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Ahhhhh... those BUBBLES

Oct. 1, 2002
Those carbon dioxide bubbles spit tiny, atomized bits of magic against the septum and ala, but that magic is quickly replaced by the harmful effects of soda on our children's oral health.

by Shirley Gutkowski, RDH, BSDH

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With the amount of freedom we have in the United States as to what we put into our bodies, you'd think our nation would be full of "super people." Diet modification and exercise can eliminate many of today's illnesses. Dr. Dean Edell, radio MD for dozens of years, likes to remind his audience that exercise is on the list of preventive measures for nearly every modern disease, from diabetes to cancer.

Alas, freedom of advertising supersedes all human reasoning. We inflict an incredible amount of damage on ourselves by way of our diets. There's something about a Frito, isn't there? Something delicious, crunchy, and satisfying — an experience unrivaled by a mini peeled carrot.

There is also something about a can of soda that quenches a part of the soul past the throat — the carbon dioxide bubbles bursting, spitting tiny, atomized bits of magic against the septum and ala. Phosphoric, carbonic, citric, and other acids bite back as the liquid's scrubbing bubbles crash into the teeth. The corrosives provide a sharp burning sensation as the soda roars past the tonsils, dragged through the esophagus by the twin forces of gravity and swallowing. The elixir travels to the stomach where it takes up space needed for nutritious foods.

The most popular sodas on the market today — the yellow one and the two brown ones — contain some of the most potent enamel dissolvers known to dentistry. At first it may seem that phosphoric acid would be the culprit in enamel damage. Margaret J. Fehrenbach, RDH, MS, and oral biologist, points out that a recent study found citric-acid-based beverages present more potential for dental erosion than phosphoric-acid-based beverages. She will speak on the topic of dental erosion at this year's ADA Annual Session. Fehrenbach was alerted to the increase in dental erosion by noted dental researcher Dr. ten Cate's work. Dr. ten Cate predicts, "The next decades will show a shift in the attention given to diseases of the dental hard tissues ... Increased attention is needed for new manifestations of pathology such as dental erosion ..."

Fehrenbach, in the research for her presentation, found that the South Dakota Dental Association Web site, as well as her online course with DH Forum, had excellent information on dental erosion. Look closely and you will see a trend:

• Soda is the primary source of sugar in the American diet.

• A 12-ounce can of regular soda contains 40 grams of added sugar, which provide about 160 calories but little else of nutritional value. This nutrient composition readily explains why the Center for Science in the Public Interest refers to soft drinks as "liquid candy."

• In 1947, soft-drink production in the United States averaged about 100 12-ounce cans for every American.

• By 1997, it reached nearly 575 cans, according to the National Soft Drink Association.

• Daily consumption of nondiet soft drinks for 12- to 19-year-olds rose between 1977 and 1994 from 7 ounces to 19 ounces a day for boys and from 6 ounces to 12 ounces a day for girls.

• Part of that increase is directly linked to serving sizes. Sodas that started out in quaint, little 6-ounce glass bottles have grown to 12-ounce cans, 20-ounce plastic bottles, and 64-ounce fast-food and convenience store cups.

• By one government estimate, 20 percent of 1- and 2-year-olds consume about a cup a day of soft drinks.

• Screw-off caps and pop-up squirt-sip lids make it possible for one container to last for hours.

What about alternatives? Obviously diet sodas are out too; they also contain the acids. Diet sodas actually have more acid in them than regular soda; the acetic and carbonic acids make the drinks palatable since they lack sugar. In addition, the type of acid has more influence on the dental erosion process than the acid's pH.

Those "sports drinks" that are supposed to be so healthy are no safer. Look at the labels and note the acids and sugars in them too. Sugar can be listed as high-fructose corn syrup or any ingredient ending in "-ose" (fructose, sucrose, glucose, dextrose), as we well know. Acid listings are a little more difficult to spot, listed sometimes as just "carbonated" (carbonic acid). The best alternatives are low-acid fruit juices, milk, and water.

Fehrenbach notes that studies show enamel remineralization was observed when cheddar cheese, skim milk, 2 percent milk, whole milk, and even chocolate milk were used as between-meal snacks. Dairy products, with the exception of sweetened yogurt, generally reduced the amount of demineralization/erosion produced in dentin. We know this; we're odontophiles. Those who have a different relationship with their teeth or body probably don't. Part of our job is to educate, and that doesn't have to stop with one person an hour. We have hygienists in our profession who are fighting the good fight against providing soda to children in school.

Since soda consumption ranks as a national nutritional crisis that will affect us personally, we need to get out of our dental chairs and stand up in community meetings and say no to Pouring Rights. A Pouring Rights contract is an agreement between a beverage distributor and an organization that allows the distributor to be the only one selling beverages at a given location. The beverage distributor generally also requires that the organization not endorse a competitor's product through posting logos or advertising. In return, the distributor pays a commission on each sale to the organization and may even guarantee a minimum commission per year. Frequently, the distributor may offer other inducements in order to be selected, such as providing athletic equipment or other donations.

Local governmental cutbacks are the real reason schools are welcoming these companies. Less money from taxes means less money for school activities. It is not difficult to understand why administrators of financially strapped school districts would find these contracts desirable.

Due to parental pressure, Coca-Cola is "pulling back" by making sure that the front of the school vending machines will not have corporate logos. Who are they fooling? In her travels, Fehrenbach has seen a front-lawn high school sign with a Mountain Dew logo on it below the activity portion of the sign. Maybe the new mascot yell should be "Go Cavities!" In addition to dental decay, heavy pop consumption has been linked to diabetes, obesity, and osteoporosis.

