Should we put more focus on the message of beverage acidity?

27 May 2019

Fifty-two percent of Australians are reportedly exceeding the World Health Organization’s (WHO) guideline for free sugar intake to be less than 10% of total daily energy intake, therefore it is to be commended that sugar takes such prominence in oral health promotion.

It is, of course, important that we highlight the fact that sugar plays a major role in causing dental disease with patients increasingly aware how badly sugar can affect their oral health.

But while we’re highlighting the role of sugar, particularly in regard to the consumption of sugary drinks, are we missing a chance to highlight the role beverage acidity plays in oral health?

Organisations across Australia, particularly in the health industry, continue to make changes to address the availability of foods and drinks with added sugars. For example, NSW Health announced in 2017 they were banning the sale of sugary drinks from all hospital and healthcare facilities. While in Queensland, Government Hospital and Health Services have continued to limit the availability of sugary drinks; an applauded move in the right direction.

However, in some hospital vending machines the sugary soft drinks are removed and instead replaced with sugar-fee soft drinks and sugar-reduced beverages, potentially portraying the wrong message to consumers.

With a message to ‘choose drinks without added sugar,’ consumers may be purchasing sugar-free drinks thinking they are doing the right thing by their oral health by potentially avoiding tooth decay. This may be true, but as dental practitioners, oral health promotion and education are a key part of our role and we need to ensure we are educating patients regarding the other harmful oral effects of beverages including energy drinks, soft drinks and sports drinks, which most notably is their high level of acidity.

Sugar-free and sugared soft drinks have similar erosive ability. Therefore, patients need to be informed about the erosive potential of these drinks, regardless of whether they come with additional sugar content and be made aware that it is not only the sugar potentially damaging the teeth, but also the added food acids.

Providing this message may be challenging as social media platforms continue to show fitness trainers or self-appointed "wellness advocates" recommending ‘low sugar’ drinks that they personally include in their diets. The strong influence held by Instagram influencers and the like mean that young Australians are faced with these advertisements or recommendations daily.

While Australia continues to make moves in the right direction, with the Queensland Government recently announcing a ban on unhealthy foods and drinks advertisements on government-owned advertising spaces, social media savvy individuals continue to have free reign to promote drink products, with people heeding their message on the basis that since they’re a personal trainer or well-known social media ‘wellness advocate’ they must know what they are talking about.

We should be encouraged that people are choosing sugarfree drinks as this shows they are increasingly conscious about the health of their body. However, this health consciousness is mostly concerned with weight gain with the health of the mouth lagging behind. As dental practitioners we must continue to have conversations with our patients to educate them on the detrimental effects, other than caries, when frequently consuming acidic drinks.

The challenge for consumers is that food acids, which are commonly added to drinks to improve their organoleptic properties and shelf life, can be hard to detect given they are often being listed as food acids, such as 338, 330 or 331 and not by their commonly-known names of phosphoric acid, citric acid and sodium citrate respectively.

Patient education becomes very important when the level of acidity of some drinks cannot be recognised through their nutritional label, only through knowledge of the production process. This includes the currently socially popular drink, kombucha. During production, the brew is left to ferment for 1-2 weeks where the fermentation process results in an increase in acidity which prevents other microorganisms from growing. The fermentation process cannot occur without added sugar, though the final level of sugar is very low.

Caries still exists as a risk as some kombucha drinks have added fruit juice. However, of most concern is the possibility of tooth erosion with frequent consumption. Patients may be unaware of the negative oral effects of kombucha as it is generally associated with 'clean’ living and sold in health food stores, where consumers may
wrongly believe all available products are good for them.

The best beverage options are water and plain milk while coffee or tea without added sugar are also acceptable.