There is much joking here at Synergy about my proclivity for LaCroix – or, as we LaCroix drinkers like to call it, “fizzy water”. Memes are passed around, and once in a while Rachael calls out from the lab, “Coconut!”, joking that there is as much flavor in the word as there is in the can. All joking aside, it has occurred to me that while there is no sugar in my beloved fizzy water, the carbonation and the flavorings could be making my beverage acidic, and therefore damaging to my enamel. In my relentless quest for knowledge of all things dental, I decided to investigate.
My research online uncovered a few published studies investigating the pH levels of common non-alcoholic, non-dairy beverages sold in the United States, as well as several unvetted articles on various websites. Information among the blog articles varied rather widely, and is as often the case with online information, appeared to use other unvetted articles as sources, with one of them slanted quite suspiciously in favor of Coca-Cola being one of the safer beverages for enamel (it’s not, it turns out), so I stuck to the published, peer reviewed studies. Of the scientific papers I found, I choose here to refer to a recent study which accounted for conditions in the mouth rather than basing erosive potential on results of extracted teeth submerged in solution – an assessment Dr. Ulm and I do not believe to be terribly practical in application, unless of course you’re inclined to hold your beverage in your mouth for 30 minutes…
An article published in the Journal of the American Dental Association in 2016 based on a study performed at the University of Alabama by Reddy and Norris, et al, looked strictly at pH levels and erosive potential of beverages for human enamel in the mouth. For reference, the pH scale ranges from 0, or very acidic (think battery acid), to 14, or very alkaline (drain cleaner). Human saliva in a healthy mouth usually hovers right around 7.0 – perfectly neutral. Enamel has a natural pH of about 5.5, and dentin, the more porous, weaker layer under the enamel, is about 6.5. In general, anything more acidic – or with a lower pH – than enamel has erosive potential. However, due to the relative short-term contact of beverages with teeth during the act of drinking and swallowing and the protective qualities of saliva, the authors concluded that a beverage needed a pH of 4.0 or lower to pose serious risk for enamel erosion. The authors categorized beverages accordingly: pH of below 3.0 = extremely erosive; pH of 3.0 – 3.99 = erosive. Above 4.0 is considered non-erosive.
Of the beverages tested, a whopping 93% had erosive potential, with pH levels below 4.0, leaving only 7% in the safe range. 39% of them were extremely erosive with pH below 3.0 (including undiluted lemon juice, all tested flavors of Powerade, most cranberry juices, Coca Cola Classic, and many, many others – see the study for the complete list, here). I was admittedly a little giddy to see the authors included a statement about fluoride in their conclusion, specifically that fluoride offers no protection against erosive potential from beverages, because fluoride itself is soluble at these pH levels. (Of course, our position is that fluoride’s risks always outweigh its benefits, especially given the availability of safe alternatives, but I always love a good scientific debunking.) Additionally, the authors mention the increased risk of erosion on primary teeth in kids (never put any of the erosive beverages in a baby bottle or sippy cup, and dilute juices for toddlers), as well as geriatric patients with receded gums and exposed root surfaces, patients taking medications which cause dry mouth, and interestingly, endurance athletes, due to dehydration and reduced saliva as a result of profuse sweating during strenuous exercise. Anyone falling into the above populations is recommended to drink primarily water.
Naturally, 2016 was before the huge fizzy water boom we’re enjoying now (or I am, anyway), and therefore LaCroix was not included in this study. My research online into specific information about the pH levels of LaCroix was a bust, with several well-meaning health websites suggesting the acidity in fizzy water was equally problematic to orange juice or soda, and one using the scare tactic of claiming that “just 30 minutes soaking in LaCroix” resulted in erosion on an extracted tooth. I’m not soaking my teeth for 30 minutes in anything except saliva, so I’m not overly fussed about this claim. What to do, though, to hopefully exonerate – or incriminate – my LaCroix?
Armed with the information in Reddy’s paper, I set out to investigate myself. We keep pH strips right here in our operatories in order to test the acidity of saliva for patients who seem to have an abnormally high tendency for cavities, despite good hygiene and good diet. They’re a handy, noninvasive tool, and just what I needed to determine the erosive potential of my beloved fizzy water. A ten-second dip in coconut flavored LaCroix revealed a pH level of about 5.5 – well above the erosive threshold of 4.0. Safe! Phew! This corresponds with the above study’s findings for pH levels of club soda and Perrier. Although I expect there may be some variation depending on the “natural flavors” included in various flavors of LaCroix, we feel confident in assuming them all to be within the safe threshold. I intend to continue testing different flavors and duplicating with a 2nd set of litmus papers, and will report here.
Now, I would be remiss to suggest that a carbonated beverage flavored with “natural flavorings” – i.e. basically anything they want to put in it, thank you, FDA! – is a “health drink”. Certainly plain old, preferably non-fluoridated, water is the best thing for our bodies and our health. But, on the list of fizzy vices, LaCroix and other sparkling water appear to be definitively better for our teeth than sodas, juices, energy drinks, and non-carbonated flavored water. While I’m always game to adjust my lifestyle toward healthier choices and was, admittedly reluctantly, willing to forgo my fizzy water if results had been different, for now I’m happy to hold on to my delicately flavored fizz, guilt free (as far as my teeth are concerned anyway).
If your favorite beverage is included in the extremely erosive group, or if you fall into one of the high-risk populations, Dr. Ulm and I suggest looking for a safer alternative. At the very least, rinse your mouth with water after enjoying that Dr. Pepper (or whatever your vice), and resist the urge to brush for at least 30 minutes. Acid weakens enamel, and in its weakened state, brushing can actually accelerate erosion. Rinse instead, and don’t drink anything acidic before bedtime or your normal brushing time.
Coconut!
Nope, I maintain it’s not the same. Happy sipping!