Literature Review Paper:

Soft Drinks and Caries

Jessica Lee
DH 237: Community Dental Health
November 26th 2023
 A topic that is always coming up in the dental world is the association between soft

drinks and caries. What is it? What is the significance? How can we improve oral health in

communities in which there is a high rate of soft drink consumption? These are all valid and

important questions to ask. There is a ton of research out there about the association of the

two. How soft drinks specifically impact the teeth and enamel eventually causing caries is the

focus here.

In one study, a tooth was immersed in hydrogen peroxide for 10 days. It was then

immersed in Coca-Cola for another 10 days. The tooth was then checked in regular time

intervals of 2 days (Hanin, 2018). The results of this study showed significant staining and

erosion of the enamel. What causes the weakened enamel is phosphoric acid, which is a main

ingredient added to soda for flavoring. Phosphoric acid essentially etches the tooth and then

chromogens (an ingredient added to soda for coloring) cause the staining on the eroded area.

This is an important study to note because although people won’t be “soaking” their teeth in

soda, many of them drink several sodas a day. This combined with poor oral hygiene or lack of

preventative care (or both) is a recipe for rampant caries, staining, and dentinal hypersensitivity.

Dental disease is increasing all over the world but why is that? What is causing this

change? According to this study (Inchingolo 2023) it is the increased consumption of not only

sugary beverages but soft drinks. Soft drinks have a low pH due to several acids found in the

ingredients of the soda itself. The acidic environment created by the consumption of soft drinks

in the oral cavity also affects the buffering capacity of one’s saliva. If you already have a reduced

salivary flow, it can worsen the problem. “Unfortunately, sometimes carbonated drinks, now so

common in modern society, replace drinking water. Enamel, while the hardest part of the body,
is still a vulnerable structure when exposed to chemicals, such as those found in sodas and

beverages. The roughness and hardness of the enamel surface are two reference parameters

considered to evaluate the damage of the acids of carbonated drinks, and it has been

highlighted that the roughness is the change of the enamel that occurs as an initial erosion

phenomenon. Daily consumption of carbonated drinks increases the risk of tooth erosion”

(Inchingolo 2023). A key takeaway from this study is that the public needs more dental

education. Health professionals should encourage changed behaviors or additional habits such

as drinking more water, eating more fresh fruits and vegetables, and improving personal oral

hygiene care. It may also be helpful for primary care providers to have educational tools at their

disposal. Many people will seek medical care before dental care.

Another factor that can be associated with soft drink consumption is alcohol. Many

adults enjoy mixed beverages which can contain both alcohol and soft drinks. We know about

the damage soft drinks can have on enamel but what about when it’s combined with alcohol?

“Alcoholics have higher risk of developing dental caries, gingival diseases and oropharyngeal

cancers” (Çetinkaya 2020). The study goes on to explain that while there is a correlation

between dental diseases and alcohol consumption, it is hard to determine the root cause due to

several factors such as age, gender, consumption amount and type along with tobacco use. The

study also analyzed the consumption of sugar-free soft drinks and their impact on caries. Many

people opt to choose diet versions to be ‘healthy’ when combining alcohol with soda. “...current

knowledge does not give clear answer to the question about strength of association between

sugar-free soft drinks and dental caries…although they were generally found less erosive than

regular versions” (Çetinkaya 2020).

 Coming back to the importance of educating the community, oral health instruction is a

major factor in preventing dental disease, that not only dental professionals should know but

other health care professionals as well. Not everyone in the community can afford dental care

and having that basic knowledge can be life-changing for some. Another study investigated the

relationship between cervical caries and the consumption of soft drinks. Patients that were part

of this particular study had reported that not only have they consumed a high amount of soft

drinks for several years (over 6), but they also had poor oral hygiene habits. The patients in this

study did not have any underlying systemic problems. “Following the anamnesis and clinical

examination it was found that etiological factors of caries are poor oral hygiene and excessive

consumption of carbonated soft drinks which accelerate the progression of lesions and the

occurrence of xerostomia” (Cãlin 2013). Emphasizing the importance of drinking water and

utilizing 45-degree angulation brushing to the gumline would benefit these types of patients.

