Table Clinic

1. WHAT’S INYOUR
WATER?
Megan Simpson
State Fair Community College
Dental Hygiene Program

2. PICO Question
■ Does the pH in bottled water negatively
affect patients’ oral and overall health?

3. Thesis Statement
■ Dental professionals are continuously educating on the
importance of keeping a low acidic diet due to the increased
risk of dental erosion and caries.
■ The purpose of this research project is to determine whether
or not the pH balance in water bottles has adverse effects on
individuals’ oral and overall health.

4. What is pH?
■ pH is “the symbol of hydrogen ion
concentration expressed in numbers
corresponding to the acidity of
alkalinity of an aqueous solution”
(Wilkins, 2017).
■ pH ranges on a scale from 14 which
is pure base, to 0 which is pure acid.
Thus, making 7 the neutral zone.
(Wilkins, 2017).

5. How does pH affect teeth?
Demineralization is the process in which calcium and phosphorus
are removed from the tooth structure by acids
The pH at which demineralization occurs is known as the Critical pH
Enamel: pH 4.5-5.5 Cementum: pH 6.0-7.0
(Wilkins, 2017).

6. Methods &
Materials
This study was a pilot in-vitro study completed to test different
popular brands of water bottles to evaluate their pH values and
whether it matched with what the companies were marketing that
the pH was.
A total of 14 beverages we tested using a calibrated Corning pH
meter model 240.The beverages were selected by a convenience
sample and included; popular brands of bottled water, tap water,
and other beverages that were known to be acidic.
• Ten out of the fourteen beverages tested to be acidic (pH<7)
• Two “tap” waters tested at a neutral (pH=7)
• Two bottles of water tested at an alkaline level (pH<7)
The majority of the waters tested in the lab tested at a lower pH
than what the manufactures had advertised.
(Wright, 2015)

7. (Wright, 2015)

8. Methods & Materials
■ This case study consists of four authors that focused on relieving dry mouth and
how dental professionals recommend a consistent intake of water to help relieve
the symptoms of xerostomia.
■ The authors of this study tested eight different common brands of bottled water.
The pH was determined using the Denver Instruments basic pH meter.They tested
each bottled water 6 times and averaged the results to determine the pH.
– Two of the bottled waters tested had a pH of 5.2 and 5.5
– Six of the bottled waters tested were below a pH of 6.8
■ The results of this study concluded that of the 8 bottles of water that were tested,
all eight of them either fell into the category of critical pH for enamel or for
cementum.The authors emphasized the importance of patient education about the
acidity of many brands of bottled water.They recommended that clinicians discuss
with patients that have xerostomia about the benefits of drinking alkaline water.
(Fisher, et al., 2017)

9. Methods &
Materials
■ This study was completed by dental students
that attended the University of North Carolina at
Chapel Hill.The authors conducted this study to
determine the erosive potential of well water,
bottled water, and vegetable juice.
■ They collected thirteen different brands of
bottled water, fifteen samples of well-water
across the state of NorthCarolina, and nine
different brands of vegetable juice to test the
products titratable acidity (TA).
– Of the thirteen bottles of water, six of them
tested to be within the critical pH of both
enamel and cementum
– Six out of the fifteen samples of well water
also tested within the critical pH range for
both enamel and cementum
– All nine vegetable juices tested within a pH
range of 4.0-4.3
■ The authors concluded by explaining the risk of
dental erosion if there is long-term exposure to
beverages with a low pH.
(Guha, 2015)

10. Methods &
Materials
The authors concluded their study explaining that while there may
still need to be further research about the benefits of an alkaline
diet, they know that there are many benefits already certain.They
emphasized that limiting a diet high in pH may very well be a step in
the right direction.
This next study was a meta-analysis conducted to determine if there
was a relation to an alkaline diet and a reduction in morbidity and
mortality from chronic diseases.The authors found that there may
be potential health benefits to practicing an alkaline diet, such as
Benefits in
bone health
Reduction in
muscle wasting
Improvement
in
cardiovascular
health
Improvement
in memory
(Schwalfenberg, 2012)

