backlogged, so the government has allowed these Marines to have their dental needs taken care of off base rather than waiting to be seen by base dentists. In other words, she said, all Marines’ dental disease treatment must be completed before these Marines return to another tour of duty.

Feltham noted that the soldiers had excellent hygiene so the condition of their teeth is not from neglect. While talking to her soldier patients, she was told that they have “unlimited and free access to various energy drinks” while on active duty. She explained that “energy drinks contain ‘titratable acids’ that are known to be over two times as acidic as sports drinks. I truly believe much of the permanent dental damage I have observed is caused mainly from the ‘titratable acids’ found in such drinks.”

Feltham has been on a 15-year mission to educate the public on the dangers of sour acid candy which has been destroying the enamel of unsuspecting consumers for years. While the damage caused by sour acid candy and other acidic foods is getting more recognition by dentists and dental product companies, researchers and dental hygienists around the country are also now recognizing the irreparable harm being done when people use energy drinks to stay awake and alert.

From her research, Feltham feels that “acids are more concerning than sugar.” The titratable acid used in energy drinks is made to be resistant to neutralization so it takes a lot more water or saliva to counteract its effect on tooth enamel. It is used to prolong the drinks’ shelf life and to cover up the bitter taste of caffeine which is its major ingredient. While the amount of caffeine in these drinks has already caused concern in the medical field, the amount of acid in them is now causing concern in the dental community.

Feltham cited a study in the May/June 2012 issue of General Dentistry, “A comparison of sports and energy drinks,”* which compared the fluoride level, pH, and titratable acidity of popular brands of sports and energy drinks sold around the country. Researchers studied the weight loss of enamel following exposure to these drinks; and examined the relationship between the physiochemical properties (fluoride, pH, titratable acidity) and enamel weight loss. Samples of enamel were exposed to each drink as well as to artificial saliva to simulate the consumption of those beverages.

The researchers found that of the 22 beverages tested, “Red Bull Sugar Free, Monster Assault, Von Dutch, Rockstar, and 5-Hour Energy had the highest titratable acidity among the energy drinks, while Gatorade Blue and Hydr8 had the highest titratable acidity among the sports drinks.”

Part of the conclusion of the study was that “the percent enamel weight loss after pH cycling in energy drinks is significantly higher than it is for sports drinks. It should be noted that exposure to both sports drinks and energy drinks resulted in considerable percent enamel weight loss after only five days of simulated exposure.”

In interacting with the Marines in her care, Feltham was told “these drinks help keep these young men and women ‘alert and on point’ while on duty.” In her opinion, “Dental damage to their enamel and root surfaces may be increased when multiple drinks are consumed within a 24-hour period. I believe many soldiers serving and returning from overseas are totally unaware of the potentially devastating and permanent damage to their teeth due to these acids. Public awareness and education is imperative to help minimize the damaging dental effects from these drinks.”

Drinking water right after an energy drink to wash away the acids can help minimize the damage as does limiting the number of energy drinks consumed each day. Regular check ups and cleanings at the dentist are also important for everyone in identifying any problems before extensive and expensive treatment is required.

While more research needs to be done, the damage acids cause is being seen in dental offices all over the United States in patients of all ages. What concerns Feltham is that “the consumer believes energy drinks are better for them than soda.” Her intention in bringing this issue to the public is “not to ban or restrict energy drinks, but to inform the consumer exactly what is in these energy drinks that potentially makes the drinks so very destructive.”

The extreme damage to the teeth of some Marines has especially got her attention and, “as a dental professional, I’m hoping this is not the tip of the iceberg but instead only exceptions to what is actually occurring with our active military soldiers’ teeth.”

Erika Feltham, a registered dental hygienist, has worked in both periodontal and general dental practices. She is a 2008 Johnson & Johnson ADHA Hygiene Hero Honoree and has had several articles published on dental erosion and demineralization. She is the CDHA Sour Candy Spokesperson and spearheaded the unanimous passage of a resolution outlining the oral health dangers of sour acid candy.

*”A comparison of sports and energy drinks—Physiochemical properties and enamel dissolution,” by Poonam Jain, BDS, MS, MPH; Emily Hall-May, MS; Kristi Golabek; Ma Zenia Agustin, PhD; featured in General Dentistry, May/June 2012. Pgs. 190-197.