of Sports and
As consumption of these
beverages increases, so do the negative
effects on the tooth surface, including a
higher risk of erosion and dental caries. By Darice K. Pacak, RDH, MSEd, and
Heidi Emmerling Muñoz, RDH, PhD, FAADH
The consumption of sports and energy
drinks continues to increase as more
products are introduced to the market.
While sports and energy drinks are often advertised as
improving performance or providing nutritional benefits,
they can have devastating consequences for oral health.
Dental hygienists need to be aware of the oral and systemic
health effects caused by the consumption of these beverages so they can educate their patients, mitigate the
resultant destruction of tooth surfaces, and promote
BEVERAGE CONSUMPTION TRENDS
The fastest growing beverage categories in the United
States are sports and energy drinks. More than 100 different
brands are currently available.3 These beverages are popular
because of their supposed ability to rehydrate the athlete
after high intensity workouts and to provide energy. Many
also claim to offer an improvement in sports, academic,
and overall performance.1 Sports drinks generally have a
low pH and contain sugars (eg, glucose, short chain glucose
polymers, and sucrose). Sports drink manufacturers frequently
claim these sugars can provide energy and electrolytes
to substitute those lost while sweating.4
Acid-induced loss of tooth
structure caused by energy drink
The contents of sports and energy drinks vary greatly, which
makes it difficult to make broad statements about their health effects. Many sports drinks contain
about 6% to 8% carbohydrates
(including glucose, fructose,
sucrose, and maltodextrin). Other
ingredients include sodium, potassium,
and magnesium for electrolyte
loss replacement. In active
individuals, however, additional
electrolytes are not needed if a
well-balanced diet is maintained.
Energy drinks frequently contain
caffeine and tend to have a
higher carbohydrate content (9%
to 10%). The large amounts of caffeine
contained in energy drinks
can cause wakefulness, restlessness,
anxiety, insomnia, gastrointestinal
upset, tremors, psychomotor agitation,
and seizures.2,4–8 The amount
of caffeine is not usually listed on beverage containers; instead, comparisons
are used, such as "contains a similar amount of caffeine as a cup of
coffee."4 Caffeine is the most physiologically active ingredient in energy
drinks and its presence often leads to the drinks' ergogenic claims.3
Table 1 provides information on the specific pH, grams of carbohydrates,
amount of caffeine, and calories per serving for many popular
sports and energy drinks, as well as other commonly consumed
beverages.9–11 Sports and energy drinks can be quite caloric—ranging
from 100 calories per serving to more than 300 calories per serving.
Low-carbohydrate sports and energy beverages are marketed as part
of a weight maintenance program, but they often come in larger
containers (16 ounces or 32 ounces) while one serving is 8 ounces. By
consuming the entire bottle, calorie intake can more than double.
The end result is that a high level of physical activity is needed to offset
the caloric intake of these drinks.4 The consumption of caffeineladen
energy drinks can also disrupt sleep, causing fatigue, which is
another risk factor for weight gain.
Both sports and energy drinks contain sugars and have a low pH,
which creates an erosive and cariogenic process within the oral cavity.
1 Sports drinks are heavily marketed to athletes—from high performance
athletes to weekend warriors—to help them rehydrate.
However, consuming these drinks will lead to erosion and eventually
decay—creating life-long oral health problems.1,4
Dental erosion is the nonbacteriogenic, acid-induced loss of
anatomic tooth structure (Figure 1).3,12–14 Studies show that mandibular
first permanent molars are most commonly affected by erosion
that originates from sports and energy drink consumption, followed
by occlusal surfaces of all other posterior teeth.12 The application of
dental sealants on the mandibular teeth among those who consume
sports and energy beverages is vital to preserve tooth structure.3 Root
surfaces are also more susceptible to erosion than crown surfaces.2
Besides increasing the risk of weight gain due to high caloric content
and the devastating effects on oral health, energy drinks present
another health concern because they are often combined with alcohol.
