ORIGINAL CONTRIBUTIONS

The pH of beverages in the

United States
Avanija Reddy, DMD, MPH; Don F. Norris, DMD; Stephanie ABSTRACT
S. Momeni, MS, MBA; Belinda Waldo, DMD; John D. Ruby,
DMD, PhD Background. Dental erosion is the chemical dissolution
of tooth structure in the absence of bacteria when the
environment is acidic (pH < 4.0). Research indicates that

S
weetened and flavored beverage consumption low pH is the primary determinant of a beverage’s erosive
has increased dramatically over the past 35 years potential. In addition, citrate chelation of calcium ions may
in the United States with carbonated soft drinks contribute to erosion at higher pH. The authors of this
being consumed the most frequently, and most study determined the erosive potential measured by the pH
often by children, teens, and young adults.1-3 In 1942, the of commercially available beverages in the United States.
annual production of soft drinks was approximately 60 Methods. The authors purchased 379 beverages from
12-ounce servings per person; that number has increased stores in Birmingham, Alabama, and categorized them (for
almost 10-fold since 2005.4 Between 1999 and 2002, daily example, juices, sodas, flavored waters, teas, and energy
carbonated soft drink drinks) and assessed their pH. They used a pH meter to
and fruit drink con- measure the pH of each beverage in triplicate immediately
sumption by 13- to 18- after it was opened at a temperature of 25
C. The authors
year-olds was 26 oun- recorded the pH data as mean (standard deviation).
ces, and the Center for Science in the Public Interest has Results. Most (93%, 354 of 379) beverages had a pH of
reported that in 2004, total consumption of these drinks less than 4.0, and 7% (25 of 379) had a pH of 4.0 or more.
for every man, woman, and child was approximately 68 Relative beverage erosivity zones based on studies of apatite
gallons per year.4 The prevalence of dental erosion in the solubility in acid indicated that 39% (149 of 379) of the
21st century has also increased due to our enhanced beverages tested in this study were considered extremely
preference for sweet and sour.5 The consumption of erosive (pH < 3.0), 54% (205 of 379) were considered
acidic beverages contributes to an erosive oral milieu and erosive (pH 3.0 to 3.99), and 7% (25 of 379) were consid-
should be of concern to the dental practitioner.6-9 ered minimally erosive (pH $ 4.0).
The pH of commercial nonalcoholic, nondairy bev- Conclusions. This comprehensive pH assessment of
erages ranges from 2.1 (lime juice concentrate) to 7.4 commercially available beverages in the United States
(spring water).10 Commercially available beverages with a found that most are potentially erosive to the dentition.
pH of less than 4.0 are potentially damaging to the Practical Implications. This study’s findings provide
dentition.11 Acids are added to beverages and compose a dental clinicians and auxiliaries with information
flavor profile giving the beverage a distinctive taste. Acids regarding the erosive potential of commercially available
provide a tartness and tangy taste that helps to balance beverages. Specific dietary recommendations for the pre-
the sweetness of sugar present in the beverage; they are vention of dental erosion may now be developed based on
key factors in the taste of the beverage. Phosphoric acid is the patient’s history of beverage consumption.
added to cola drinks to impart tartness, reduce growth of Key Words. Erosive potential; commercial beverages;
bacteria and fungi, and improve shelf-life. Citric acid, a pH; dental erosion.
JADA 2016:-(-):---
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Copyright ª 2016 American Dental Association. All rights reserved.

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 ORIGINAL CONTRIBUTIONS

TABLE 1 TABLE 1 (CONTINUED)

pH of waters and sports drinks.*
WATERS AND SPORTS DRINKS pH (STANDARD WATERS AND SPORTS DRINKS pH (STANDARD
DEVIATION) DEVIATION)
Extremely Erosive Vidration Vitamin Enhanced Water Defense 2.92 (0.01)
Activ Water Focus Dragonfruit 2.82 (0.04) Pomegranate-Acai-Blueberry

