January 2018 Issue of Wines & Vines
 
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Tooth Care for Wine Professionals

Protect your teeth against occupational hazards

 
by Geoff Cowey and Dr. Sarbin Ranjitkar
 
 

Tasting the fruits of one’s labor is one of most rewarding parts of being a grapegrower or winemaker. However, it can also be an occupational hazard, with a greater predisposition among winemakers and wine judges to experience premature gum recession (from harsh tooth brushing), tooth erosion, tooth sensitivity and dry mouth due to greater and more frequent exposure to the acids present in wine. This article addresses some of the dental issues relevant to wine industry personnel as well as preventative measures that should be taken when tasting large numbers of wines in situations such as wine shows.
 

What are teeth made of?
The hard, outer layer of teeth is called enamel. Enamel does not contain any living tissue, being made solely of calcium phosphate, a substance even harder than bone. Dentin lies underneath the enamel and is a bone-like tissue made of collagen and calcium phosphate; it provides tooth support and structure. The soft core of the tooth is called the pulp and is the living tissue that contains connective tissue, blood vessels and nerves responsible for pain detection.4
 

What are the effects of wine tasting on teeth?
 

Tooth erosion and sensitivity: All teeth experience some amount of erosion or wear with time, generally correlating with age, where teeth appear shorter and have worn surfaces. Erosion occurs when enamel is dissolved from the tooth surface.1 Acids present in wine (but also in soft drinks, sports drinks and fruit juices) can dissolve calcium and phosphate from the enamel, leading to tooth demineralization and tooth erosion. Continued erosion and exposure of the dentin underneath causes tooth sensitivity to temperature changes and touch during brushing.
 

Erosion is different from dental decay or tooth cavities.2 Cavities occur due to a breakdown of the teeth. Plaque, a build-up or biofilm of bacteria, feed on food debris and sugar, which anaerobically produce lactic acid that dissolves calcium and phosphorus in the enamel.
 

Saliva and dry mouth: Saliva produced by salivary glands/ducts neutralizes mouth acids, increasing mouth pH above a critical level of 5.5, below which demineralization occurs. Tooth decay occurs at around this pH, and erosion occurs in a more acidic environment (at or less than 3.0 pH). It also forms a protective film over the teeth, which provides some protection from acids. Note, however, that saliva cannot penetrate plaque or tartar.6
 

Red wine tannin has been reported to inhibit the salivary duct’s transport of fluid and salts, resulting in decreased saliva production and dry mouth during tasting of red wines. The same effect was not observed for white wines.7 Decreased saliva amounts then limit the acid neutralization capability in the mouth. 
 

Are winemakers considered high-risk individuals for damage to teeth?
Damage to teeth is related to the number and frequency of wine tastings, and the effects are cumulative. Tasting more than 50 wines in one week is considered high risk.5 This would be considered normal practice at most wine shows and during vintage and allocation tastings. 
 

Studies at the University of Adelaide have shown that 50% of wine tasters experience increased tooth sensitivity after five to 10 years.5 Of tasters that experience sensitivity, a common link was quality and quantity of saliva produced by those individuals. Some medications (used to treat asthma, depression and hypertension) may reduce saliva production. Your dentist can test your saliva to indicate your risk status. Other predisposing conditions that exacerbate the risk of tooth erosion are tooth grinding during sleep, gastric reflux (regurgitation) and an acidic diet.
 

How can I prevent or reduce tooth erosion and sensitivity?
It is important to boost oral defense (protection) from saliva and restore demineralization (mineral loss)/remineralization (mineral gain) balance in the mouth. A summary of preventative steps provided by the Adelaide Dental School at the University of Adelaide is included below.
 

Steps to take the night before tasting:
• Brush teeth with a readily available fluoride toothpaste (1,000 mg/L fluoride).
• With a toothbrush or fingertip, apply a 1.5-cm strip of Tooth Mousse/ MI Paste (casein phospho peptide-amorphous calcium phosphate) or high-concentration sodium fluoride toothpaste such as Colgate Neutrafluor 5000, available from a dentist, and leave for four minutes (alternately use a custom-made dental tray). Spit out paste but do not rinse. Avoid drinking for one hour.
Steps to take the morning of tasting:
• Brush gently with a soft or extra soft brush.  
• Apply with your finger a 1.5-cm strip of Tooth Mousse and leave on for four minutes. Spit out and do not rinse.
Steps to take during wine tasting:
• Drink still water to rinse the mouth and dilute acids. (Sparkling water is acidic.)
• Eat cheese or drink milk to enrich teeth with calcium and phosphate.
• Eat crackers to stimulate saliva production. Beware of olives, pickles or other acidic foods.
 