This combination exposes the user to the side effects of both
alcohol and the energy drink, and may alter an individual's perception
of his or her impairment, leading to reduced impulse control.3,4
DENTAL HYGIENIST'S ROLE
Dental hygienists need to include a discussion of beverage consumption,
including type, frequency, and amount, as part of a comprehensive
evaluation. Adolescent boys between 14 and 15 are the
largest consumers of both sports and energy drinks, so
the health effects should be discussed in detail with
this patient population.15 Habitual consumers of
sports and energy drinks should be advised to
consume the drinks quickly and not to rinse or
hold the beverage in the oral cavity. Using a
straw and swishing water after consuming the
beverage may also assist in minimizing contact of
the drink with the teeth, thereby decreasing the
likelihood of decay. Additionally, frequent applications
of fluoride, along with dental sealants,
can assist in caries prevention. However, the best
advice to offer patients is to refrain from consuming
these beverages. Plain water is the best
rehydrator in people who are exercising for less
than 60 minutes. The general rule is to consume
1 cup to 2 cups of water every 15 minutes during
the activity, with additional water after the exercise
is finished. Drinking water has many benefits, including improving student readiness to learn, limiting weight gain,
and preventing caries.2,4,16
The consumption of sports and energy drinks is increasing, although
many people remain unaware of any health consequences. These
drinks, which contain large amounts of caffeine and carbohydrates,
coupled with a low pH, have the potential to cause dental caries
and raise the risk of weight gain. As such, a question regarding consumption
of these beverages should be included during a comprehensive
written and oral health history and an individualized
education program that covers the side effects of sports and energy
drinks, preferable frequency and method of intake, awareness of
alternative choices, topical fluoride application, and/or placement of
dental sealants or restorations, should be initiated.
The authors would like to thank Heather Maloney and Paul Casamassimo, DDS, MS,
for their assistance with this article.
- Kawashita Y, Fukuda H, Kawasaki K, et al. Pediatrician-recommended use of
sports drinks and dental caries in 3-year-old children. Community Dent Health.
- Ehlen LA, Marshall TA, Qian F, Wefel JS, Warren JJ. Acidic beverages increase
the risk of in vitro tooth erosion. Nutr Res. 2008;28:299–303.
- Duchan E, Patel ND, Feucht C. Energy drinks: a review of use and safety for
athletes. Phys Sportsmed. 2010;38:171–179.
- Meadows-Oliver M, Ryan-Krause P. Powering up with sports and energy
drinks. J Pediatr Health Care. 2007;21:413–416.
- Stegeman CA, Davis JR, Boyd LD. The Dental Hygienist's Guide to Nutritional
Care. 3rd. ed. Philadelphia: Saunders; 2010:203.
- Sullivan MG. Kids Should Avoid Energy and Sports Drinks. Available at:
_ttnews[tt_news]=127499. Accessed September 21, 2012.
- LaBotz M. Sports, Energy Drinks Not Beneficial for Children. Available at:
Accessed September 21, 2012.
- Lussi A, Megert B, Shellis RP, Wang X. Analysis of the erosive effect of
different dietary substances and medications. Br J Nutr. 2012;107:252–262.
- Our Drinking Water. Sports Drinks vs Water. Available at: www.our-drinkingwater.
com/sports-drinks-vs-water.html. Accessed September 21, 2012.
- Klimis-Zacas D. A guide to the best and worst drinks. In: Consumer Reports
on Health July 2006. Dubuque, Iowa: McGraw-Hill; 2008:13-18.
- Nix S. Williams' Basic Nutrition and Diet Therapy. St. Louis: Elsevier;
- Mathew T, Casamassimo PS, Hayes JR. Relationship between sports drinks
and dental erosion in 304 university athletes in Columbus, Ohio, USA. Caries
- Bryant S, McLaughlin K, Morgaine K, Drummond B. Elite athletes and oral
health. Int J Sports Med. 2011;32:720–724.
- Buyer DM. Are you drinking your teeth away? How soda and sports drinks
dissolve enamel. J Indiana Dent Assoc. 2009;88:11–13.
- Gambon DL, Brand HS, Boutkabout C, Levie D, Veerman EC. Patterns in
consumption of potentially erosive beverages among adolescent school
children in the Netherlands. Int Dent J. 2011;61:247–251.
- Patel AI, Hampton KE. Encouraging consumption of water in school and
child care settings: access, challenges, and strategies for improvement. Am J of
Public Health. 2011;101:1370–1379.
From Dimensions of Dental Hygiene. October 2012; 10(10): 45-46, 49.