Fall 1995 Mission


A bitter

Dentist targets a snacking habit
engrained in Texas folkways

By Jim Barrett

Sucked on a lemon today? If you're young and from Texas, you probably have. Thousands of children and teens do it every day, and have no idea they are headed for serious tooth problems.

Eating whole lemons goes back generations in the Southwest: Cut a hole in a lemon, insert a dried, salted piece of fruit called "Chinese candy," and squeeze out the tangy, salty juice.

Today, youngsters often skip the lemons and buy packets of citrus powders that are imported from Mexico and sold by supermarkets, convenience stores and ice-cream truck vendors. The powder is just as tangy, but not as messy. It contains salt, sugar, citric acid, chili powder and silicon dioxide. And, unfortunately, it is much more concentrated than a lemon.

Because citrus snacks are so popular and have such low pH values, they are now considered a regional public health threat. Lemons and citrus powders are hard on tooth enamel, and constant users are flirting with trouble.

"You can't expose your teeth to something that is just slightly less corrosive than battery acid and expect that there will be no damage," said Peggy P. Gragg, DDS, associate professor of dental diagnostic science and dental hygiene. With Mauricio Marcushamer, DDS, assistant instructor of pediatric dentistry, she is leading a campaign to educate youngsters about citrus snacks.

Image In 1994, Dr. Gragg began a formal study of the region's schoolchildren that showed widespread use of lemons and powders and a startling lack of understanding about their dangers.

Sampling 1,400 seventh graders, she reported that 72 percent use the citrus products and 31 percent don't think they are harmful. The citrus habit is particularly popular in the Hispanic community, she said.

Now she has produced a videotape and informational brochure to warn youngsters, their parents and even dentists, many of whom are unaware of the citrus-snack fad. This fall, she began showing the tape to seventh- and eighth-graders in the school districts where she did the study.

The study and educational program are underwritten by the Regional Research Center for Minority Oral Health, which is funded by the National Institute of Dental Research.

Even dentists can underestimate the risks and overlook trouble signs. Melissa Gonzales, 26, a dental assistant at the Health Science Center, knows that. She grew up in a small town outside San Antonio, eating lemons with her friends. She learned the hard way about this seemingly innocuous behavior. At age 19, her tooth restorations cost $3,000.

"My dentist never said anything was wrong," said Gonzales, who had regular check-ups through childhood.

She started using Chinese candy at 7. "We always had a big jar of it and we'd do the lemons and watch TV. All of my friends did it, too," Gonzales said.

By 15, her teeth began to hurt when she ate ice cream or drank something cold. The pain got worse. She noticed that the enamel on her front teeth had eroded and become discolored. She quit eating lemons as snacks, but the harm was done.

Dr. Gragg, who supervises clinical instruction in the Health Science Center's Dental School, moved from North Carolina to Texas in 1981. She worked as a member of the Public Health Service stationed at the Barrio Comprehensive Health Care Center on San Antonio's West Side.

"I kept seeing patients who had a characteristic pattern of decalcification of their teeth. I'd never see this before. Tooth structure was just simply missing from the facial surfaces of the upper front teeth," she said.

"Later, when I joined the faculty at the Health Science Center, I saw the same thing among many patients who came to our clinic for dental care. Everyone gave a similar history of eating lemons and Chinese candy in a highly stylized manner and most were quite dismayed by the turn of events," Dr. Gragg said.

"I thought it was a shame that we weren't intervening before the damage was done, the correction of which includes costly laminate veneer or cosmetic bonding. Also, once the damage is done, many of the affected people don't have the money to pay for those restorations," she said.

Enlisting help from the schools, Dr. Gragg now hopes to reach youngsters before they have to learn the bitter lesson about citrus snacks.

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