Activ Water Vigor Triple Berry 2.67 (0.01) Vidration Vitamin Enhanced Water Energy 2.91 (0.01)
Tropical Citrus
Gatorade Frost Riptide Rush 2.99 (0.01)
Vidration Vitamin Enhanced Water Multi-V 3.59 (0.01)
Gatorade Lemon-Lime 2.97 (0.01) Lemon Lime
Gatorade Orange 2.99 (0.00) Vidration Vitamin Enhanced Water Recover 3.61 (0.01)
Powerade Fruit Punch 2.77 (0.01) Fruit Punch
Powerade Grape 2.77 (0.01) Vitamin Water Connect Black Cherry-Lime 2.96 (0.01)
Powerade Lemon Lime 2.75 (0.01) Vitamin Water Dwnld Berry-Cherry 3.04 (0.01)
Powerade Mountain Berry Blast 2.82 (0.01) Vitamin Water Energy Tropical Citrus 3.15 (0.01)
Powerade Orange 2.75 (0.02) Vitamin Water Essential Orange-Orange 3.23 (0.00)
Powerade Sour Melon 2.73 (0.00) Vitamin Water Focus Kiwi-Strawberry 3.04 (0.01)
Powerade Strawberry Lemonade 2.78 (0.01) Vitamin Water Multi-V Lemonade 3.19 (0.01)
Powerade White Cherry 2.81 (0.01) Vitamin Water Power C Dragonfruit 3.05 (0.00)
Powerade Zero Grape 2.97 (0.01) Vitamin Water Revive Fruit Punch 3.65 (0.01)
Powerade Zero Lemon Lime 2.92 (0.00) Vitamin Water Spark Grape-Blueberry 3.19 (0.01)
Powerade Zero Mixed Berry 2.93 (0.01) Vitamin Water XXX Acai-Blueberry- 2.98 (0.01)
Pomegranate
Powerade Zero Orange 2.93 (0.01)
Vitamin Water Zero Go-Go Mixed Berry 3.08 (0.01)
Erosive
Vitamin Water Zero Mega C Grape-Raspberry 3.05 (0.00)
Activ Water Power Strawberry Kiwi 3.38 (0.03)
Vitamin Water Zero Recoup Peach-Mandarin 3.01 (0.01)
Clear American (flavored water) Kiwi 3.70 (0.01)
Strawberry Vitamin Water Zero Rise Orange 3.46 (0.00)
Clear American (flavored water) Pomegranate 3.24 (0.01) Vitamin Water Zero Squeezed Lemonade 3.19 (0.00)
Blueberry Acai Vitamin Water Zero XXX Acai-Blueberry- 3.05 (0.01)
Clear American (flavored water) Tropical Fruit 3.07 (0.01) Pomegranate
Clear American (flavored water) White Grape 3.43 (0.01) Minimally Erosive
Dasani Grape 3.05 (0.01) Aquafina regular 6.11 (0.23)
Dasani Lemon 3.03 (0.01) Birmingham, Alabama, municipal water 7.20 (0.05)
Dasani Strawberry 3.03 (0.01) Dasani regular 5.03 (0.04)
Gatorade Blueberry Pomegranate Low Calorie 3.21 (0.01) Perrier carbonated mineral water 5.25 (0.10)
Gatorade Fierce Grape 3.05 (0.00)
Gatorade Fierce Melon 3.05 (0.00) substance naturally occurring in citrus drinks and added
Gatorade Fruit Punch 3.01 (0.01) to many others, imparts a tangy flavor and functions as a
Gatorade Rain Berry 3.17 (0.01) preservative. Malic acid occurs naturally in apples, pears,
Gatorade Rain Lime 3.19 (0.01) and cherries, and is added to many noncarbonated
Gatorade Rain Strawberry Kiwi 3.17 (0.01) beverages such as fruit drinks, fortified juices, sports
Propel Berry 3.01 (0.00) drinks, and iced teas because it enhances the intrinsic
Propel Grape 3.10 (0.01) flavor. Malic acid also is added to artificially sweeten
Propel Kiwi Strawberry 3.17 (0.00) carbonated beverages to intensify taste and reduce the
Propel Lemon 3.03 (0.00) amount of other added flavorings. These additives give
S. Pellegrino Sparkling Natural Mineral Water 4.96 (0.09) the beverage its distinctive sugar and acid signature taste.
Skinny Water Acai Grape Blueberry 3.81 (0.02) Dental erosion is the irreversible acidic dissolution of
Skinny Water Goji Fruit Punch 3.67 (0.01) surface tooth structure by chemical means in the absence
Skinny Water Raspberry Pomegranate 3.68 (0.01) of microorganisms. It primarily occurs when hydrogen
Sobe Life Water Acai Fruit Punch 3.22 (0.01) ions interact with the surface fluorapatite and hydroxy-
Sobe Life Water Blackberry Grape 3.15 (0.01) apatite crystals after diffusion through plaque-pellicle
Sobe Life Water Cherimoya Punch 3.28 (0.00) biofilm—a process termed proton-promoted dissolu-
Sobe Life Water Fuji Apple Pear 3.53 (0.01) tion.12 Erosion may initially progress through the enamel
Sobe Life Water Mango Melon 3.29 (0.01)
Sobe Life Water Strawberry Dragonfruit 3.32 (0.01)
* For manufacturer information, please see the Appendix (available ABBREVIATION KEY. NIDCR: National Institute of Dental
online at the end of this article). and Craniofacial Research.

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TABLE 2 TABLE 2 (CONTINUED)

