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148 WINES&VINES January 2018 WINEMAKING PRACTICAL WINERY & VINEYARD T asting 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 winemak- ers 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 ad- dresses some of the dental issues relevant to wine industry personnel as well as preventa- tive 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 ex- perience 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 demineral- ization 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 break- down 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 protec- tive 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 in- hibit 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 medica- tions (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 (min- eral loss)/remineralization (mineral gain) bal- ance 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 phos- phate) or high-concentration sodium fluo- ride 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 min- utes. 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% fluo- ride mouth rinse. Spit out after two minutes. Tooth Care for Wine Professionals Protect your teeth against occupational hazards By Geoff Cowey and Dr. Sarbin Ranjitkar KEY POINTS Wine tasting is an important part of wine production; however, it can also be an oc- cupational hazard, with winemakers and wine judges being more susceptible than the general population to a range of dental issues. This article describes some effects that frequent wine tasting can have on dental health, and a range of measures that can be taken to reduce the risks of damage to teeth from wine tasting.