Causes of dental erosion
- Dental erosion is most commonly caused by acidic foods and drinks with a pH below 5.0-5.7.
- Soft drinks, alcohol, fruit juices (such as orange juice), and carbonated drinks (such as colas) are known to trigger dental erosion.
- Wine, with a pH as low as 3.0-3.8, can also erode teeth.
- Poorly regulated chlorinated swimming pool water and gastric acid regurgitation can be sources of erosive acids.
- Medications with acid components and chronic diseases in children can increase the risk of dental erosion.
- Extrinsic acid erosion occurs when acids come from outside the body.
- Acidic foods and drinks, such as fruit juices, sports drinks, wine, beer, colas, lemonades, fresh fruits, ketchup, and pickled food in vinegar, contribute to dental erosion.
- Infants using feeding bottles containing fruit juices are at greater risk of acid erosion.
- Fruit juices are the most resistant to saliva's buffering effect, followed by fruit-based carbonated drinks, non-fruit-based carbonated drinks, and sparkling mineral waters.
- Certain medications, like chewable vitamin C, aspirin, and some iron preparations, can also contribute to acid erosion.
- Intrinsic dental erosion occurs when gastric acid from the stomach comes into contact with the teeth.
- Conditions like anorexia nervosa, bulimia nervosa, gastroesophageal reflux disease (GERD), and rumination syndrome can cause intrinsic dental erosion.
- Eating disorders, like bulimia, can reduce salivary flow rate and increase vulnerability to acidic food and drinks.
- GERD, which involves increased acid production by the stomach, can also cause dental erosions.
- Gastrointestinal disorders can cause dental erosions in children as well.
- Acid erosion often coexists with abrasion and attrition.
- Abrasion is commonly caused by brushing teeth too hard.
- Frothing or swishing acidic drinks around the mouth before swallowing increases the risk of acid erosion.
- Sucking citrus fruits can also contribute to acid erosion.
- Acid erosion can be worsened by certain behaviors and habits.
Diagnosis of dental erosion
- In-vivo studies are advantageous in assessing dental erosion directly from the patient's mouth.
- Dental erosion can be diagnosed through changes in tooth appearance and sensitivity.
- Tooth color changes, such as transparency on the cutting edge of central incisors and a yellowish tint, can indicate dental erosion.
- Changes in tooth shape, such as broad rounded concavities and larger gaps between teeth, are also signs of dental erosion.
- Dental indices, like the Basic Erosive Wear Examination (BEWE), can help dentists grade the severity of tooth wear, but they have limitations in measuring progression and monitoring all affected teeth.
Prevention and management for dental erosion
- Individuals should consult a medical doctor if they notice signs and symptoms of gastroesophageal reflux disease (GERD) or have eating disorders or chronic alcoholism.
- Caution should be exercised when purchasing certain items like vitamin C tablets, aspirin, and mouth rinses with low pH, as they can potentially lead to erosion.
- Dental professionals can prescribe or administer neutralizing agents like antacid tablets to relieve symptoms of GERD.
- Patients should maintain a healthy body mass index (BMI) and consider changes in medications that induce hyposalivation and vomiting.
- Referral to a medical doctor or dietician may be necessary for severe cases or persistent symptoms.
- Individuals should reduce the frequency of acidic food intake, particularly carbonated drinks and fruit juices.
- Consuming food items enriched with calcium or stimulating saliva flow can help neutralize acids and promote remineralization.
- Drinking through a straw and rinsing the mouth with water or chewing sugar-free gum after consuming acidic drinks can minimize acid contact with teeth.
- Gentle brushing with a soft-bristled toothbrush and delaying brushing after an acidic meal can prevent further erosion.
- Using fluoride-containing mouth rinses and toothpastes can promote repair of acid-damaged tooth surfaces and reduce dentine permeability.
- Dental professionals should be familiar with the appearance of tooth erosion, such as short, cupped, saucer-shaped teeth with a shiny surface and loss of surface architecture.
- The Basic Erosive Wear Examination (BEWE) is a scoring system that helps determine the severity of erosion in each sextant.
- BEWE scores can guide appropriate management and are more accurate than Tooth Wear Index (TWI) scores.
- Minimal intervention and prevention are the first-line treatments after detecting acid erosion, focusing on remineralization and prevention.
- Various methods of remineralization include professionally-applied fluoride varnish, home-applied fluoride gel, and toothpaste with stannous fluoride formulation.
Restorative treatment for dental erosion
- Resin composite fillings are used to restore small areas of erosion on the biting surfaces of teeth.
- Ceramic or resin composite veneers can restore moderate damage at the upper front teeth.
- Ceramic crowns or overlays are used to restore large extent of damage involving two or more surfaces of a tooth.
- Long-term treatment success requires eradication of the causes of acid erosion.
- Combining active treatment with preventive measures and regular recall appointments is necessary for best outcomes.
Industry and recommendations for prevention and management
- Occupational areas with repeated exposure to acidic particles should be avoided when possible to prevent dental erosion.
- Subsidizing regular dental services for high-risk individuals, such as professional wine tasters, competitive swimmers, and industrial workers, can help prevent dental erosion.
- Workers should be educated about potential occupational hazards and encouraged to maintain good oral health.
- pH or chelation properties of acidic soft drinks, especially those with citric or phosphoric acid, should be altered to reduce their erosive effects.
- Wearing personal protective equipment for the eyes and face and gargling during or after work can help prevent dental erosion.
- Suitable at-home preventive oral hygiene habits should be recommended, including proper tooth brushing technique and the use of toothp
Acid erosion is a type of tooth wear. It is defined as the irreversible loss of tooth structure due to chemical dissolution by acids not of bacterial origin. Dental erosion is the most common chronic condition of children ages 5–17, although it is only relatively recently that it has been recognised as a dental health problem. There is generally widespread ignorance of the damaging effects of acid erosion; this is particularly the case with erosion due to consumption of fruit juices because they tend to be considered as healthy. Acid erosion begins initially in the enamel, causing it to become thin, and can progress into dentin, giving the tooth a dull yellow appearance and leading to dentin hypersensitivity.
| Acid erosion | |
|---|---|
| Other names | Dental erosion |
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| An example of severe dental damage due to acid erosion. | |
| Specialty | Dentistry |
| Complications | Oral infection, tooth decay, tooth loss, xerostomia |
The most common cause of erosion is by acidic foods and drinks. In general, foods and drinks with a pH below 5.0–5.7 have been known to trigger dental erosion effects. Numerous clinical and laboratory reports link erosion to excessive consumption of such drinks. Those thought to pose a risk are soft drinks, some alcohol and fruit drinks, fruit juices such as orange juice (which contain citric acid) and carbonated drinks such as colas (in which the carbonic acid is not the cause of erosion, but citric and phosphoric acid). Additionally, wine has been shown to erode teeth, with the pH of wine as low as 3.0–3.8. Other possible sources of erosive acids are from exposure to poorly regulated chlorinated swimming pool water, and regurgitation of gastric acids. In children with chronic diseases, the use of medicines with acid components is a risk factor too. Dental erosion has also been recorded in the fossil record and was likely caused by the consumption of acidic fruits or plants.