pH of fruit juices and fruit drinks.*
FRUIT JUICES pH (STANDARD FRUIT JUICES pH (STANDARD
DEVIATION) DEVIATION)
Extremely Erosive Minimally Erosive
Lemon juice 2.25 (0.01) Campbell’s Tomato Juice 4.01 (0.01)
Minute Maid Cranberry Apple Raspberry 2.79 (0.01) Naked Protein Zone 4.69 (0.01)
Minute Maid Cranberry Grape 2.71 (0.01) Tropicana Orange Juice (With Calcium) 4.09 (0.01)
Ocean Spray Cranberry 2.56 (0.00) V8 Vegetable Juice 4.23 (0.01)
Ocean Spray Cran-Grape 2.79 (0.01) V8 Vegetable Juice Low Sodium 4.17 (0.01)
Ocean Spray Cran-Pomegranate 2.72 (0.01) V8 Vegetable Juice Spicy Hot 4.19 (0.00)
Ocean Spray Strawberry Kiwi Juice Cocktail 2.90 (0.01) FRUIT DRINKS pH (STANDARD
V8 Splash Berry Blend 2.94 (0.01) DEVIATION)
V8 Splash Strawberry Kiwi 2.99 (0.01) Extremely Erosive
V8 Splash Tropical Blend 2.93 (0.00) Barber’s Lemonade 2.69 (0.00)
Erosive Barber’s Orange Drink 2.96 (0.00)
Amp Energy Juice Mixed Berry 3.62 (0.01) Bug Juice Berry Raspberry 2.99 (0.01)
Amp Energy Juice Orange 3.60 (0.01) Bug Juice Grapey Grape 2.83 (0.00)
Barber’s Orange Juice 3.81 (0.01) Country Time Lemonade 2.72 (0.01)
Dole Pineapple Juice 3.40 (0.01) Crystal Light Fruit Punch 2.96 (0.02)
Juicy Juice Apple 3.64 (0.01) Crystal Light Raspberry Ice 2.77 (0.01)
Juicy Juice Berry 3.78 (0.01) Hi-C Tropical 2.81 (0.03)
Juicy Juice Sparkling Apple 3.47 (0.01) Kool-Aid Mix Cherry 2.71 (0.00)
Juicy Juice Sparkling Berry 3.50 (0.01) Kool-Aid Mix Grape 2.83 (0.01)
Juicy Juice Sparkling Orange 3.49 (0.01) Kool-Aid Mix Lemon-Lime 2.73 (0.01)
Minute Maid Apple Juice 3.66 (0.01) Kool-Aid Mix Orange 2.77 (0.01)
Minute Maid Natural Energy Mango 3.34 (0.02) Kool-Aid Mix Pink Lemonade 2.66 (0.01)
Tropical Kool-Aid Mix Tropical Punch 2.69 (0.00)
Minute Maid Natural Energy Pomegranate 3.33 (0.01) Minute Maid Fruit Punch 2.86 (0.00)
Berry
Minute Maid Lemonade 2.57 (0.01)
Minute Maid Natural Energy Strawberry 3.40 (0.01)
Kiwi Minute Maid Orangeade 2.85 (0.00)
Minute Maid Orange Juice 3.82 (0.01) Minute Maid Pink Lemonade 2.59 (0.00)
Minute Maid Pineapple Orange 3.71 (0.01) Simply Lemonade 2.61 (0.01)
Minute Maid Ruby Red Grapefruit Juice 3.07 (0.03) Snapple Kiwi Strawberry 2.77 (0.01)
Naked Blue Machine 3.81 (0.01) Snapple Mango Madness 2.89 (0.01)
Naked Orange Mango 3.75 (0.01) Sobe Black and Blueberry Brew 2.69 (0.00)
Ocean Spray Orange Juice 3.83 (0.01) Sobe Citrus Energy 2.63 (0.00)
Ocean Spray Pineapple Peach Mango 3.64 (0.01) Sobe Power Fruit Punch 2.43 (0.02)
Juice Blend Sobe Strawberry Banana 2.62 (0.01)
Ocean Spray Ruby Red 3.07 (0.01) Sun Fresh Lemonade 2.68 (0.01)
Simply Apple 3.67 (0.01) Sunny D Smooth 2.92 (0.01)
Simply Orange Orange Juice 3.78 (0.00) Sunny D Tangy Original 2.86 (0.01)
Tango Energy Juice 3.47 (0.00) Tropicana Cranberry Cocktail 2.70 (0.01)
Tropicana 100% Juice Apple Juice 3.50 (0.02) Tropicana Juice Beverage Cranberry 2.59 (0.00)
Tropicana 100% Juice Orange Juice 3.80 (0.01) Tropicana Juice Beverage Grape 2.58 (0.00)
Tropicana Apple Orchard Style Juice 3.57 (0.00) Tropicana Lemonade 2.70 (0.01)
Tropicana Grape Juice 3.29 (0.01) Tropicana Twister Blue Raspberry Rush 2.62 (0.00)
V8 Fusion Cranberry Blackberry 3.56 (0.01) Tropicana Twister Cherry Berry Blast 2.63 (0.00)
V8 Fusion Pomegranate Blueberry 3.66 (0.00) Tropicana Twister Orange Strawberry 2.89 (0.01)
V8 Fusion Strawberry Banana 3.66 (0.00) Banana Burst
Very Fine Grapefruit Juice 3.22 (0.03) Tropicana Twister Strawberry Kiwi Cyclone 2.59 (0.01)
Welch’s 100% Grape Juice 3.38 (0.00) Welch’s Blueberry Kiwi Blast 2.57 (0.01)
Welch’s Apple Juice 3.57 (0.01) Welch’s Cranberry 2.59 (0.02)
Welch’s Orange Juice 3.73 (0.00) Welch’s Grape Juice Cocktail 2.92 (0.01)
* For manufacturer information, please see the Appendix (available Welch’s Ruby Red Grapefruit Juice 2.97 (0.01)
online at the end of this article).

