sports drinksLaura Hinds reviews the current research on sports drinks and their impact on oral health.

Sports drinks are an increasingly popular way of rehydrating post workout, particularly within the last couple of decades, but do we truly know the true impact of these on dental health? Or, if there is any impact at all on dental health?

It is without a doubt that these types of drinks are popular amongst adolescents, predominantly those who participate in exercise, or are looking for a quick ‘sugar fix’.

Sports drinks, usually consisting of either: a hypotonic solution, (required for post workout as this is less concentrated than bodily fluids) or an isotonic solution (needed to replace energy lost during exercise), were primarily manufactured to rehydrate pre, post or intra-workout. These are usually replaced in the form of carbohydrates; maltose, glucose or dextrose, in order to create the optimum carbohydrate-electrolyte balance.

From an athlete viewpoint, this is necessary. However, from a dental perspective, these elements play a part not only in the caries process, but can also affect tooth surface, thus contributing to tooth erosion/wear.

A recent literature review (although low on the hierarchy of evidence) highlights that the earliest sports drinks date back to the 1960s, where these consisted of sodium, sugar, monopotassium phosphate, ‘and a dash of lemon flavouring’ – these should give clinicians an idea of what sports drinks contain, but more significantly from this, is the fact that this highlights the importance of carrying out risk assessments, particularly when it comes to NCTSL and tooth wear/erosion.

Oral health impact

It seems that this is, however, a topic that still requires further research due to its vagueness. In the literature that was under review, there was no evidence to prove that sports drinks negatively impact oral health, nonetheless, through some in-vitro studies – again, although these sit low on the hierarchy of evidence, demonstrate signs that sports drinks can affect the weight of a tooth; through enamel dissolution. The accuracy of this may be flawed; when consumed normally, sports drinks coat the teeth as opposed to being entirely immersed in solution, which the extracted teeth in review were subjected to. These were also weighed and checked for any deformities such as calculus or caries, immersed entirely in a range of sports drinks and compared with a control solution – usually water, and re-weighed after a set period.

The majority of literature that was reviewed showed either no signs, or implied that there was not enough impact caused to be classed as tooth wear/ erosion when sports drinks were tested in-vitro.

Given that the literature was based on in-vitro studies, even though this causes some issues with regards to accuracy, this is the most ethical way of testing for tooth wear.

Some studies also used methods such as face-to-face questioning with athletes. Consent was gained throughout, however, this also comes with flaws in that the athletes could have answered questions according to what they thought the correct answer would be, and so the results could be inaccurate.

Interestingly, one study in particular brought to light that by adding a certain element – in this instance, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), at a specific concentration between 0.09% and 0.25%, this would reduce the erosion depths that the tooth was exposed to.

This suggests that by adding this to sports drinks that are currently on the market, this reduces the erosive potential of the drinks, thus making it ‘safer’ for consumers. This also raises the point, are sports drink companies already doing this during manufacture without consumers’ awareness. If this is the case, does this affect the way in which dental professionals are, or have been giving oral hygiene and diet advice?

Changes in manufacturing methods

The results show that out of the sports drinks tested, which included the popular ‘Lucozade Sport’, and ‘Gatorade’, which were a combination of both flat and carbonated. These only had the potential to cause erosion, and was not the sole factor in tooth erosion wear.

The only difference, which the review showed, was that ‘Red Bull’ and ‘Gatorade’ had a higher mean percentage of enamel weight loss. Again, not sufficient enough to be classed as erosion.

Overall, in the last 20 or so years, there has been minimal changes in the way these drinks are manufactured. There could also be much more research into flat/carbonated drinks to assess whether these factors have any impact. Many would assume without much thought that drinks such as Coca Cola have a negative impact on dental health, especially in the incidence of caries.

In addition, there would need to be more research which looks into whether sports drinks affect the incidence of caries, if not, why not? What are the the main reasons for NCTSL and caries amongst patients, as these are conditions that are still predominant amongst society.