Mocha lattés, coffee chillers, iced coffees, flavored creamers, and sweetened espressos are some of today’s popular companions to traditional coffee. These companions are sweet, flavorful, trendy, and readily available for all ages. Beyond the sodas, exercise drinks, and juices, coffee and their companions are the other group of silent enamel demineralizers. Hygienists need to include this category of beverages in their professional responsibility of nutritional counseling for patients.
First, consider the location and popularity of coffee companions. There is a growing trend in North America (and perhaps throughout the developed world) toward increased consumption of noncola drinks and nontraditional beverages (for example, prepackaged coffees and teas).3 Coffee houses and coffee drinks have become more accessible nationwide. Conversations in the break rooms at the coffee pot are just as common as discussions around the office water cooler. College campuses have invited coffee cafés into their educational institutions and offer coffee punch cards. Shopping malls have included cafés as tenants. Just take a look at all of the sugar-laden coffee drinks available on your local store shelves. Lastly, drive-thru coffee availability has increased, and some fast food chains mix your creamers and sugars for you!
Nutritionally, coffee companions are made up of corn syrup solids, sucrose, flavorings, and sugar. As hygienists, our nutritional education has taught us that these particular ingredients are activators in the decay process. The frequent consumption of fermentable carbohydrates, such as sucrose and glucose, produces the acids that cause tooth destruction, which leads to dimineralization.1 Prolonged exposure of these ingredients in the oral cavity has negative repercussions. Once the sugar has entered the oral cavity, it attacks one of the most vulnerable structures, the enamel of our teeth. The enamel is the armor that protects our teeth. Thus, when the armor is attacked, the tooth is susceptible to decay and destruction. Demineralization is the major stage of the destruction process in which minerals, calcium, and phosphate are dissolved from tooth structures by acids.1 As the acid increases in the oral cavity through frequency of sugared intakes, the pH drops below 5.5. This is the environment necessary for demineralization to occur. As sugared coffee drinks are consumed over long periods of time, the pH is consistently lowered for several hours.1 During this time, acid continually bathes and attacks enamel, causing demineralization. Studies indicate that foods to which table sugars are usually added before consumption, such as coffee, chocolate, and tea drinks, are associated with high DMFT (decayed, missing, filled teeth) scores.4 Thus, through the repeated exposure of various liquid sugars concentrated in the maxillary anterior sextant, evidence of incipient to gross decay - lingual and interproximal - may become apparent.
In conclusion, an integral part of our oral hygiene instructions and patient education should consist of nutritional counseling. So many variations of hot and cold sugared coffee drinks are readily available and consumed by many people throughout the day. Hygienists need to be cognizant of the fact that sugared coffees could be the culprit in causing demineralization in patients. If demineralization is evident in a patient, the hygienist should ask if coffee and its sugared companions are being consumed.
1 Wilkins E. Clinical practice of the dental hygienist. 9th Edition, 2005.
2 Fraunhofer, Anthony, Rogers, Matthew. Dissolution of dental enamel in soft drinks. General Dentistry July-Aug. 2004; 308-311.
3 Jones C, Woods K, Whittle G, Worthington H, Taylor G. Community, sugar drinks, deprivation, and dental caries in 14-year-old children in the northwest of England in 1995. Community Dental Health June 1999; 16(2):68-71.
4 Ismail A. Food cariogenicity in Americans aged from 9-29 years assessed in a national cross-sectional survey, 1971-74. J Dent Res Dec. 1986; 65(12):1435-40.