# Presentation: 807388

## Sipping Toward Disaster

**Sipping Toward Disaster**

**Brian Jacobsen, DMD**

**Tongue Point Job Corps Center**
**Astoria, Oregon**

**Educating Students on the Risks of Soda Consumption**

## Presentation Overview

- Answers to two burning questions
- Soda and its effects on teeth and health
- Brief research overview
- Educational techniques and materials
- Case studies

## Where is Astoria, Oregon?

- Why do they call it Tongue Point?

## Tongue Point

**A Large Job Corps Center (~500 students)**
**On an Old Naval Base**
**Has Seamanship Program**

**Notes:**
Tongue Point
A Peninsula That Protrudes Like a Tongue into the Columbia River
Tongue Point has the only Job Corps seamanship program, and is one of the largest centers.

## Tongue Point

**Notes:**
Looking upriver from Astoria toward Tongue Point.

## Slide 6

**Notes:**
Mothballed ships at Tongue Point after World War II.

## Slide 7

**Notes:**
Dr. Jacobsen packs cord as his work-based learning student assists.

## Slide 8

**Notes:**
Dr. Doug Pratt providing hygiene care.

**Notes:**
Marty Lindholm, our multitalented dental assistant and front office staff.

## Astoria, Oregon

**Founded 1811**

**Notes:**
Founded in 1811 as a Fur Trading Post
Oldest American Settlement West of the Rocky Mountains

## Slide 11

## Wreck of the Peter Iredale

**October 25, 1906**

**Notes:**
A Four-masted Sailing Vessel, Built: 1890, Weight: 2075 tons,
 Length: Almost 300 feet, Now Located: Fort Stevens State Park (approx 3 miles from my house).
Notoriety:  Most photographed shipwreck.
How it happened:  A “fearful storm” caused heavy seas.  
The sailors were hurrying to receive a bonus for a speedy trip into Portland.  
They got disoriented when trying to enter the Columbia river and beached the ship
 on the sand so hard that it was significantly damaged and could not be freed.

## Slide 13

**Notes:**
My son, William, splashing near the remains of the Peter Iredale in 2004.

## Our Students are 

- Floating in a sea of soda machines
- Bombarded by a fearful storm of flashy
- 	advertising and celebrity endorsements
- Lost in a fog of misinformation and addiction
- Often in a big hurry

- Our Students are
- “Sipwrecking”
- Their Teeth!

## Soda: The “Perfect Storm”

**Consider the following:**
- Widely available
- Addictive
- Inexpensive
- Sugars feed bacterial plaque
- Acid directly attacks teeth
- It coats all exposed tooth surfaces
- Plastic bottles favor portability and sipping

## We must empower our students to make better decisions about soda consumption through educating and motivating them.

## Is there a problem?

## Source:  “Liquid Candy:  How Soft Drinks are Harming Americans' Health”

*Source:  “Liquid Candy:  How Soft Drinks are Harming Americans' Health”*
*	** **Michael F. Jacobsen, PhD, http://www.cspinet.org/sodapop/liquid_candy.htm*

## Disturbing Trends

- 12 to 19-yr-old boys: 24 oz of soda/day (868 cans per year).
- 	Girls = only 1⁄4 less
- 1983– boys: twice as much milk as soda
- 	    girls:  50% more milk than soda.
- 2003– both:  twice as much soda pop as milk.
- Increase in serving size of Coca-Cola:
- 	1950s: 6 1⁄2 oz bottle.
- 	1970s-1980s: 12 oz can
- 	1990s-today: 20 oz bottle

*Source:  “Liquid Candy:  How Soft Drinks are Harming Americans' Health”*
*	**	**Michael F. Jacobsen, PhD, http://www.cspinet.org/sodapop/liquid_candy.htm*

## Soda and Current Health Trends

*Sources:  *
*	**“**Liquid Candy:  How Soft Drinks are Harming Americans' Health”*
*	**	**Michael F. Jacobsen, PhD, **<date/time>*_[ttp://www.cspinet.org/sodapop/liquid_candy.htm](http://www.cspinet.org/sodapop/liquid_candy.htm)_
*	**National Center for Health Statistics, NHANES III*
*	**Dietz, WH.  Pediatrics 1998 pg. 518-525*

- Teenage girls risk osteoporosis
- Obese boys consume more calories from soda
- Obesity up 30% in last 10 years
- Obesity raises risk of type 2 diabetes and                                                  cardiovascular disease

**Notes:**
Osteoporosis:  Teenage girls who are soda drinkers consume about 50% of the recommended calcium.
As soda consumption has risen, so has obesity.  Soft drinks provide 10.3% of the 
calories consumed by overweight teenage boys, but only 7.6% of the calories
consumed by other boys.
The obesity rate in youth is up nearly 30% in the last decade and is still rising.
Obesity increases the risk of type 2 diabetes and cardiovascular disease.

## We’ve All Seen This Mouth

**We’ve All Seen This Mouth**

## Caries Formation 

**is a Multifactorial Process**

- The Principle:
- “Acids . . . diffuse into tooth enamel or
- dentin and dissolve . . . minerals from
- crystals inside the tooth.”

