Willershausen conducted an in vitro study
to assess the enamel damage observed with
European vinegars. The use of these expensive
vinegars is also currently trendy with certain
groups on an international level. Five vinegars
were selected in this study, and the vinegars
were evaluated on extracted third molar teeth.
The pH of the five vinegars ranged from 2. 7 to
3. 9. Depth levels were measured using the mi-cro-electron probe. The loss of enamel due to
Bio vinegar and raspberry vinegar led to a significantly higher loss of minerals than all other
The authors concluded that the erosion
potential was evident but cautioned against
transfer to in vivo from the in vitro results. Even
though detectable losses occurred with the
vinegar in general, tooth erosion does occur over
a lifetime, and some buffering capacity from
saliva protects the teeth to some degree. These
vinegars are used frequently on all types of salads
and may be consumed several times a day.
However, what about those individuals who
are using shot glasses of vinegar, or those who
drink the liquid throughout the day for weight
loss purposes? Are they drinking the vinegar
before they leave for work and then brushing
soft enamel after consumption of the product?
Or, with the new diet craze using selected
types of vinegar on salads, are we adding to
the possibility of enamel damage? If you couple
this with bad habits such as bruxism or others
on the provided list, are patients experiencing
more enamel damage than we really know (see
Reports of clinical characteristics similar
to GERD destruction and disordered eating
practices seem to be increasing. The teeth may
appear dull, smooth, and increasingly thin.
Over time, this may not even be noticeable to
the patient. The whitewashed appearance that
is found in disordered eating practices may
not even be evident to a clinician in the early
stages. Once seen, it is usually not forgotten.
DIALOGUE WITH PATIENTS
Ask the patient about complaints of halitosis.
Patients who have long-term, untreated GERD
Does the patient constantly chew gum?
This may be related to GERD due to a bad taste
in the mouth. Gum chewing may occur when
the patient is trying to quit smoking as well.
• Ask the patient about the use of vinegar
products and lemon products. “Do you
use lemon in your tea or glass of water?”
“Are you using vinegar for weight loss?”
“Do you use vinegar products?”
• Is there evidence of bruxism? Nervous
habits also promote bruxism. This is
usually obvious when talking to a patient.
Watch for muscle tension.
• Show the patient the areas of concern.
Show the patient an image of a tooth with
normal anatomy and compare it with the
loss of anatomy in the patient’s teeth.
• A food diary for a week is always a great
idea. Patients may be using more
acid-producing food and beverage
products than they really know. Some
phone apps can assist with this documentation. HealthLine Media and
EngergizeForLife.com publish articles
with lists for both low and high acidic
foods. The articles could be helpful to
those patients suffering with GERD.
AN ORAL MEDICINE PERSPECTIVE
Assisting our patients in total health is our
optimal goal. The foods that we place in our
bodies have a major effect on all mechanisms
such as weight control, dental health, mental
health, and cellular health. Taking the time to
help patients in assessing enamel loss clinically
is well worth the effort and time spent. Many
health issues are derived from body inflammation, lack of exercise, and poor food
Watching societal trends will assist us in
optimal dental health for our patients and in
making the correct dental recommendations.
The current trend for the usage of vinegar,
lemons, and other acidic products is damaging
the enamel in many patients and should be
on our radar. Recommending the correct
Sources of enamel destruction and tooth sensitivity
• Bleaching products when used persistently over time
• Soda products
• Sugar products
• Apple cider vinegar use (for weight loss)
• Eating disorders and purging
• Frequent vomiting during pregnancy (usually during first
• Bruxism (excessive grinding especially during sleep)
• A very acidic diet (many foods are acidic such as
coffee and popular vinegars)
• Certain medications
• Chewable vitamin C
• A lactovegetarian diet
• Wine consumption or wine tasters
• Chlorine treated pools frequently used by swimmers
• Lemon juice/fresh lemons used throughout
the day in drinking water
• Abrasive dental products
continued on pg. 76