Chiseled body, rotten teeth: Energy drinks wreak havoc

Picture the typical endurance athlete: chiseled body, strong focus on good health, and well-versed in proper nutrition.

And a mouth full of rotting teeth.

Acids and sugars in the sports drinks, energy gels and other snacks routinely consumed by runners, cyclists and swimmers are wreaking havoc on the dental hygiene of athletes and non-athletes alike, causing a range of problems including loss of enamel, tooth decay and gum disease.

The products are so ubiquitous that dozens of brands are routinely handed out at sporting events from sprint triathlons to ultra-marathons. They are designed to be digested quickly and easily, delivering critical fuel to athletes as they progress along the course.

And even kids and teens who aren't doing any athletic training are consuming energy drinks with regularity during a typical school day.

Hard data on the proliferation of energy drinks and their impact on oral hygiene is a little hard to come by. But it's a concern big enough to raise the attention of researchers at the Academy of General Dentistry. In 2012, they published a study in their journal, General Dentistry, that outlined the dangers of energy drinks on oral hygiene.

The study found that high acidity levels in the drinks erode tooth enamel, the glossy outer layer of teeth, causing irreversible damage.

The American Beverage Association, in a statement, took issue with the study, noting that its methodology "in no way mirrors reality."

And a Gatorade spokesman said, "Many factors can contribute to dental erosion and while some research suggests there is a link between dental erosion and beverage consumption, these findings are general and true of many commonly consumed beverages. Proper consumption of sports drinks, proper dental hygiene and standard saliva production contribute to healthy oral hygiene."

But Gilbert dentist Howard Brauer, an endurance runner, mountain biker and triathlete who has met and trained with many elite athletes, has seen the ravages of using sports drinks for training and competition purposes.

Many of the athletes he's trained with look as though someone took a chisel to their teeth, and have since become patients of his, and his wife, Joy, also a dentist.

"It is definitely an issue," said Brauer, who has completed the Ironman Arizona triathlon several times, run in the Boston Marathon and rides in mountain-biking events that can last up to 10 hours.

"I don't know if it's rampant, but I've had patients that are getting cavities, who are in these activities, and they didn't have cavities when they weren't doing them. It's because of the products they use and changes in their diet. It's a constant concern, and not just for athletes. All of the energy drinks that are prevalent today are a big concern."

The problem is two-fold.

First, athletes consume a lot of these products during training and racing. And physical exertion causes people to dehydrate and breathe through the mouth instead of the nose, which dries the mouth and teeth.

And that's a bad combination, according to the experts.

"Those gels and drinks are acidic things and very, very sticky," said Timothy Kindt, a Mesa dentist. "They can get into places other food doesn't reach. Bacteria like dark, warm and dry. And they'll just go to town."

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Acid — in particular citric acid — is the real troublemaker.

"Sugar is bad for teeth, but acids are worse," Brauer said. "Most of the products we use out there are water, sugar and acid. And sugar feeds bacteria, and bacteria produce more acids. If you have an acidic environment to begin with, that just gives everything a head start."

Study finds loss of enamel

The General Dentistry study looked at 13 different sports drinks, including brands of Gatorade and Powerade, and nine energy drinks, including Red Bull and Monster Assault, and measured how much enamel the drinks took off teeth.

The researchers, led by Poonam Jain, an associate professor of dentistry at Southern Illinois University, found that teeth lost enamel with exposure to either kind of drinks, although sports drinks did not do as much damage as the energy drinks.

To conduct the study, researchers submerged parts of molars in a petri dish in the drinks for 15 minutes at a time, then moved the teeth to artificial saliva for two hours. The process was repeated four times a day for five days.

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Enamel loss was easily identified after the five days, researchers found, with sports drinks eroding about 1.5 percent of the enamel in that time period, and energy drinks eroding more than 3 percent.

The American Beverage Association was quick to dispute those findings in a May 2012 statement.

"People do not keep any kind of liquid in their mouths for 15 minute intervals over five day periods," the statement said. "Thus, the findings of this paper simply cannot be applied to real life situations. Furthermore, it is irresponsible to blame foods, beverages or any other single factor for enamel loss and tooth decay (dental caries or cavities)."

Local dentists acknowledge that genetics may also play a role in tooth decay.

Kindt, the Mesa dentist, said some people have a more acidic body chemistry and are more apt to develop cavities. The sugar/acid combination of sports drinks and products exacerbates that.