Maria Perno Goldie, RDH, MS, a speaker on women's health issues, has been trying to get support for a bill in California that would impose a two-cent tax per 12-ounce serving of soda. Perno-Goldie belongs to the Dental Health Foundation, a dental public health organization in California. The foundation has its sights set on taxing beverage distributors on soda and other sweetened beverages with less than 10 percent natural fruit juice. Her group would allocate the funds to help middle and high schools that voluntarily abandon the sale of junk food. She and others in her group showed that the tax would provide money for nutrition and physical-education programs at elementary schools, obesity-prevention programs, dental care, and other family-related programs. Only water, milk, fruit drinks with at least 50 percent juice, and certain sports drinks could be sold in California schools. Carbonated beverages would be banned. According to supporters of the legislation, the revenue would help schools decrease their reliance on vending machine contracts with soda companies.

The bill was recently defeated. The soda industry said that the bill would "limit the choice of people to eat and drink what they want," and the misguided California Teachers Association feared losing funds that schools receive from contracts with soda companies. Perno-Goldie and her group will try again next year. Each of us needs to investigate our local school policies and see that these important health issues are brought to the forefront now that we know the facts!

Perno-Goldie is not the only one putting up a fight. Grass-roots efforts headed up by hygienists are springing up across the country. Hygienists are educating the administrators of their own children's schools on the damage soda can do to oral health. They are teaching the teachers how improper nutrition and painful teeth are causative factors in poor attendance and improper classroom behavior.

Cappy Snider, RDH, is an excellent example. She is a mother, wife, and hygienist who is just beginning her quest to educate teachers. Two years ago, the school her eldest daughter attended was blown away by a tornado. The building is now being rebuilt.

Snider decided that this was the perfect time to institute healthier choices into the school's curriculum. She approached the principal of the elementary school her children attend with the idea that they not have easy access to the empty calories in soda. Instead she recommended water or juice vending machines.

She has two goals: First, she wants to assure a nutritionally safe environment for her children by educating the educators. Second, she wants to start educating schoolchildren about how to make safer choices. She did not go in there with guns ablazin'. Instead, she approached the principal with a compromise — a way to make the learning environment better.

Using the Internet, Snider is building a case against the availability of soda in vending machines by pointing out the obesity crisis, the Type II diabetes crisis, as well as the damage soda causes to teeth. It's a large undertaking, and she's giving herself lots of time to work on it. After her presentation to the educators, she will be putting one together for the children to be presented during Children's Dental Health Month in February.

The simple truth is this: Advertising works when the target audience is exposed to the messages over and over. Products that have an impressive presence in our schools have an overwhelming advantage over those that don't. When those products are harmful to children, we must do something! Follow the examples of these hygienists. For more ideas, browse the North Carolina School Nutrition Action Committee's Web site at SoftDrinkFinal.pdf. Memorize the statistics and sally forth to mobilize your own brigade to protect our children's health.


• Pepsi, Coke, or other sodas are now hawked in at least 60 percent of all public and private middle and high schools nationwide.

• Universities now contract for millions of dollars with these same companies (one such Midwest contract is for $10 million over 10 years). A soft-drink industry spokesperson was quoted as saying, "We contribute to their education and hope (students) will remember us in the future when they're going down the aisle in the supermarket."

• Coca-Cola is paying the Boys & Girls Clubs of America $60 million to make its company's products the only brands sold in more than 2,000 clubs.

• The National Soft Drink Association is selling this all with the fact that soda contains water: "They can quench thirst and help fulfill daily fluid intake requirements that are needed to maintain proper hydration for individuals."

• Studies now show that families who own baby bottles with popular beverage logos are four times more likely to give children the respective beverage in bottles.

• Students ages 5-17 missed 1,611,000 school days in 1996 because of acute dental problems. This is an average of 3.1 days per 100 students.

• The U.S. Surgeon General states that oral health is essential to the general health and well-being of all Americans, yet it is estimated that one in every four children lives with untreated dental disease that is often painful and debilitating.

• Studies show that 47 percent of tooth decay in children ages 2-9 has not been treated and two-thirds of all 15-year-olds also have untreated carious lesions.


Los Angeles, which has the second largest school district in the nation, decided in late August to ban the sale of carbonated soft drinks on campuses during school hours.

California has been a leader in several efforts to improve nutrition in its schools. The state's legislature passed a bill in 2001 that prohibits the sale of junk food in elementary schools and bans the sale of soda pop in middle schools. The bill takes effect in January 2004, the same date established by the policy approved by the Los Angeles Unified School District. Oakland's schools banned the sales of soda and candy last February.

The decision by the Los Angeles school district was heralded because of the sheer numbers involved. The district is responsible for 677 campuses and more than 700,000 students. In addition, the pending state law does not apply to high schools.

In 2004, Los Angeles schools will only be able to sell water, milk, drinks containing at least 50 percent fruit juice, and sports drinks with less that 42 grams of sugar per 20-ounce bottle.

The school district, which sold carbonated beverages for fund-raising efforts, encountered opposition from the National Soft Drink Association and a decrease in school projects funded by beverage manufacturers was expected after the policy change.

But one Los Angeles board member proclaimed, "I find it appalling that we are discussing economics at the risk of our children's health."

References available upon request.

Shirley Gutkowski, RDH, BSDH, has been a full-time practicing dental hygienist in Madison, Wis., since 1986. A widely published author, Ms. Gutkowski also speaks to groups through Cross Links Presentations. She can be contacted by email at [email protected].