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 ORIGINAL CONTRIBUTIONS

TABLE 2 (CONTINUED) that becomes quite susceptible to removal by abrasion

and attrition.15
The frequent consumption of acidic beverages is a
FRUIT DRINKS pH (STANDARD developing problem for children, teenagers, and adults.
DEVIATION)
The dramatic increase in consumption of acidic soft
Erosive
drinks, fruit juices, fruit drinks, sports drinks, and
Barber’s Fruit Punch 2.96 (0.00)
carbonated beverages is now thought to be the leading
Bug Juice Fruity Punch 3.09 (0.00)
cause of dental erosion observed among children and
Bug Juice Leapin Lemonade 3.06 (0.00)
adolescents.16-18 A literature review of dental erosion in
Bug Juice Whistlin Watermelon 3.40 (0.01)
children indicates its prevalence may range from 10% to
CapriSun Surfer Cooler 3.08 (0.00)
80%.19 Primary teeth, having a thinner enamel layer,
Crystal Light Green Tea Raspberry Mix 3.11 (0.02)
are more susceptible to rapid erosion into dentin,
Fuze Banana Colada 3.45 (0.03)
leading to exposure of the dental pulp.19 It is evident that
Fuze Blueberry Raspberry 3.20 (0.01)
erosion causes many clinical problems, with restorative
Fuze Green Tea Honey and Ginseng 3.28 (0.02)
treatment becoming necessary to replace lost tooth
Fuze Orange Mango 3.34 (0.02)
structure, eliminate dental pain, and restore function and
Fuze Peach Mango 3.53 (0.01)
esthetics.
Fuze Strawberry Banana 3.54 (0.01)
Research has indicated pH, not titratable acidity, is
Fuze Strawberry Guava 3.55 (0.02)
the critical determinant of a beverage’s erosive poten-
Fuze Strawberry Melon 3.18 (0.01)
tial.10,19-24 Citrate may also contribute to dental erosion
Fuze Tropical Punch 3.17 (0.01)
by removing calcium ions through ligand-promoted
Jumex Guava 3.38 (0.02)
dissolution (chelation) at a higher pH approaching 6.12
Jumex Mango 3.41 (0.01)
The purpose of this study is to determine the
Jumex Peach 3.33 (0.02)
hydrogen ion concentration (pH) of beverages including
Jumex Strawberry Banana 3.68 (0.01)
new products that are commercially available in US
Kool-Aid Burst (Tropical) 3.07 (0.01)
stores, gas stations, and vending machines. Information
Little Hug Grape 3.09 (0.01)
obtained from this study will enable dental care practi-
Little Hug Orange 3.00 (0.01)
tioners to make appropriate dietary beverage suggestions
Mondo (Legendary Berry) 3.07 (0.01)
when counseling patients on the damaging effects of acid
Mondo (Primo Punch) 3.10 (0.01)
in drinks.
Sesame Street Elmo’s Punch 3.87 (0.01)
Sobe Fuji Apple Cranberry (low calorie) 3.16 (0.01) METHODS
Sobe Orange Carrot 3.34 (0.00)
We purchased nonalcoholic, nondairy beverages from
Sobe Pina Colada 3.25 (0.01)
convenience stores, grocery stores, gas stations, and
TumE Yummies Fruitabulous Punch 3.35 (0.00)
vending machines in the Birmingham, Alabama, area.
TumE Yummies Orangearific 3.34 (0.01)
We studied and categorized a total of 379 beverages.
TumE Yummies Soursational Raspberry 3.18 (0.00)
Groups included waters and sport drinks (Table 1); juices
TumE Yummies Very Berry Blue 3.33 (0.00)
and fruit drinks (Table 2); sodas (Table 3); and energy
Vitamin Stix Dragonfruit Acai 3.11 (0.01)
drinks, teas, and coffee (Table 4). We used an Accumet
Vitamin Stix Passionfruit Citrus 3.19 (0.01)
AR15 pH meter (Fisher Scientific) to measure the pH of
Vitamin Stix Strawberry Kiwi 3.06 (0.01)
each beverage in triplicate immediately after opening at a
Welch’s Orange Pineapple 3.20 (0.01)
temperature of 25
C. We recorded the pH data as range
Welch’s Strawberry Kiwi 3.03 (0.01)
and mean (standard deviation [SD]). Nutritional infor-
mation labels on the containers were used to determine
lamellae, exposing dentinal tubules leading to dentinal the type of acids added to the beverages.
sensitivity; however, with continuous erosive insult to the
surface enamel, larger areas of the dentoenamel junction RESULTS
will eventually become exposed, leading to enhanced All pH data were expressed as range and mean (SD).
sensitivity.7,13,14 As the oral cavity pH drops to less than Seventy waters and sports drinks had a pH range of 2.67
4.0, the tooth surface erodes, and with each unit of to 7.20 and a mean (SD) value of 3.31 (0.77) (Table 1).
decrease in pH there is a 10-fold increase in enamel Fifty-one juices had a pH range of 2.25 to 4.69 and a
solubility resulting in a 100-fold increase in enamel mean (SD) value of 3.48 (0.47) (Table 2). Seventy-eight
demineralization as the pH approaches 2.0 from 4.0.11 fruit drinks had a pH range of 2.43 to 3.87 and a mean
Importantly, the consumption of beverages with higher (SD) value of 2.99 (0.31) (Table 2). Ninety-four sodas had
concentrations of available hydrogen ions (pH < 4.0) a pH range of 2.32 to 5.24 and a mean (SD) value of 3.12
results in the immediate softening of the tooth surface (0.52) (Table 3). Sixty-eight energy drinks had a pH range