Steps to take after wine tasting:
• Do not brush teeth for at least two hours after tasting. Teeth are in a demineralized state and much softer, so even though the teeth are stained, avoid brushing to reduce the risk of damaging the enamel.
• Wash mouth with readily available 0.2% fluoride mouth rinse. Spit out after two minutes.
• Avoid other mouthwashes, which are generally acidic. Mouthwash often is used after tasting as a replacement for brushing teeth, but acidic products can do more harm than good.
• Chew recaldent (calcium phosphopeptide) or sugar-free gum to help stimulate saliva production to neutralize acid.
• Apply Tooth Mousse, Colgate Neutrafluor 5000 Plus or other remineralizing agents before bed using spit-and-not-rinse method.
 

Stained teeth
Wine tannins can form complexes with calcium and proteins bound to the tooth surface and stain the tooth. Brushing can remove/polish off some discoloration, but it is important to avoid brushing when teeth are still soft and in a demineralized state after tasting. Use of whitening toothpaste can have a bleaching action, but it may increase tooth sensitivity. Dentists can professionally remove stains and also apply transparent resins to prevent teeth staining after cleaning.
 

Gum recession 
Regular vigorous brushing or scrubbing to remove stains can result in gum erosion and exposure of the roots of the tooth that are at greater risk of decay or erosion (depending on the pH level).3 Note that gum erosion is more commonly linked to gingivitis or gum disease, via the buildup of bacteria in plaque that causes gums to become inflamed and bleed during brushing, or later, when the gum and bone pull away from the teeth, leaving small spaces between teeth and gums. A dentist is the best person to determine the cause of gum recession.
 

Longer term prevention
Longer term preventative strategies include visiting a dentist at least once per year and having a preventive plan in place. Annual topical fluoride applications also are recommended, as with regular home application of remineralizing agents such as fluoride and CPP-ACP products. Factors exacerbating erosion should be controlled (such as wearing a night guard for sleep-related tooth grinding and medical management of gastric reflux). 
 

Geoff Cowey is senior enologist at the Australian Wine Research Institute. Dr. Sarbin Ranjitkar is a senior lecturer at the University of Adelaide School of Dentistry. This text was edited from original publication in The Australian Wine Research Institute Technical Review #230, October 2017.

Dr. Diane Hunt and Dr. John McIntyre from the School of Dentistry at the University of Adelaide are acknowledged as the authors of source material drawn upon in preparing this article. For leaflets on tooth care, please visit adelaide.edu.au/arcpoh/dperu/special.

References
1. University of Adelaide Dental Practice Education Research Unit, School of Dentistry. What’s wearing away your teeth? Tooth Erosion. Special Topic Pamphlet No.2.    adelaide.edu.au/arcpoh/dperu/special/erosion/erosionph.pdf
2. University of Adelaide Dental Practice Education Research Unit, School of Dentistry. Detecting and managing dental erosion. Practice information sheet.   adelaide.edu.au/arcpoh/dperu/special/erosion/ErosionA3.pdf
3. University of Adelaide Dental Practice Education Research Unit, School of Dentistry. Patient pamphlet- Sensitive teeth. adelaide.edu.au/arcpoh/dperu/special/hypersensitivity/Sensitive%20Teeth%20DL.pdf
4. Colgate Oral Care Centre. Are teeth bones? Mouth and Teeth anatomy.
   colgate.com/en/us/oc/oral-health/basics/mouth-and-teeth-anatomy/article/are-teeth-bones-1116
5. Ranjitkar, S. Smales, R. Lekkas, D. 2012. Prevention of tooth erosion and sensitivity in wine tasters. Wine Vitic. J. 27 (1): 34-37; 2012.
6. The Academic Wino - What causes dry mouth after drinking red wine? Tannic acid effects on saliva production. 2015. academicwino.com/2015/06/dry-mouth-red-wine-tannic-acid-saliva.html/ 
7. Imamura, A. Nakamoto, T.*, Mukaibo, T. Munemasa, T. Kondo, Y. Kidokoro, M. Masaki, C. Hosokawa, R. 2015. Effects of beverage ingredients on salivary fluid secretion with an ex vivo submandibular gland perfusion system: tannic acid as a key component for the inhibition of saliva secretion. Open J. Stomatol. 5, 12-18.
 

 
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