Although they reported reduced salivary flow, this could be a direct result of the amount of

soda consumed and not necessarily a genetic factor. Encouraging them to replace 1 or 2 sodas a

day with a glass of water or even having a glass of water alongside the soda should help

increase the buffering capacity of their saliva. Demonstrating how to ensure the gum line and

cervical areas of teeth are freed from debris will also help ensure none of the acids and sugars

are stuck, contributing to their dental disease.

An interesting topic that has also been brought to discussion in several countries is the

implementation of a sugar-sweetened beverage tax. The idea that by adding a consumer paid

tax to any purchase of sugar sweetened beverages (not just soft drinks) will decrease the

amount of dental disease, fillings needed and health care costs to the country. In one study
model, the implementation of the 20% tax to sugar sweetened beverages (including soft drinks)

did reduce dental decay and the need for dental care. A cohort model was designed, ‘that

accounted for the consequences of the tax through the mechanisms of consumer response to

price increase, the effect on oral health due to change in sugar intake, and the implications for

dental care use’ The study was conducted in Australia (Sowa 2019). “Imposing a 20% ad valorem

tax, compared with maintaining the status quo, would lead to 3.89 million DMFT units averted

in the Australian adult population over 10 years. The corresponding cost savings associated with

dental care avoided, assuming all DMFTs would get treated, amounted to A$666 million over

the 10-year period” (Sowa 2019). There can also be an argument against the tax because it is

limiting a consumer’s choice due to increased cost. If more education was provided, specifically

on the topic of how soft drinks affect teeth and how to clean your teeth, this problem may not

be as rampant.

From these various studies it is easy to conclude that soft drink consumption has a high

influence on dental decay and disease. With all things it is important to remember moderation.

This means maintaining a healthy diet and choosing to opt for things like water and fibrous

foods. Additionally, educating yourself and the public on how to properly clean your teeth and

interproximal margins is significant in maintaining dental health. This includes emphasizing the

importance of preventative dental care and cleanings. Practitioners should maintain a current

list of resources for low-income individuals and families to access affordable dental education

and care. Above all, acknowledging the relationship between soft drinks and caries as well as

educating others on the implications of soft drink consumption and dental disease is paramount

to combating this systemic problem.

References:

Cãlin, D. L., Mitrea, M., & Sintea, C. (2013). Aesthetic Restoration of Cervical Caries Caused by

Consumption of Soft Drinks. Romanian Journal of Functional & Clinical, Macro & Microscopical

Anatomy & of Anthropology / Revista Româna de Anatomie Functionala Si Clinica, Macro Si

Microscopica Si de Antropologie, 12(4), 325–330

Çetinkaya, H., & Romaniuk, P. (2020). Relationship between consumption of soft and alcoholic

drinks and oral health problems. Central European Journal of Public Health, 28(2), 94–102.

https://doi-org.lanecc.idm.oclc.org/10.21101/cejph.a5745

Hanin, S. M. A., & M. S., T. (2018). Association between dental erosion and carbonated drinks.

Drug Invention Today, 10(11), 2335–2337.

Inchingolo, Angelo Michele, et al. "Damage from Carbonated Soft Drinks on Enamel: A

Systematic Review." Nutrients, vol. 15, no. 7, Apr. 2023, p. NA. Gale Academic OneFile,

link.gale.com/apps/doc/A746947881/AONE?u=laneccoll&sid=bookmark-AONE&xid=bbc7b9a8.

Accessed 28 Oct. 2023.

Sowa, P. M., Keller, E., Stormon, N., Lalloo, R., & Ford, P. J. (2019). The impact of a sugar-

sweetened beverages tax on oral health and costs of dental care in Australia. European Journal

of Public Health, 29(1), 173–177. https://doi-org.lanecc.idm.oclc.org/10.1093/eurpub/cky087