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Bottled Water

Do your patients know what’s in their drinking water?

Dec. 15, 2022
This hygienist is very aware of the harmful effects that drinking water can have on oral health. But do patients know what they're drinking?

There’s a lot of evidence to support the fact that oral bacteria thrive in acidic environments and can raise the risk for tooth decay and periodontal disease.1 I educate patients about the importance of maintaining the pH levels in their mouth and body to prevent dental disease and chronic illness. Our bodies at inconsistent acidic pH levels can cause oxidative stress, which results in inflammatory problems.2

What does this have to do with drinking water? Even though the human body is made up of 60% water, most people don’t consume enough. Proper hydration is a struggle for 80% of Americans,3 and our lifestyles involve convenient access to soft drinks, energy drinks, sparkling water, alcohol, and other acidic beverages that contribute to dental decay and health problems. In addition, our water choices can also affect pH levels and overall health.

How do we obtain optimal hydration if the water we drink is contributing to health issues and acidic levels in our mouths and bodies? Here are some basics we should all know about drinking water so we can make better decisions about consuming it.

Drinking water basics

Humans are magnificent in our ability to develop intricate systems to deliver drinking water to every household. In America, the EPA and CDC have regulations for the treatment of water to sustain the delivery systems and ensure that it’s safe for people to consume as well as safe for the environment.

When I’m not evaluating a patient from a demographic point of view, I consider how this water could be affecting their overall health, especially when they have rampant decay and systemic inflammatory problems. For example, one of the many chemicals used to treat tap water is chlorine. Chlorine disinfects and lowers the levels of dangerous microbes in the water. Chlorine is recommended at levels up to 4 mg/L or four parts per million (ppm), a very low concentration to be effective yet claim to be nontoxic.4

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Chloramine is also used to treat the biofilm slime that forms in pipes that makes it difficult to kill bacteria. These chemicals are toxic to many pets. The CDC has disclosed that people who are sensitive to chemicals should seek advice from their medical providers before contacting the local health department.4

What to know about bottled water

Bottled water is regulated by the FDA.5 The global bottled water industry is valued at $303.9 billion in 2022 and is estimated to grow to $509.2 billion by 2030.6 Bottling water was a game-changing industry, making water even more convenient and accessible, particularly to underserved communities. This is a very positive development, but we must also consider the threat to our planet caused by the plastic bottle waste that’s produced on a massive scale.7

Most people don’t know that despite what the labels claim, the distillation and filtration process results in lower pH levels in the water for the bottled water to be marketable and have a quality shelf life. If you test the pH levels of the most common brands, a majority are acidic.8

Some communities get their water supplies from private well water systems. Common well water problems are hard water, acidic water, high fluoride levels, hydrogen sulfide caused by bacteria, iron and manganese, turbidity from nearby construction zones, and fecal bacteria. Well water is not regulated by the EPA so may require management by well owners and regular annual testing.5

There is an overwhelming number of water filtration systems available for a wide variety of prices. The quality of filtration also varies. The right system will depend on goals, budget, and health priority. The top 10 types are sediment filtration, activated carbon block, granular activated carbon, reverse osmosis, distillation. ion-exchange, ultraviolet disinfection, ultrafiltration, activated alumina, and ionization.9

As intelligent humans, it’s our responsibility to be aware of the quality of tap water in our areas and take steps to filter and improve it. As health-care professionals, it’s up to us to address patients' dental concerns first, but also to direct them to the right resources so they can educate themselves.10 This awareness and action can make a significant difference in preventing dental disease and chronic illness.


  1. Svensäter G, Larsson UB, Greif EC, Cvitkovitch DG, Hamilton IR. Acid tolerance response and survival by oral bacteria. Oral Microbiol Immunol. 1997 Oct;12(5):266-273. doi: 10.1111/j.1399-302x.1997.tb00390.x
  2. 2. Preiser JC. Oxidative stress. JPEN J Parenter Enteral Nut 2012 Mar;36(2):147-154. doi: 10.1177/0148607111434963
  3. Nearly 80 percent of working Americans say they don’t drink enough water. PR Newswire. https://www.prnewswire.com/news-releases/nearly-80-percent-of-working-americans-say-they-dont-drink-enough-water-quench-survey-300668537.html
  4. Water disinfection with chlorine and chloramine. Centers for Disease Control and Prevention. https://www.cdc.gov/healthywater/drinking/public/water_disinfection.html
  1. Importance of water quality and testing. Centers for Disease Control and Prevention. https://www.cdc.gov/healthywater/drinking/public/water_quality.html
  2. Bottled water market size. Grand View Research. https://www.grandviewresearch.com/industry-analysis/bottled-water-market
  3. Why are disposable water bottles harmful to the environment? Office H2O. https://www.officeh2o.com/2020/02/27/why-are-disposable-water-bottles-harmful-to-the-environment/
  4. Brands of bottled water that are acidic. My Own Water. https://www.myownwater.com/blog/best-bottled-water-that-are-acidic
  5. The 10 types of home water filtration systems at home. Brizfeel. https://brizfeel.com/water-purification-system/
  6. Environmental working group tap water database 2021 update. https://www.ewg.org/tapwater/