Sports Drinks and Dental Erosion
By Brian Sutton MS, MA, PES, CES, NASM-CPT
Sports drinks have long been associated with improved athletic performance, delaying the effects of fatigue, and keeping athletes hydrated. Athletes participating in vigorous activity have increased fluid needs due to increased heat production and water loss from exercise. Research demonstrates sport drinks (containing 6-8% carbohydrate) are good options for athletes engaging in moderate-to-high-intensity activity lasting longer than 60 minutes to replace carbohydrate and electrolyte loss (1). However, some research postulates that sports drinks can erode tooth enamel. Should athletes now avoid sports drinks? This article will examine the potential effects of sports drinks on tooth enamel and provide some guidance for athletes.
Rees et al. examined the enamel erosive potential of five sports drinks (2). The researchers examined the erosive potential of sports drinks by measuring their pH, titratable acidity, and their ability to erode enamel. The sports drinks were then compared to a positive control, orange juice and a negative control, water. The researchers concluded that many of the sports drinks tested were found to be erosive however orange juice has greater erosive potential (2).
A 2012 in vitro study examined the acidity levels of various sports and energy drinks (3). The acidity levels varied among brands and flavors, with energy drinks having greater levels of acidity and erosive capability compared to sports drinks. According to the researchers, “The findings indicated that energy drinks have significantly higher titratable acidity and enamel dissolution associated with them than sports drinks. Enamel weight loss after exposure to energy drinks was more than two times higher than it was after exposure to sports drinks” (3).
A study performed by Milosevic aimed to determine the dental hazards associated with eight different sports supplement drinks (4). According to Milosevic, “The chemicophysical analyses indicate that all the sports drinks in this study have erosive potential. However, drinks with higher pH, lower titratable acidity, and higher concentrations of calcium, phosphate, and fluoride will reduce this erosive potential” (4).
Sirimaharaj et al. investigated the consumption patterns of acidic foods and drinks among several sports groups and examined any relationships between consumption patterns and dental erosion (5). The researchers distributed a dental-health questionnaire to 32 sport groups (690 members) at the University of Melbourne and received a 75% response rate. 25.4 percent of respondents reported dental erosion. The result of the questionnaire indicated the consumption of acidic foods and drinks was frequent among most athletes; however no significant associations were identified between dental erosion and the frequency of drinking soft drinks or sports drinks (5).
Mathew et al. performed a cross-sectional, observational study using a convenience sample of 304 athletes to evaluate whether regular consumption of sports drinks was associated with dental erosion. Following statistical analysis the researchers found no relationship between consumption of sports drinks and dental erosion (6).
Lastly, Coombes performed a literature review of recent studies investigating the relationship between sports drinks and dental erosion. According to Coombes, “there is much in vitro evidence that acidic drinks such as wine, fruit juices and carbonated soft drinks have erosive potential and there are relationships between consumption of these drinks and erosion, only one study has reported an association between sports drinks and dental erosion. Other factors such as drinking habit and salivary production may be more important determinants of dental erosion“ (7).
In agreement with the literature, it appears that fruit juices and energy drinks appear to have greater erosive potential versus sports drinks. However some in vitro studies (researchers immersing samples of human tooth enamel in sports drinks) demonstrates a potential to damage teeth. To mitigate such problems athletes should follow proper oral hygiene care and limit sports drink consumption to exercise sessions lasting 60 minutes or more. Physical activity lasting 60 minutes or less warrants the use of water to help keep athletes hydrated and minimize tooth enamel erosion.
1. American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine Position Paper (Nutrition and Athletic Performance). J Am Diet Assoc. 2000;100:1543-1556.
2. Rees J, Loyn T, McAndrew R. The acidic and erosive potential of five sports drinks. Eur J Prosthodont Restor Dent. 2005 Dec;13(4):186-90.
3. Jain P, Hall-May E, Golabek K, et al. A comparison of sports and energy drinks-Physiochemical properties and enamel dissolution. Gen Dent. 2012 May;60(3):190-7.
4. Milosevic A. Sports drinks hazard to teeth. Br J Sports Med. 1997 Mar;31(1):28-30.
5. Sirimaharaj V, Brearley Messer L, Morgan MV. Acidic diet and dental erosion among athletes. Aust Dent J. 2002 Sep;47(3):228-36.
6. Mathew T, Casamassimo PS, Hayes JR. Relationship between sports drinks and dental erosion in 304 university athletes in Columbus, Ohio, USA. Caries Res. 2002 Jul-Aug;36(4):281-7.
7. Coombes JS. Sports drinks and dental erosion. Am J Dent. 2005 Apr;18(2):101-4.