There is reduced clearance of bacteria and food from the mouth, reduced buffering of acid challenges, and diminished remineralising potential.  The oral cavity becomes more acidic.
When the pH of the mouth lowers, the balance between the remineralisation and demineralisation moves to favour demineralisation.  Softening of external tooth surfaces in these acidic conditions can lead to:
(a) increased tooth (attrition);
(b) labial wear with toothbrush abrasion; or
(c) erosion of teeth from either internal (eg gastric reflux) or external (ie acidic drinks) acid sources.

An acidic environment favours the growth of more acid tolerating and caries producing bacteria, leading to loss of tooth structure from dental decay.

What is oral balance?

Oral balance is the equilibrium that exists between the demineralising effect on tooth surfaces caused by acids, balanced by saliva, with buffering and remineralising benefits.

The source of acid can be:
• bacterial breakdown of fermentable carbohydrates (organic acids);
• ingested acidic foods and drinks (eg fruit and carbonated soft drinks);
• internal sources (eg gastric reflux).

Saliva’s effectiveness is influenced by several properties of both stimulated and unstimulated saliva, including flow rates, viscosity, pH and buffering capacity.
While oral balance is influenced by other factors such as oral hygiene and fluoride exposure, the dominant influence is the daily battle between saliva and acid.

We routinely perform saliva testing for children to gain a better picture of his/her resting (unstimulated) saliva, viscosity, and resting pH of unstimulated saliva.  Should any of these findings be extremely low then additional testing of saliva buffer capacity may be required.

We recommend the following preventive strategies:

  • Optimising salivary function:

Increase water intake.
Use of water bottles in school bags.
Use of sugar-free gum to enhance salivary flow.
For adults, use of water dispensers or water jugs in work environment.
For adults, avoiding caffeine and alcohol containing products.

  • Reducing acid exposure:

Being aware that certain foods have a high erosive potential (eg citrus fruits, soft drinks, fruit juices, vinegar and pickles, yoghurts, wine).

Limiting the intake of acidic foods and drinks to meal times.

Decrease the time taken to consume acidic drinks (ie not holding carbonated drinks in mouth, reducing sipping habits).

Use a straw to avoid acidic drinks contacting teeth.

Consumption of neutral foods immediately after a meal (eg cheese).

Rinsing mouth out with water after acid exposure (ie after episode of vomiting).

Avoid brushing teeth for at least 30 minutes after acid exposure (extrinsic or intrinsic causes).

  • Additional external protection:

0  Use of neutral fluoride mouthwash/ gel (only as recommended by a dental professional)

0  Use of supplements containing CPP-ACP (eg Recaldent® tooth mouse) to enhance  remineralisation. (only as recommended by a dental professional)



© Kidz Teeth | Specialist Paediatric Dentists - Auckland, New Zealand