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TABLE 3 TABLE 3 (CONTINUED)

pH of sodas.*
SODA pH (STANDARD SODA pH (STANDARD
DEVIATION) DEVIATION)
Extremely Erosive Erosive
7UP Cherry 2.98 (0.01) 7UP 3.24 (0.02)
Boylan’s Black Cherry 2.76 (0.02) 7UP Diet 3.48 (0.00)
Boylan’s Grape 2.91 (0.01) A&W Cream Soda 3.86 (0.01)
Boylan’s Sugar Cane Cola 2.54 (0.01) Ale 8-One 3.13 (0.01)
Canada Dry Ginger Ale 2.82 (0.01) Boylan’s Orange Cream 3.59 (0.01)
Coca-Cola Caffeine Free 2.34 (0.03) Boylan’s Orange Soda 3.22 (0.00)
Coca-Cola Cherry 2.38 (0.03) Boylan’s Original Birch Beer 3.80 (0.00)
Coca-Cola Cherry Zero 2.93 (0.01) Buffalo Rock Ginger Ale 3.23 (0.01)
Coca-Cola Classic 2.37 (0.03) Coca-Cola Caffeine Free Diet 3.04 (0.01)
Coca-Cola Lime Diet 2.96 (0.03) Coca-Cola Diet 3.10 (0.05)
Coca-Cola Zero 2.96 (0.03) Dr Pepper Cherry 3.06 (0.02)
Crush Grape 2.76 (0.01) Dr Pepper Diet 3.20 (0.00)
Crush Orange 2.87 (0.01) Dr Pepper Diet Cherry 3.32 (0.01)
Dr. Pepper 2.88 (0.04) Fresca (1 liter) 3.08 (0.01)
Fanta Grape (2 liter) 2.67 (0.02) Grapico Diet 3.04 (0.01)
Fanta Orange 2.82 (0.02) Hansen’s Cane Soda Black Cherry Diet 3.47 (0.02)
Fanta Pineapple (2 liter) 2.79 (0.02) Hansen’s Cane Soda Creamy Root Beer 3.73 (0.01)
Fanta Strawberry 2.84 (0.01) Diet

Grapico 2.77 (0.03) Izze Sparkling Blackberry 3.28 (0.01)

Hansen’s Cane Soda Cherry Vanilla 2.91 (0.01) Izze Sparkling Clementine 3.27 (0.01)
Crème Izze Sparkling Pomegranate 3.01 (0.01)
Hansen’s Cane Soda Kiwi Strawberry 2.59 (0.01) Jones Cream Soda 3.04 (0.01)
Hansen’s Cane Soda Mandarin Lime 2.57 (0.01) Jones Red Apple 3.40 (0.02)
Hansen’s Cane Soda Pomegranate 2.55 (0.00) Jones Root Beer 3.42 (0.02)
Hawaiian Punch (Fruit Juicy Red) 2.87 (0.01) Mellow Yellow 3.03 (0.00)
Jolly Rancher Grape 2.60 (0.01) Mountain Dew (regular) 3.22 (0.07)
Jolly Rancher Orange 2.88 (0.01) Mountain Dew Code Red 3.27 (0.01)
Jones Blue Bubblegum 2.99 (0.01) Mountain Dew Diet 3.18 (0.01)
Jones Green Apple Soda 2.65 (0.01) Mountain Dew Voltage 3.05 (0.01)
Jones Mandarin Orange 2.93 (0.00) Mug Root Beer 3.88 (0.02)
Jones M.F. Grape 2.89 (0.02) Pepsi Diet 3.02 (0.01)
Jones Orange & Cream Soda 2.79 (0.01) Sierra Mist 3.09 (0.02)
Jones Strawberry Lime 2.81 (0.02) Sierra Mist Diet 3.31 (0.01)
Mr. Pibb Xtra 2.80 (0.01) Sprite 3.24 (0.05)
Natural Brew Draft Root Beer 2.90 (0.00) Sprite Zero 3.14 (0.01)
Pepsi 2.39 (0.03) Sunkist Diet 3.49 (0.01)
Pepsi Max 2.74 (0.01) Sunkist Solar Fusion Tropical Mandarin 3.02 (0.01)
Pepsi Max Ceasefire 2.70 (0.01) Welch’s Grape Soda 3.11 (0.02)
Pepsi Wild Cherry 2.41 (0.03) Minimally Erosive
RC Cola 2.32 (0.02) A&W Root Beer 4.27 (0.02)
Schweppes Tonic Water 2.54 (0.03) A&W Root Beer Diet 4.57 (0.00)
Sunkist Orange 2.98 (0.01) Barq’s Root Beer 4.11 (0.02)
Sunkist Peach 2.89 (0.01) Boylan’s Creme Soda 4.17 (0.02)
Sunkist Strawberry 2.99 (0.01) Boylan’s Diet Black Cherry 4.00 (0.01)
Tab 2.72 (0.01) Boylan’s Diet Root Beer 4.05 (0.02)
Vault 2.77 (0.02) Boylan’s Root Beer 4.01 (0.01)
Vault Red Blitz 2.80 (0.01) Canada Dry Club Soda 5.24 (0.03)
Vault x 2.89 (0.03) IBC Root Beer 4.10 (0.02)
* For manufacturer information, please see the Appendix (available Maine Root Root Beer 4.36 (0.02)
online at the end of this article).