"So we have people who can go 25 years and hardly ever have a cleaning, they don't floss or brush like they should and they don't have decay," he said. "Others can walk by a Baby Ruth bar and they're going to get a cavity."

In a recent interview with the Republic, the CEO of Glukos Energy, a Scottsdale-based start-up whose lineup of products includes gels, powders, chews, tablets and will release a bottled sports drink, said that the company has not done any research on its products effects on teeth.

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"If you look at the ingredients in the average energy bar, they average about 35 ingredients," chief executive Mick McCormick said, noting his company's products contain only four to eight ingredients, all of which are natural. "We use dates as the main ingredient in our energy bars, because dates are a super food and are one of the fruits with the highest glucose content."

Still, like the other products, Glukos includes citric acid.

Drink water, don't brush

So should you brush your teeth as soon as possible after consuming a gel or drink?

Actually no, dentists say.

"People who are conscientious about their health will use the products and then try to brush their teeth right away," Brauer said. "Actually, that can be bad, too. When you're using the products, the acidity softens the enamel of the teeth. They're broken down.

"If you brush right away, you can wear away that enamel. So two things are happening when we use these products. Some people will get tooth decay. And some people who brush their teeth too soon after they're finished will get a thinning of the enamel."

During dental school, the Brauers gave their clinical grand rounds presentation about a patient who consumed large amounts of Mountain Dew and had an obsessive-compulsive disorder that led him to brush his teeth many times a day.

"He brushed well," Brauer said. "He basically had glass nubs for teeth. He had brushed his teeth away."

That's an extreme example, but thinning of the enamel is a real danger, Brauer said.

So what's the solution?

Water.

"When you're out on the trail, get your energy, get what you need, and then swish your mouth aggressively with water and drink a little water," Kindt said. "It will tend to keep your mouth feeling a little moister and you won't have the products sticking to your teeth."

Brauer said swishing is a great way to avoid problems, even if you don't swallow.

"Exposure time to the acid is critical. It's a real factor. So get the product down the hatch as quickly as possible, and then chase it with some water or hold it in your mouth and swish it around."

Brauer said athletes should incorporate plain water into their training and racing. It serves several purposes.

First, it removes sugar and acid from the teeth. Second, it rehydrates the body and creates moisture in the mouth. And, maybe most important, water creates an environment that allows the enamel to harden — within as little as 30 minutes.

"I've been an athlete all my life, and I used to drink a lot of orange juice as a kid," Brauer said. "We tend to think of fruits and fruit juices as healthy because they're natural. But they still have sugars and acids — they just happen to be natural.

"When I was a kid, I had cavities. Then my stomach started bothering me, and my doctor told me he wanted me to drink water or tea and no juice or soda. I had three cavities worked on when I was 10 years old, and I haven't had one since. I pretty much quit drinking juice and started drinking water and I've stuck with it."

That's not to say Brauer doesn't consume energy products. He trained for Ironman using Gatorade because it was offered during the race.

"It's convenient, cheap and the product works," he said. "But if I do have something that's acidic, I'm hitting the water pretty quickly after it. And all of these things have a ton of acid in them."

Brauer says he tells his patients to beware of the pitfalls of using energy products. It's not difficult.

Both dentists recommend getting fluoride treatments and using fluoride toothpastes to harden enamel.

Those who don't want to use fluoride can ask their dentists about natural products with dairy protein and calcium to strengthen teeth, Brauer said. He said some athletes carry antacid tablets to pop into their mouths after training or racing to reduce acid and prepare the enamel for a good brushing.

The good news is that although people who run, bicycle, hike or swim are more likely to consume energy products, they also are likely to pay attention to the effects. That's another reason Brauer said people who are not athletes should be wary about highly caffeinated energy drinks, especially the kids and young adults targeted by those products.

Kindt concurred.

"I think the average person consuming some of these products might have more problems," he said. "People who are more athletic and active, the ones who run and hike and ride bikes, they tend to use more of the sports energy products.

"But they also tend to be more conscientious about their diet and their health habits, brushing, flossing and all of those things. I would say that I see less decay in those people simply because they do more to prevent it."

Like the drinking photo in middle of the story?

Here's how we did it: Photojournalist Michael Chow cut two parallel slits on the side of an empty 32-ounce sports-drink bottle, then added a diagonal slit to create a window. He used the plastic flaps to secure a waterproof GoPro camera to the bottle. Liquid went in, and Chow used his cellphone to control the cam as reporter Bob Young rehydrated.

See more of Chow's work at BehindTheLens.azcentral.com and follow him on Twitter @photochowder.