In August, 1999, a 47-year-old female patient of mine, Mrs.”X”, visited for her nine-month regular continuing care appointment. An update of her medical history showed her in good health, taking no medications. She stated, however, that she was experiencing a “dry mouth” and was dieting to lose weight. Another concern was her “two front teeth” which seemed to be getting “thinner” and the incisal edges were chipping (see Figs. 1 & 2). An examination revealed little enamel was left on the lingual surfaces of the front incisors (see Fig. 2). They were also sensitive to cold. I suggested she see her physician regarding her dry mouth. I asked if she was bulimic or regurgitated her food to aid her dieting. The answer was negative. I gave her appointments for two crowns on #11 & 21. After insertion of the crowns we booked her a nine-month recall.
Mrs. “X” visited my office seven months later on June 19th, 2000, complaining of a lost filling and toothache in tooth #15 (see Fig. 3). She also complained of sensitivity in all her teeth, especially to cold, and that her “gums” were sore and “burned”. An update of her medical noted she had been diagnosed as having Sjogrens Syndrome. Oral examination and x-rays revealed an abscessed tooth #15, inflamed gingival tissues, and severe deterioration of her enamel since I had seen her seven-month’s earlier. The enamel was badly eroded yet there was no decay. I was puzzled and dismayed to see that from the second molars forward, maxillary and mandibular, there was little to no enamel left on her teeth. The amalgam fillings on her first molars were protruding out from the dentine 1/2 to 11/2 millimeters (see Figs. 3-6).
I again asked her if she was bulimic or had been regurgitating her food. She said emphatically, “N0”! I promised to phone her physician to find out what was in her medication. (She was taking five pills a day for her Sjogrens Syndrome). I felt the loss of enamel must have some relationship to the Sjogrens Syndrome and/or her dieting. When I talked to her physician I asked him if he thought she was bulimic and he replied that there was no indication that she was. He said there was nothing in her medication to cause such a problem. He had treated similar patients before and never had such a severe side effect. When I had finished the root canal on tooth #15 (see Fig. 7) I had another consultation with Mrs. “X” and asked her to record everything she ate or drank for a week and we would try to find what was causing the problem. The following week she returned, declaring, “Doctor, I know what is causing my problem! I have been using a lot of artificial sweetener, especially in my coffee, because of my dieting. After reading the label on the artificial sweetener bottle I noticed that its ingredients include sodium cyclamate and carbolic acid.” She informed me that as soon as she stopped using the artificial sweetener the soreness in her gums disappeared and her teeth became less sensitive to cold. Then Mrs. “X” requested that I replace the remaining dentition to its original shape, form, and function. Besides the two crowns I had done previously, and over a period of several months I restored the rest of her severely damaged teeth (see Figs. 8-12). Mrs. “X” does not use artificial sweetener any more, and when I saw her recently she reported that her teeth and gums looked and felt great. A real dental detective story with a happy ending!
Artificial sweeteners used by patients with Sjogrens Syndrome may have deleterious effects if they are using them to excess. The reason is that these patients produce little saliva to dilute any acidic ingredients. Although Mrs. “X” stated she never used self-induced vomiting to help her lose weight, the severe attrition of her tooth enamel would suggest some sort of “acid” was responsible. However, I suggest three reasons why her problem was due to the artificial sweetener and not Bulimia.
1. The outer surfaces of her teeth, even the molars, had severe loss of enamel.
2. Since stopping the artificial sweetener she reports her teeth and “gums” feel fine.
3. She emphatically denied any bulimic behavior whatsoever.
4. Testing of the artificial sweetener with blue litmus paper revealed it’s contents to be acidic (blue litmus paper turned red). Therefore because of the above conclusions it seems evident to me that the combination of a dry mouth and excessive use of artificial sweetener caused the rapid deterioration of her dentition.OH
Dr. Matthew Taylor graduated from the University of Alberta in 1963. He served as President of N.P.D.A. (1995-96). He was named Fellow, Academy General Dentistry (1983). He has been in private practice in St. Catharines, ON, since 1967.
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1.Sjorgrens Syndrome: According to Dorland’s Illustrated Medical Dictionary this disease is marked by dryness of all mucous membranes, resulting from deficient secretion of the glands, particularly the lachrymal and salivary glands, those of the upper respiratory tract, the sweat glands and the glands of the stomach. The disease is named after Swedish physician Tage Sjogren (sye’grenz) (1859-1939)
2.Bulimia: Re: Mayo Clinic Family Health Book. 2nd Edition “a condition characterized by binge eating, with or without alternation cycles of purging by self-induced vomiting, fasting, or abuse of laxatives, pills, or diuretics.”