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TABLE 4 TABLE 4 (CONTINUED)

pH of energy drinks and teas and
coffee.* ENERGY DRINKS pH (STANDARD
DEVIATION)
ENERGY DRINKS pH (STANDARD
DEVIATION) Monster Low Carb 3.60 (0.01)
Extremely Erosive Monster M-80 3.29 (0.00)
24:7 Energy Cherry Berry 2.61 (0.01) Monster MIXXD 3.35 (0.00)

180 Blue Orange Citrus Blast 2.82 (0.00) Nitrous Monster Anti-Gravity 3.64 (0.01)
180 Blue With Acai 2.82 (0.01) Nitrous Monster Killer B 3.31 (0.00)
5-Hour Energy Berry 2.81 (0.03) Nitrous Monster Super Dry 3.46 (0.00)

5-Hour Energy Extra Strength 2.82 (0.00) No Fear Sugar Free 3.06 (0.01)

5-Hour Energy Lemon-Lime 2.81 (0.00) NOS Fruit Punch 3.32 (0.00)
Amp Energy Elevate 2.79 (0.01) NOS Grape 3.27 (0.01)
Amp Energy Overdrive 2.78 (0.01) NOS High Performance Energy Drink 3.31 (0.01)

Amp Energy regular 2.81 (0.01) NOS Power Shot 3.03 (0.02)
Amp Energy Sugar Free 2.86 (0.01) Redbull regular 3.43 (0.01)
Jolt Blue Bolt 2.96 (0.00) Redbull Shot 3.25 (0.03)

Jolt Passion Fruit 2.82 (0.01) Redbull Sugar Free 3.39 (0.00)
Jolt Power Cola 2.47 (0.01) Redbull Sugar Free Shot 3.28 (0.02)
Meltdown Energy Peach Mango 2.77 (0.00) Redline Xtreme Grape 3.23 (0.01)

No Fear regular 2.97 (0.02) Redline Xtreme Triple Berry 3.24 (0.01)
Orange County Choppers 2.78 (0.02) Redline Xtreme Watermelon 3.41 (0.00)
Purple Stuff Lean 2.87 (0.01) Rhinos Energy Drink 3.51 (0.01)
Redline Peach Mango 2.74 (0.02) Rhinos Sugar Free Energy Drink 3.32 (0.01)

Redline Princess Exotic Fruit 2.85 (0.01) Rockstar Energy Cola 3.14 (0.01)
Redline Triple Berry 2.77 (0.01) Rockstar Juiced Energy þ Guava 3.16 (0.01)
Rockstar Energy Drink 2.74 (0.01) Rockstar Juiced Energy þ Juice Mango 3.05 (0.01)
Orange Passion
Rockstar Punched (Energy þ Punch) 2.83 (0.01)
Rockstar Sugar Free 3.15 (0.03)
Rockstar Recovery 2.84 (0.01)
TEAS AND COFFEE pH (STANDARD
Erosive DEVIATION)
Crunk Citrus 3.20 (0.01)
Extremely Erosive
Crunk Energy Drink 3.31 (0.01)
Admiral Iced Tea Raspberry 2.94 (0.00)
Crunk Grape Acai Energy Drink 3.30 (0.01)
Arizona Iced Tea 2.85 (0.03)
Crunk Low Carb Sugar Free 3.34 (0.00)
Lipton Green Tea With Citrus 2.93 (0.00)
Drank 3.09 (0.01)
Lipton Green Tea With Citrus Diet 2.92 (0.00)
Fuel Energy Shots Lemon Lime 3.97 (0.01)
Nestea Iced Tea With Natural Lemon 2.94 (0.01)
Fuel Energy Shots Orange 3.44 (0.01) Flavor
Full Throttle Blue Agave 3.10 (0.01) Nestea Red Tea Pomegranate and Passion 2.87 (0.01)
Full Throttle Citrus 3.09 (0.01) Fruit
Full Throttle Red Berry 3.08 (0.01) Snapple Peach Tea 2.94 (0.01)
Hydrive Blue Raspberry 3.45 (0.01) Snapple Raspberry Tea 2.92 (0.00)
Hydrive Citrus Burst 3.03 (0.01) Erosive
Hydrive Lemon Lime 3.42 (0.01) Admiral Iced Tea Green Tea 3.72 (0.01)
Hydrive Triple Berry 3.15 (0.01) Admiral Iced Tea Mango 3.41 (0.00)
Jolt Ultra Sugar Free 3.14 (0.00) Admiral Iced Tea Sweet Tea 3.76 (0.01)
Killer Buzz 3.23 (0.01) Arizona Diet Green Tea þ Ginseng 3.29 (0.01)
Killer Buzz Sugar Free 3.36 (0.00) Snapple Diet Raspberry Tea 3.39 (0.02)
Monster Assault 3.58 (0.01) Snapple Diet Peach Tea 3.32 (0.01)
Monster Energy 3.48 (0.01) Minimally Erosive
Monster Hitman Energy Shot 3.44 (0.01) Milo’s Famous Sweet Tea 4.66 (0.02)
Monster Khaos 3.47 (0.01) Milo’s No Calorie Famous Sweet Tea 5.18 (0.03)
* For manufacturer information, please see the Appendix (available Red Diamond Tea Fresh Brewed Sweet 5.04 (0.02)
online at the end of this article). Tea
Starbucks Medium Roast 5.11 (0.05)