11. Methods & Materials
■ The author of this article discusses the potential health benefits of
an alkaline diet and water intake, as well as how that may relate to a
reduction of the bacterial load in the digestive tract.The author
begins by outlining the two most common causes of chronic
acidosis:
– Increase in age- resulting in a decrease in kidney function
– Diet
■ The author describes literature supporting the evidence that an
alkaline-based diet and water intake has been shown to “prevent
osteoporosis and protect pancreatic beta cells with its antioxidant
effects” (Mousa, 2016).
(Mousa, 2016)

12. Methods & Materials
■ This final study was an online survey conducted by Purdue University.They wanted to understand
individuals' perceptions on tap and bottled water.
■ Consisted of a random sample of 2,045 Purdue University students. However, there were only 677
students that took the survey.
■ “This study revealed that women drink disproportionately more bottled water then men while
undergraduate students drink more than graduate students, staff and faculty.”
■ The study also discovered perceived thoughts about bottled vs. tap water from the results as well:
such as,
– Bottled water is safer than tap water
– Taste of bottled water is better
– Bottled water is more convenient
(Amberg et al., 2011)

13. Results
■ Of the six sources discussed throughout this research project, three of them conclude with
the findings that many popular bottled water brands are testing to have a low pH value,
thus confirming there is a risk of dental erosion with the prolonged use of certain types of
bottled water.
■ Two of the sources discussed throughout this research project support the implementation
of an alkaline-based diet and the oral and overall health benefits that accompany the
lifestyle.
■ The last study discussed, describes the misconceptions that many individuals may believe
about bottled water.
– Many believe bottled water is safer than tap water
– Bottled water is more convenient
– Many prefer the taste of bottled water vs. tap

14. Conclusion
■ Individuals should be cautious about the pH balance in many commercially available
bottled waters. Studies have concluded that many companies that advertise their pH,
have a lower pH than what they are marketing.
■ Clinicians should be mindful of the acidic qualities of certain bottled water brands and
warn patients about the potential harmful effects. Chronic consumption of low pH
bottled water may lead to dental erosion and caries (Fisher, et al., 2017).
■ Clinicians should recommend neutral or alkaline water to ensure that patients are
optimizing their oral health (Fisher et al., 2017).
■ Studies have shown that there are many health benefits to an alkaline-based diet,
such as, improved bone health, reduction in muscle wasting, improved cardiovascular
health, and improved memory and cognition (Schwalfenberg, 2012).

15. References
■ Amberg, S., Prokopy, L., Saylor, A. (2011).What'sWrongWith theTap? Examining Perceptions ofTap
Water and BottledWater at Purdue University. U.S. National Library of Medicine. Retrieved from
https://pubmed.ncbi.nlm.nih.gov/21643837/.
■ Fisher, J., Spencer, A., Haywood,V., & Konchady, G. (2017). Relieving Dry Mouth:Varying Levels of pH
Found in BottledWater. U.S. National Library of Medicine. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/28727472.
■ Guha, & Upoma. (2015). Erosion potential of well water, commercially available bottled water, and
vegetable juice. Retrieved from https://cdr.lib.unc.edu/concern/dissertations/7s75dc78g.
■ Mousa, Haider. (2016). Health Effects of Alkaline Diet andWater, Reduction of Digestive-tract
Bacterial Load, and Earthing. Alternative therapies in Health and Medicine. ResearchGate. Retrieved
from
https://www.researchgate.net/publication/301497159_Health_Effects_of_Alkaline_Diet_and_Water_
Reduction_of_Digestive-tract_Bacterial_Load_and_Earthing.
■ Schwalfenberg,G. K. (2012).TheAlkaline Diet: Is there Evidence that an Alkaline pH Diet Benefits
Health? U.S. National Library of Medicine. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195546/.
■ Wilkins, E. M. (2017). Clinical Practice of the Dental Hygienist (12th ed.). Philadelphia, PA: Lippincott
Williams &Wilkins.
■ Wright, K. F. (2015). IsYour DrinkingWater Acidic? A Comparison of theVaried pH of Popular Bottled
Waters. Journal of Dental Hygiene. Retrieved from https://jdh.adha.org/content/89/suppl_2/6.