Know which acidic foods to avoid during and post your treatment.

The World Dental Federation (FDI), that represents dental professionals around the world, defines oral health as “multi-faceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex [head, face, and oral cavity]”.

What you eat and drink daily has a significant effect on your oral health as well as your overall health. A symbiotic relationship exists between oral health and diet. Diet and nutrition affect the health of the tissues in the mouth; and conversely the health of the mouth affects how well you absorb nutrients. The common side effects of cancer treatment like nausea and hair loss are well known but it is less commonly realized that most people treated for cancer develop problems in the mouth as well. These problems can make it hard to eat, talk, and swallow. This may interfere with cancer treatment and lessen quality of life. Apart from direct effects on cancer treatment, what you eat to maintain good oral health, optimal digestion and ability to move your bowels regularly can have a profound effect on how you deal with cancer treatment regardless of the type of cancer you have. This blog talks about one of the most common culprits that affects good oral health- eating a disproportionate amount of acidic foods.

The human body is built to naturally maintain an optimal balance of acidity and alkalinity and the levels of acidity and alkalinity are measured on the pH scale. The scale ranges from 0-14 and apart from body fluids like the saliva in the mouth, we can also measure the pH balance of foods and drinks that we consume. Foods and drinks that fall below a pH of 7 are considered acidic while those with a pH above 7 are considered alkaline.

The relationship between tooth decay and carbohydrates is fairly well understood; dental enamel is demineralized by acidic by-products produced by bacteria in dental plaque via fermentation of ingested carbohydrates. More specifically, there is a rapid fall in pH (to 5.5 or below) in tooth biofilm after carbohydrates are ingested. This lower pH can also affect the balance of microbes in the mouth such that there is a higher proportion of acidic biofilm species, worsening tooth demineralization. Unregulated carbohydrate consumption is therefore an important nutritional factor in the development of tooth decay. Sugars, specifically, are considered to be the most important drivers of tooth decay. This includes all sugars added to food/beverages, as well as the naturally occurring sugars found in fruit juices and concentrates, honey, and natural syrups.

Just like sugars, foods and beverages that are high in acids wear away the enamel that protects your teeth, a process known as tooth erosion. This changes the appearance of your teeth and opens the door for bacteria that can cause cavities or infection. Highly acidic foods will cause the same problem as sugary foods, just faster. Foods like oranges, lemons, coffee, and pickled foods are very efficient at weakening tooth enamel and causing erosion. The tooth enamel is the hard outer layer that protects the soft inner layers. Unfortunately, once your enamel has eroded, it is gone for good. Under ordinary conditions, enamel erosion takes time and you can slow down and even prevent it through regular visits to the dentist, along with good oral hygiene habits. Cancer treatment however adds another level of stress and aggravation to your oral health and can accelerate tooth decay by decreased saliva production, periodontal disease as well as bone loss.

“Unfortunately, priority is often given to the more “life-threatening” condition that is cancer, and administering oral care has become an activity frequently neglected.”

M. Miller and N. Kearney, “Oral care for patients with cancer: a review of the literature,” Cancer Nursing, vol. 24, no. 4, pp. 241–254, 2001 & G. J. Barker, J. B. Epstein, K. B. Williams, M. Gorsky, and J. E. Raber-Durlacher, “Current practice and knowledge of oral care for cancer patients: a survey of supportive health care providers,” Supportive Care in Cancer, vol. 13, no. 1, pp. 32–41, 2005. 

As discussed in the previous blogs, it is recommended that you visit your dentist to take stock of your dental and oral health before your treatment begins. Once cancer treatment has started, ensure that your dentist and your cancer care team are working together in your recovery journey.

With regards to acidic foods, here are some high acid foods to enjoy in moderation:

• Citrus Fruits & Juices. While citrus foods (lemons, limes, oranges) can be good for gum health, they can gradually dissolve tooth enamel leading to dental erosion if you eat too many of them. If at all, eat whole fruits and not the juice because juices are typically stripped of the beneficial added fiber that whole fruits contain. Remember, even a squirt of lemon juice in your water, which seems harmless, can deliver a ton of acid.
• Sodas, both Regular & Diet. The sugar in soda combines with bacteria in your mouth to form acids which work towards breaking down the tooth enamel over time. Even the diet or “sugar-free” soda still contains citric and/or phosphoric acid, which also can damage teeth.
• Pickles. Pickles are surprisingly acidic since they are preserved in vinegar or brine. If you are a pickle lover, eat them in moderation and when you’re finished eating them rinse your mouth with water.
• Sports Drinks. These drinks can potentially do more damage than even soda. Their high acid content can weaken tooth enamel and the high sugar content will also cause bacteria in the mouth to form acids. Sports drinks are meant to replace lost electrolytes after intense physical activity or exercise. Using them for that purpose alone will make sure you are not exposing your teeth to unnecessary sugars and acid.

While it is a good idea to limit the foods/drinks above, it is not realistic to never have an orange or enjoy an occasional soda.

To lessen the damage when eating or drinking acidic foods or beverages try the following:

• Use a straw when drinking soda, sports drinks, etc. This will minimize the acid contact with your teeth.
• Wait to brush your teeth for at least an hour after eating or drinking something acidic. While this seems counterintuitive, it is a good idea to wait to brush after eating acidic foods since your enamel is temporarily weakened.
• Have a glass of water after eating acidic foods. This can help reduce the damage that acidic foods can cause.