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 ORIGINAL CONTRIBUTIONS

of 2.47 to 3.97 and a mean (SD) value of 3.13 (0.29)

(Table 4). Seventeen teas had a pH range of 2.85 to 5.18 1,000
and a mean (SD) value of 3.48 (0.77); coffee had a pH of
5.11 (Table 4). Most beverages tested had a pH lower than 900
4.0 (354 of 379; 93%) (Tables 1-4). Relative beverage
erosivity zones based on data from studies of apatite 800
solubility in acid indicated 39% (149 of 379) of the bev-
erages tested were considered extremely erosive (pH < 700
3.0), 54% (205 of 379) were considered erosive (pH ¼ 3.0-

SOLUBILITY (g/L)
3.99), and 7% (25 of 379) were considered minimally 600
erosive (pH $ 4.0) (Figure25). The most acidic beverages
tested with a pH lower than 2.4 were lemon juice 500
(pH ¼ 2.25), RC Cola (pH ¼ 2.32), Coca-Cola Classic
(pH ¼ 2.37), Coca-Cola Cherry (pH ¼ 2.38), and Pepsi 400
(pH ¼ 2.39). Citric acid, followed by phosphoric acid,
and then malic acid were the most frequently added 300
acids to the drinks tested.
200
DISCUSSION
100
Laboratory studies have determined the pH of beverages
for human consumption.6,10,22,24,26-29 Our study deter-
0
mined the pH of 379 beverages available to the US 2 3 4 5 6
consumer and is the most comprehensive in terms of
pH
beverage numbers and diversity. An increase in beverage
diversity in the marketplace probably accounts for the Extremely Erosive Erosive Minimally Erosive
large number of beverages procured.
Our results are consistent with reported beverage
pH values by other investigators. For example, we Figure. Erosion zones based on theoretical solubility of apatite as a
determined the pH of Coca-Cola was 2.37 (Table 3) as function of pH. g: Grams. L: Liters. Adapted with permission of S. Karger
compared with 2.46,21 2.45,24 2.48,26 2.53,30 2.39,22 2.40,25 AG from Larsen and Nyvad.25

2.49,31 and 2.5328; the pH of Schweppes Tonic Water was

2.54 (Table 3) as compared with 2.506 and 2.4825; the pH Teeth erode in the pH range of 2.0 to 4.0, although
of Gatorade Lemon-Lime was 2.97 (Table 1) as compared surface enamel starts to demineralize as the pH drops to
with 2.93,31 2.95,27 3.01,21 2.90,10 3.08,29 3.17,24 and 3.2922; less than 5.5 when the external milieu of the oral cavity
the pH of Pepsi was 2.39 (Table 3) as compared with becomes undersaturated for hydroxyapatite.35 Apatite
2.53,25 2.36,22 2.39,24 2.30,10 2.46,26 and 2.5328; and the pH solubility studies indicate a logarithmic increase in
of apple juice was 3.57 and 3.66 (Table 2) as compared apatite solubility as pH drops under laboratory equilib-
with 3.60,10 3.41,24 and 3.60.32 rium conditions as can be seen in the solubility curve
The pH of extrinsic solutions (dietary beverages) (Figure).25,36 Apatite solubility above pH 4.0 is minimal; a
coming into contact with the dentition appears to be drop of 1 unit to 3.0 results in a 10-fold increase in apatite
the main determinant of dental erosion; the hydrogen solubility. Moreover, as pH drops from 3.0 to 2.0 there
ion concentration or acidity, as measured in pH, is is an increase in apatite solubility that approaches 1,000
primarily responsible for the immediate dissolution grams per liter (Figure). Based on the apatite solubility
and softening of surface tooth structure (erosive po- curve in the figure, we propose that the chemical erosive
tential) by acidic beverages composed of weak acids, potential of beverages be segregated into 3 zones:
for example, citric and phosphoric acid.10,12,19-24 The - extremely erosive: pH lower than 3.0;

titratable acidity or buffer capacity—intrinsic to these - erosive: pH 3.0 to 3.99;

acids—does not play as critical a role in dental erosion - minimally erosive: pH more than or equal to 4.0.

as pH because of the limited time exposure the denti- Furthermore, the relative erosivity zones (extremely
tion has with ingested liquids during each drinking erosive, erosive, minimally erosive) of 379 beverages as
and swallowing episode.19,20,22,33,34 Therefore, pH or determined by pH testing indicated 39% (149 of 379) were
hydrogen ion concentration (acidity) at the time of extremely erosive (pH < 3.0), 54% (205 of 379) were
dental exposure is the important chemical parameter erosive (pH ¼ 3.0-3.99), and 7% (25 of 379) were mini-
to assess when determining the erosive potential of mally erosive (pH $ 4.0). Although apatite solubility as a
beverages. function of pH is on a continuum, the segregation of

