Tooth Wear–Erosion page

Tooth wear pages–1234567

The five major causes of pathologic, non carious tooth wear:

  • Abrasion:
    • Bruxism
    • Toothpaste Abuse
  • Erosion
    • Regurgitation
    • Soda Swishing (Coke Swishing, Pepsi Swishing, etc.)
    • Fruit Mulling

Erosion page 2–Soda Swishing

Erosion of tooth structure means the dissolving of hard tooth structures, both enamel and dentin, due to frequent exposure of the teeth to acidic solutions.  There are three major forms of erosive processes in the mouth.  These are Regurgitation of stomach contents into the mouth, Soda Swishing, and Fruit Mulling.  There are other unusual habits that can cause tooth erosion, but they are very patient specific and, taken as separate entities, are fairly rare.

Soda Swishing

I have been telling my patients for years that diet soda can’t harm their teeth.  If it has no sugar, it can’t contribute to tooth decay.  I was, of course correct about the decay, but I was not prepared for something I learned in a lecture by Dr. Thomas C.  Abrahamsen.  Having spent over 30 years studying erosion of tooth structure, Dr. Abrahamsen informed the hall about the phenomenon of “Coke Swishing”.


Coke swishing is the habit of retaining each mouthful of soda or Coca Cola in the mouth for a few seconds and swishing it around between the teeth before swallowing.  It turns out that it is not just Coke.  It could be virtually any soda.  Most of my patients who do this are using Mountain Dew.  Thus, I will refer to this habit as “Soda Swishing

All sodas, including diet soda contain three acids.  Phosphoric acid is added to impart a tart flavor and to counteract the sweetness of the sugar or artificial sweeteners, and also as a preservative to prevent the growth of mold.  Citric acid is added, especially to fruit flavored sodas to give a bit more of a zippy flavor.  Carbonic acid is a byproduct of the carbonation process, but is the weakest of the three acids and is probably the least harmful to the teeth.  (I’m happy to report that since beer only contains carbonic acid, it is much less harmful to the teeth–even when swished.)

When a patient drinks a diet soda without swishing it, it goes past the teeth quickly, and does very little damage to the teeth.  But when a patient develops a soda swishing habit, then it it is held in the mouth for long enough to dissolve tooth structure.


The type of patient who swishes soda

  • Soda swishing almost always starts out when the patient is quite young, but continues into adulthood.
  • These patients swish the soda around in their mouths in order to remove the carbonation which hurts their throat.
  • These patients are NOT high volume soda consumers.  One can of soda can last a very long time.

Recognizing soda swishing erosion

  • Cupping or cratering is always present.  This cupping has sharp enamel edges unless the patient is also a toothpaste abuser.
    • The most cratering will be seen on the mandibular first molars because these are the first adult teeth to erupt and the habit is usually well established in early childhood (see image above).  The most cratering will be seen on the lingual aspect of the mesiobuccal cusp of the lower first molar.
    • Mandibular molars are much more heavily affected than maxillary molars because gravity keeps the soda in contact with them.
  • Over the years, the posterior teeth become more worn than anterior teeth due to tongue position while swishing.
  • Silver amalgams in posterior teeth are elevated above the enamel surface because the acids in the soda dissolve the enamel around them.
  • This habit can be found in combination with bruxing and toothpaste abuse stigmata, but it is never seen with damage from regurgitation or fruit mulling.
  • The easiest way to confirm the diagnosis is to ask the patient if they swish the soda before swallowing it since most patients will freely admit to the habit.
  • Hand articulated plaster study models show that the worn occlusal surfaces on the lower teeth do not match wear on the opposing upper teeth.

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