*Source:*
*	**John D.B. Featherstone, MSc, PhD.  “The Caries Balance:  Contributing Factors*
*	**	**and Early Detection”, Journal of the California Dental Assoc., Feb. 2003.*

## “Dissolution of dental enamel in soft drinks”

- “Effects of sports drinks and other beverages on
- dental enamel”
- J. Anthony von Fraunhofer, Msc, PhD
- Matthew M. Rogers, DDS
- Eric Jacobsen, DDS (’06) Research Assistant

- Enamel blocks were immersed in beverages for 14 days.
- They were weighed at 24-48 hour intervals.

- The research:

## Key Findings

- Enamel dissolution occurred
- Diet soda dissolution = regular soda
- Non-cola >>> cola drinks
- Enamel aggressivity more important than pH
- Less time and rinsing beneficial

*Source: http://www.agd.org/library/2004/aug/vonFraunhofer.pdf  *

**Notes:**
“Carbonated soft drinks may cause significant long-term enamel dissolution . . .
	No differences were found in enamel dissolution between regular and diet 
	versions . . . The data clearly indicated that non-cola beverages were far 
	more aggressive than cola drinks.  The data suggest that beverage
	composition rather than beverage pH determines enamel aggressivity.  
	Reduced residence times of beverages in the mouth by salivary
	clearance or rinsing would appear to be beneficial.”

## Slide 25

## Slide 26

## Slide 27

## ACID

**+**
**ADDITIVES**
**+**
**TIME **
**=**
**DENTAL CARIES**

**Notes:**
My summary of the von Fraunhofer recipe for caries.

## How are we helping our students 

- to understand and apply this message?

**Posters**
**Brochures**
**Collaboration With Other Departments**
**Object Lessons**
**Verbal Education and Follow-up**
**Support of Water-promotion Efforts**

## Slide 30

## Minnesota Dental Association

- Posters, flyers, magnets, stickers, and an educational PowerPoint CD.

## Stop the Pop: http://www.modental.org/

## Slide 33

## Brochures From Patterson Dental Supply Co.

## These and other

- brochures are
- available in
- our waiting area.

## Collaboration With Healthy Choices Committee

- Centerwide Newsletter Encouraging Water

**Notes:**
I have collaborated with other staff at Healthy Choices Committee 
meetings, where we've discussed ways to improve fitness, reduce
soda consumption, increase water quality and availability, etc.
A recent center-wide newsletter touted the benefits of water and advertised
availability of refillable water bottles at the center pointmart.

## An interesting

- chairside
- object lesson.

- 18 teaspoons
- of sugar!

## Verbal Education and Follow-up

**Verbal Education and Follow-up**

- Watch for characteristic caries
- Discuss role soda can play
- Make notation in chart
- Follow-up at future visits
- Offer praise and encouragement

**Notes:**
When characteristic problems manifest themselves at 
the initial exam, we discuss the role soda can play.  I watch for rampant caries (especially interproximal and along gingival margins) as well as widespread interproximal incipiencies.  
Notes are made in the chart, and we follow-up at future visits.
I love to praise students who return to the clinic in the 
future with a bottle of water!

## Poster in Cafeteria

- Providing Convenient
- Filtered Water

- “Water Wednesdays”

**Notes:**
Poster supplied by us and placed by our food services manager.
We've made efforts to plainly label water.
Our cafeteria practices “Water Wednesdays”

## Encouraging Results

- Soda education at initial exam
- Positive feedback reports from hygiene visit
- Students buying and using water bottles
- Reinforcement at hygiene visit

**Notes:**
Typically, I see students for the initial exam 
prior to their hygiene visit.
Many times, we have discussed their soda intake.
Doug reports how proud many of “my people” are to 
show their water bottle and report their elimination 
of sipping and/or reduction of consumption.
Water bottles are 100 points at the pointmart

## Student now carrying only water

- Drinks soda 1 to 2 times/week.

## “Well, I do drink a lot of soda”

- Clean Teeth, Healthy Gums, Negative Drug History

- “Well, I do drink a lot of soda”

**Notes:**
The film is from a student whose clean teeth
and healthy gums support her statement that she
routinely brushes and flosses.  Her drug history is
essentially negative, and she was dumbfounded as
to how she could have cavities.

She later admitted, “Well, I do drink a lot of soda” and 
now understands she needs to change.
She's going through Prevident like crazy, and we've 
speedily gotten her treatment underway.

## This slim young man said “I used to 

- be over 300 pounds,” and he had the
- stretch marks to prove it.
- How could his plaque removal could
- be this good, and his caries this bad?

## Slide 45

## Three main contributing factors:

- Smoking lessens saliva
- Historically lax homecare
- 2-Liter+ of Mt. Dew/day
-  when 300 lbs.

- An RCT and several composites
- later, our carpentry student has
- reason to smile and the knowledge
- to keep himself doing so.

## Slide 47

## May we all be clinically proficient

- and educationally effective as we
- use the tools at our disposal to
- educate, motivate, and empower
- those we serve.