The Erosive Potential of Some Flavoured Waters Jeremy Reesa, BDS, MScD, FDSRCS (Ed), PhD Theresa Loyna, FIBMS Lindsay Hunterb, BDS, MScD, FDSRCS (Ed), PhD Leili Sadaghiania, DDS, MFDS (Ed) Alan Gilmoura, BDS, MScD, FDSRCS (Ed), PhD AbstrAct Objectives: To assess the erosive potential of a number of readily available flavoured waters in the laboratory. Methods: The erosive potential was assessed by measuring the pH, neutralisable acidity and ability to erode enamel. These were compared to an orange juice positive control. Results: The pH of the flavoured waters ranged from 2.64-3.24 with their neutralisable acidity rang- ing from 4.16-16.30 mls of 0.1M NaOH. The amount of enamel removed following 1-hour immersion in the drinks ranged from 1.18-6.86 microns. In comparison, the orange juice control had a pH of 3.68, a neutralisable acidity of 19.68 mls of 0.1 M NaOH and removed 3.24 microns of enamel. Conclusions: Many of the flavoured waters tested were found to be as erosive as orange juice. This information will be of use to clinicians when counselling patients with tooth surface loss. (Eur J Dent 2007;1:5-9) Key words: Dental erosion; Dental enamel; Non-carious tooth surface loss IntroducIno Dental erosion is defined as an irreversible loss of dental hard tissues due to a chemical process without the involvement of microorganisms.1 This process may be caused by extrinsic or intrinsic agents. Extrinsic agents include acidic food stuffs, beverages, snacks or following environmental exposure to acidic agents.2,3 Intrinsic causes are associated with gastric acid and may present in- tra-orally following vomiting, regurgitation, gas- tro-oesophageal reflux or rumination.4 The evidence linking erosion with diet is based on a number of case reports and a few epide- miological studies. Millward et al5 examined 101 school children and found a high level of erosion associated with the consumption of soft drinks, a Department of Adult Dental Health b Department of Child Dental Health, Dental School, Wales College of Medicine, Cardiff University, Heath Park, Car- diff, CF14 4XY, UK. Corresponding author: Prof J. S. Rees Department of Adult Dental Health, Dental School, Wales College of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XY UK Tel: + 44 2920 746 557 Fax: + 44 2920 743 120 E-mail: reesjs1@cardiff.ac.uk January 2007 - Vol.1 particularly carbonated beverages. Jarvinen et al6 carried out the only case-controlled study and found that the risk for erosion was increased if cit- rus fruit was consumed more than twice daily or if sports drinks were consumed more than once a week. Sales of soft drinks within the UK have increased over seven fold since 19507 and Coca-Cola® is the biggest selling brand in the UK today, while Pepsi- Cola® is the eighth biggest brand.8 Sales of min- eral waters have also increased rapidly over the last decade in a similar fashion to soft drinks. Re- cently manufacturers have introduced flavoured waters to the market and this sector has grown rapidly with 25% of adults in the UK consuming these drinks.9 The term flavoured water is a mis- nomer as under bottled water regulations nothing can be added to water, except carbon dioxide for carbonated bottled waters. As soon as any addi- tional ingredient is added, whether it is a colour, flavour or sweetener then the product becomes a soft drink.10 However, for the sake of clarity the term ‘flavoured water’ will be used throughout this article as it is in common usage. The pH of still mineral waters has been found to be close to neutrality, while the pH of carbon- European Journal of Dentistry