Living at Elevation: Dry Mouth, Sports Drinks, and Sierra Teeth

Oakhurst sits in the Sierra Nevada foothills at the southern gateway to Yosemite, and several ordinary features of life in the area have a bearing on teeth: the source of household water, how long a drink lasts on a trail, and how dry indoor air becomes with a wood stove running all winter.

This is general education about patterns we see in mountain living. What’s happening in your own mouth is something an examination, usually with x-rays, can answer.

Well water and fluoride

Many households in the foothills draw from a private well or a small local water system instead of a large municipal supply. That matters for teeth because fluoride occurs naturally in groundwater at levels that vary from one well to the next. Some wells contain very little. Some contain more than a public system would deliver on purpose. The concentration cannot be judged from the taste, the hardness or a neighboring well.

The only way to know the level is to test the water. Have your water analyzed by a certified laboratory and ask specifically for fluoride, along with whatever else you are testing for. Keep the report, and bring the number with you to your dentist or your child’s physician.

That number matters most for children whose permanent teeth are still forming. Fluoride supplements are prescribed based on the concentration in the water a child drinks daily, the child’s age and what other fluoride sources are already present. Both too little and too much are real considerations, which is why supplements are a prescription decision. Adults benefit from fluoride as well, usually through toothpaste and in-office applications.

Two related points apply. Bottled water often contains little or no fluoride unless the label states otherwise, so a household drinking only bottled water may be getting very little regardless of what the well holds. And many home filters leave fluoride in the water, although reverse osmosis systems and distillation do remove it. If your kitchen has a reverse osmosis tap, mention it at your next visit.

Why dry mouth matters

Saliva performs several protective functions. It rinses food off the teeth, it neutralizes acid after meals, it carries the calcium and phosphate that help repair the earliest stages of damage, and it holds antibacterial proteins. When saliva flow drops, that protection drops with it, and the risk of decay can climb quickly.

Dry mouth in this area usually has ordinary causes. Wood heat and forced air heat pull moisture out of indoor air all winter. Allergy season, a deviated septum or nasal congestion can lead to breathing through the mouth overnight, which leaves the mouth dry by morning. Many common medications list dry mouth as a side effect, including some blood pressure medications, antidepressants, antihistamines and bladder medications, and the effect can compound when someone takes several of them. Alcohol and heavy caffeine can contribute. So can snoring.

Those causes often combine in a mountain climate. Dry indoor air, nasal congestion and a long day outdoors together can leave someone in a low saliva state for hours at a time, which is when teeth lose the protection they normally have between meals.

If you think a medication is drying your mouth, ask your physician or pharmacist about it. Any change to a prescription is a decision to make with them.

Measures that can help: a humidifier in the bedroom during heating season, water at the bedside, having persistent nasal congestion evaluated, sugar free gum after meals to keep saliva moving, and a review of your medication list at your next dental appointment. Over the counter dry mouth rinses and gels suit some people, and a pharmacist can describe what is available. If your mouth is persistently dry, mention it at an exam and cleaning, because it can change what is recommended for home care and how often you are seen.

How long a drink lasts

The timing of a drink matters as much as its contents. Every time you drink something sweetened or acidic, the surface of the teeth turns acidic for a while afterward, and saliva slowly brings it back. Teeth tolerate that recovery cycle well when it happens a few times a day. A cycle that never completes is a different matter. A sports drink sipped over three hours on a trail keeps the mouth acidic for much of those three hours. The same bottle finished in ten minutes at the trailhead does far less. The amount of sugar is the same in both cases. The difference is how long the teeth spend in the acidic state.

The same pattern appears in many daily routines: the energy drink that lasts a whole workday, the sweetened iced coffee that lasts all morning, the soda refilled through an afternoon at the lake, the water bottle mixed with electrolyte powder on a hot afternoon.

Sports drinks and energy drinks are often acidic in their own right, separately from their sugar, and so are citrus flavored waters, kombucha and sparkling waters with added flavoring. Acid alone can wear enamel without bacterial involvement. That is erosion, and it looks different from decay: the biting edges of front teeth can become translucent and thin, cusps flatten into shallow cups, older fillings can begin to sit slightly higher than the tooth surface around them, and teeth can become sensitive to cold. Decay is a bacterial process that damages one spot at a time. Erosion is a chemical process that thins whole surfaces. Both can be present in the same mouth.

Practical changes

• Make water the default for hydration. Reserve electrolyte drinks for periods of heavy exertion, and finish them in one sitting rather than sipping over hours.
• Rinse with water after anything sweet or acidic. It takes a moment and it shortens the acid exposure.
• Allow some time before brushing after acidic drinks, or after reflux or vomiting. Acid can soften the enamel surface temporarily, so rinsing with water first and brushing a while later is a common recommendation.
• Be aware of sticky trail foods. Energy gels, chews, granola bars and dried fruit pack into the grooves of molars and remain there. If you rely on them, carry a small brush, or rinse well when you finish.
• Chew sugar free gum after eating when brushing is not possible. It works by stimulating saliva flow, which is the protection a dry mouth lacks.
• If you have gum recession, pay attention to the exposed root surfaces. Root surface is softer than enamel, wears faster, and is a common site of decay in older adults.

Our preventive dentistry section covers the routine side of this, and the home care page goes through products and technique.

Prevention and regular visits

Prevention carries more weight when the drive to an appointment is a long one. Small problems found at a routine visit are usually simpler and quicker to treat than the same problems found later, and regular exams and cleanings are how they get found in the first place.

In practice, that means a few habits. Keep a regular schedule of exams and cleanings. Clean between your teeth daily. Mention new sensitivity, a rough edge or a change in your bite while the problem is small. Ask about a night guard if you clench or grind. The practice sees patients from across the Highway 41 corridor and the surrounding foothills, and the same habits apply in every community. If an urgent problem arises, our dental emergencies page explains what to do first. For a life threatening emergency, call 911 rather than the office.

None of this is an argument against staying hydrated outdoors or carrying a bottle on a hike. The adjustments that help concern what goes in the bottle and how long it takes to finish it, along with having wear patterns examined before they cause symptoms. If it has been some time since your last visit, call (559) 683-4694 or request an appointment, and the first step will be an examination.