Does soda pop cause cavities. (Healthbeat).

Adverse health effects associated with excessive consumption of pop, also known as soda, soft drinks or carbonated beverages, have been recognized for at least 30 years. Recent increases in pop consumption have resulted in both an increased awareness and incidence of these deleterious effects on both oral and systemic health. Aggressive marketing by the pop industry, including corporate sponsorship of youth activities and school contracts, will likely encourage this trend in children and adolescents. Furthermore, as the previous generation's "youth" ages, a cohort effect of increased pop consumption is being observed in adults. Aggressive preventive education is necessary to limit both oral and systemic health risks associated with excessive pop consumption.

Nutrient Composition

Pops are sweetened, acidic, and often caffeinated, carbonated beverages. "Regular" pops are sweetened with blends of high fructose corn syrup and/or sucrose. "Diet" soda pops are sweetened with artificial sweeteners including aspartame, sucrose and acesulfame potassium. Aspartame is a protein by nature and, thus, not cariogenic when metabolized. Very little aspartame is used due to its intense sweetness; aspartame's contribution to energy intake is insignificant. Sucralose is a sucrose molecule having selected substitution of hydroxyl groups by chlorine. This substitution inhibits bacterial and enzymatic metabolism and sucralose neither provides energy nor is cariogenic. Acesulfame potassium is an organic salt and neither provides energy nor is cariogenic.

The measured pH of commonly consumed regular and diet pops ranges from 2.47-3.35. Phosphoric and citric acids, natural juices and carbonated water contribute to the acidity of pops.

All pops contain water and, for some individuals, may be a primary source of dietary fluid. However, neither regular nor diet pops are a significant source of micronutrients.

Oral Effects

Both sucrose and fructose are substrates for oral bacteria; therefore, regular pops are potentially cariogenic. Artificial sweeteners used in diet pops are not metabolized by oral bacteria and, therefore, diet pops do not contribute to the caries experience.

The acid in regular and diet pops has the potential to contribute to enamel erosion. Furthermore, the acid may function synergistically with the sugar in regular pops contributing to rampant caries.

Systemic Effects

Regular pops provide between 150-180 kcal per 12 oz can. Current dietary recommendations for added simple sugar consumption are 10% of total energy; thus, one can of regular pop per day is the maximum recommended intake for systemic health. Excessive intake of regular pop either contributes excessive energy to the diet leading to obesity or decreases intake of foods with a higher nutrient density leading to deficient nutrient intake. Considering an extra 100 kcal per day increases weight by approximately 10 pounds per year, then an extra can of pop per day could increase weight by 15-18 pounds per year. Diet pops do not contribute significant energy to the diet and are unlikely to affect weight status. Artificial sweeteners in use today have not been associated with long-term systemic concerns when consumed in quantities associated with typical dietary intakes.

Substituting regular pop for nutrient dense foods decreases nutrient intake and may contribute to deficiency states. Replacement of milk beverage with either regular or diet pops decreases dietary intake of calcium and vitamin D. This is of particular concern in adolescent females whose time frame for increasing bone density to prevent future osteoporosis is limited.

Patterns of Consumption

Actual effects of pop on oral and systemic health are a direct result of the quantity and nature of consumption. Rapid drinking of any quantity of regular pop, particularly with meals, is unlikely to affect the caries risk. However, "nursing" a regular pop-defined as frequent sips over a period of hours--increases the exposure of teeth to sugar and the risk of caries regardless of the total quantity consumed ... one 12 oz can or a 64 oz guzzler.

Systemic health is obviously affected by the quantity of regular pop consumed. Subtler, though, are the effects of patterns of consumption. Some individuals are not sensitive to liquid calories and consume large quantities of caloric beverages without compensating their total energy intake. These individuals are at great risk for obesity regardless of whether regular pop is consumed at or between meals. At the other extreme are individuals who are sensitive to liquid calories. In this instance "nursing" a regular pop blunts the appetite leading to skipped meals and a decrease in solid food intake.

Recommendations

Recommendations for pop consumption must acknowledge both oral and systemic health concerns. Pop use should be limited; however, when consumed, oral health concerns suggest that pops be consumed at meals to limit contact time between sugar, acid and teeth. Systemic health concerns dictate the regular pops be limited to 1 can per day and neither regular nor diet pop replace nutrient dense foods or beverages in the diet.

Summary

Excessive consumption of pop is known to be detrimental to both oral and systemic health. Education of patients and expected compliance are difficult issues, especially when competing with multimedia advertisements associating vibrant youth with pop consumption. To this end, we have developed a brochure, "Does Soda-Pop Cause Cavities?" for patient education. Caries and erosion of dietary habits and recommendations for consumption are discussed in the brochure.

These brochures are available from the Department of Preventive and Community Dentistry at [phone]. Brochures are sold in incremental units of 100 including postage and handling. The first 100 brochures cost $22 each. Each additional 100 brochures cost $20.

By Teresa A. Marshall, PhD, RD/LD and Marsha A. Cunningham, RDH, MS Department of Preventive Community Dentistry, University of Iowa College of Dentistry