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 ORIGINAL CONTRIBUTIONS

erosive potential into 3 discrete zones would be helpful to CONCLUSIONS

the dental clinician when providing a dietary guide of Studies suggest that pH is the primary determinant of
relative beverage erosivity to the patient. The prevailing beverage erosive potential. We determined the pH of 379
paradigm for dental erosion remains: as the pH of the nonalcoholic, nondairy beverages and assessed them for
oral milieu decreases, the solubility of apatite on the relative erosivity. Relative beverage erosivity zones based
tooth surface increases logarithmically.11 on previous studies of apatite solubility in acid indicated
Dental erosion from beverages is primarily caused 39% (149 of 379) of the beverages tested were considered
by phosphoric acid and citric acid; both are triprotic extremely erosive (pH < 3.0), 54% (205 of 379) were
acids with 3 available hydrogen ions, enabling proton- considered erosive (pH ¼ 3.0-3.99), and 7% (25 of 379)
promoted dissolution.12,37 Chelation or ligand-promoted were considered minimally erosive (pH $ 4.0). The most
dissolution by anionic citrate contributes to enamel acidic beverages tested with a pH of less than 2.4 were
demineralization by the removal of calcium ions at a lemon juice (pH ¼ 2.25), RC Cola (pH ¼ 2.32), Coca-
higher pH range approaching 6.12 At the erosive pH of Cola Classic (pH ¼ 2.37), Coca-Cola Cherry (pH ¼ 2.38),
3, only 3% of citrate ions are appropriately ionized to and Pepsi (pH ¼ 2.39). Information obtained from this
chelate calcium ions, indicating their contribution to study will enable dental care practitioners to make
the erosive process at this pH is minimal.38 However, if appropriate dietary suggestions when counseling patients
anionic citrate were to remain within the oral cavity for about the damaging dental effects of acids in the bever-
extended time intervals, allowing the pH to rise to 6, ages they drink. n
chelation could play a contributing role in the erosive
process. For example, the eating of citrus fruits more than SUPPLEMENTAL DATA
twice a day has been associated with dental erosion.39 Supplemental data related to this article can be found at:
Nevertheless, high concentrations of hydrogen ions http://dx.doi.org/10.1016/j.adaj.2015.10.019.
reflected by low pH from citric or phosphoric acid results
in undersaturation for both fluor- and hydroxyapatite, Dr. Reddy is a resident, Department of Pediatric Dentistry, School of
leading to dental erosion. Hence, pH is the controlling Dentistry, The University of Alabama at Birmingham, Birmingham, AL.
parameter in determining the erosive potential of Dr. Norris is a resident, Department of Orthodontics, School of Dentistry,
beverages.11,19-24
The University of Alabama at Birmingham, Birmingham, AL.
Ms. Momeni is a graduate student, Department of Pediatric Dentistry,
Knowledge of beverage pH is essential for the devel- School of Dentistry, The University of Alabama at Birmingham, LHRB
opment of preventive strategies for patients with clinical Room 238, 1720 2nd Avenue South, Birmingham, AL 35294-0007, e-mail
erosion.7,40,41 The elimination of extremely erosive drinks [email protected]. Address correspondence to Dr. Momeni.
Dr. Waldo is an assistant professor, Department of General Dentistry,
(pH < 3.0), minimizing erosive drinks (pH ¼ 3.0-3.99), School of Dentistry, The University of Alabama at Birmingham, Birming-
and substituting drinks with a (pH $ 4.0) would be ham, AL.
Dr. Ruby is a professor, Department of Pediatric Dentistry, School of
prudent advice for the prevention of erosion. Fluoride Dentistry, The University of Alabama at Birmingham, Birmingham, AL
does not prevent erosion because highly acidic environ-
ments solubilize fluorapatite and calcium fluoride.35,42,43 Disclosure. None of the authors reported any disclosures.
Xerostomic conditions exacerbate the erosive process This study was supported by Mary MacDougall, PhD, associate dean for
from lack of saliva essential for the dilution and buffering research and professor, director, Institute of Oral Health Research, Bir-
of hydrogen ions in the oral cavity.39,44 The primary mingham, AL, and training grant T32-DE017607 from the National Institute
dentition of children is highly susceptible to the erosive of Dental and Craniofacial Research (NIDCR). Ms. Momeni is a Dental
Academic Research Training Predoctoral Fellow under NIDCR institutional
process and low pH beverages should not be placed in a grant T-90 DE022736.
baby bottle, especially at sleep time when the mouth is
xerostomic. Athletes may have decreased salivary flow The authors thank Mr. David Fisher, Medical Education and Design
Services, The University of Alabama at Birmingham, Birmingham, AL, for
rates due to dehydration from profuse sweating after the design and production of the figure and tables. The authors also thank
prolonged, intense physical activity and should rehydrate Karger AG, Basel, Switzerland, for granting us copyright permission for the
with water.45 Geriatric patients taking medications with adaptation of the figure.
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