There’s a certain kind of mental shortcut we all take quite often to make decisions quickly and efficiently. It’s called a “heuristic, “ and though using it can be really helpful in some ways, it can also lead to errors in judgment.
For instance, when you see a phrase like “zero sugar” or “sugar-free” on a label, you might take that to assume that the product is healthy or at least won’t harm your teeth. That doesn’t always jibe with reality, though.
Some alternative sweeteners, such as aspartame, sucralose, and Ace-K, pose known risks to health and fuel chronic inflammation. Evidence suggests they may even raise the risk of some cancers. Hardly “healthy.”
A product may have other qualities that offset the lack of sugar. Diet sodas provide a great example. Not only do most contain problematic artificial sweeteners, they’re also extremely acidic and can damage tooth enamel over time.
And soda is hardly the only example.
Consider the fellow who was the subject of a paper recently published in Case Reports in Dentistry. He was in his 50s and had never had many dental problems. He was in good health and didn’t drink or use drugs. His main concern was a decades-long habit of using chewing tobacco – a habit he was trying to quit with the help of sugarless nicotine lozenges.
When he returned to the dentist a year later, almost every premolar and molar in his mouth showed signs of decay. Two teeth were so far gone, they were extracted. Another was root canaled and crowned. Eight others were restored.
Within months, every one of those restorations developed recurring caries (decay). All were repaired or redone at least once over the next five years. Ultimately, all but two of the affected teeth were extracted and replaced with implants.
Still, the patient continues to use the lozenges, although he tries to minimize damage as much as he can. He also switched to a smaller lozenge that contains only one of the two problem ingredients that the report authors identified: maltodextrin and mannitol, both of which can be fermented by oral bacteria. Those bacteria generate acids that destroy tooth enamel, allowing pathogens to infect the tooth.
Adding to the trouble is that the lozenges tend to be held in the mouth for a very long time – up to 30 minutes. The long exposure gives harmful bacteria even more time to do their dirty work.
This case study presents clinical evidence that frequent use of a sugar-free nicotine lozenge was associated with the development of rampant root caries. This occurred in spite of the patient being a healthy adult with normal salivary flow and good oral hygiene habits. The implication of this finding can be extrapolated to other products assumed to be dentally harmless such as sugar-free cough drops and hard candies. [emphasis added]
Indeed, any food – or medicine or supplement – that’s made with fermentable ingredients and held in the mouth for a long time may spell trouble, just as the nicotine lozenges did for the patient above. A similar caution might also be made about sugar-free gummies, bits of which can stick between teeth for a long while.
While the case above is extreme, it does deliver an important lesson.
Slow-dissolving products, like lozenges and cough drops, are intended to be held in the mouth for long periods of time instead of being swallowed. The sugar-free nicotine lozenge in this report contained maltodextrin, a polysaccharide that is derived from either corn, rice, potato starch, or wheat. These longer exposures in the mouth allow amylase, an enzyme in saliva, to break down carbohydrates to simpler sugars. Long exposures also mean that “tooth-friendly” ingredients with low fermentation rates (i.e., mannitol and sorbitol) have exponentially longer times to ferment, thus producing more acids.
More acids, more tooth damage.
Your best bet? Steer clear of slow-dissolving products or, if they can’t be avoided, follow them with a good rinse of fluoride-free water to help neutralize the acids. If your concern is with nicotine replacement in particular – which can be a real help in quitting tobacco, which is also notoriously harmful for oral health – consider using a patch instead of a gum or lozenge.
It would be a shame to have such a health-positive – being tobacco-free! – offset by the negative of rampant tooth decay.
Nicorette image by Lisa Zins, via Flickr
