Dental erosion is the wearing away of the tooth structure by acids. This article discusses in detail the causes and management of dental erosion.
The gradual dissolution of dental hard tissue by acids is termed dental erosion.
It is an irreversible loss of tooth structure.
It does not involve bacteria.
The dissolution of mineralized tooth structure occurs when acids come in contact with tooth structure.
Erosion - Chemical wear of the tooth structure by extrinsic or intrinsic acids.
Abrasion - Physical wear of the tooth structure due to extrinsic mechanical process, for example - tooth wear due to inadvertent brushing habits.
Attrition - Physical wear of the tooth structure due to intrinsic mechanical processes like excessive or abnormal forces from the opposite tooth.
Extrinsic acids - Mostly, the extrinsic acids causing dental erosion are contributed by acidic medications and dietary components such as acidic beverages and foods (for example, colas, juices, soda, alcohol below ph 4).
Intrinsic acids - Backflow of gastric juice from the stomach occurs in diseases such as Gastroesophageal Reflux Disease (GERD), bulimia, and rumination (regurgitation), thereby leading to dental erosion.
Teeth with diminished acid resistance, including developmental deficiencies and hypomineralization as in dental fluorosis, are more prone to dental erosion by acids.
The buffering capacity of saliva neutralizes the acids, thereby preventing erosion. But, in cases of reduced salivary flow rate, there is inadequate buffering action of saliva leading to dental erosion.
Occlusal surfaces - These are the biting or grinding surfaces of the back (posterior) teeth. These surfaces show shallow and localized dimpling and exposed dentin (inner layer of the tooth). Loss of occlusal morphology is also seen in advanced stages.
Labial surfaces - These are smooth and flat surfaces of the front teeth seen while talking and smiling. Shallow enamel defects are seen on these surfaces.
Palatal and lingual surfaces - These are the inner side of the upper and lower teeth where the tongue touches, at-rest position. Broad-based lesions and exposed dentin are seen. Flattening and loss of contour of the teeth occur in advanced stages.
Incisal edges - Tips of the upper and lower front teeth are called the incisal edges. Incisal grooving of the affected tooth is seen.
The other clinical appearance of erosion are,
Broad concavities within smooth surface enamel.
Increased incisal translucency.
Wear on non-occluding surfaces.
Raised amalgam restorations.
The clear, non-tarnished appearance of amalgams.
Loss of surface characteristics of enamel in young children.
Preservation of enamel cuff in the gingival crevice is common.
Pulp exposure in deciduous teeth.
Cupping of occlusal surfaces, that is, incisal grooving, with dentin exposure.
Bulimia is a medical condition where the patients want themselves to be sick so that they can lose weight. This can damage the tooth enamel because of the high levels of acid in the vomit.
Acids produced by the stomach come up into the mouth (known as gastro-oesophageal reflux). Dental erosion are found in people suffering from,
High prevalence is observed in children, and a high incidence is seen in adolescents.
Taking citrus fruits more than twice daily.
Consumption of soft drinks 4 to 6 times a week.
More often intake of sports drinks.
More often, intake of apple vinegar.
Symptoms or history of gastrointestinal reflux disease.
Avoid or at least reduce the dietary intake of acidic beverages.
Adopt the drinking methods that limit acid contact with teeth (use a straw, gulp down, and do not swish around).
Avoid misuse of acidic medication, including vitamin C.
Use proper protection to minimize occupational hazards.
Clinical interventions - Treat the underlying medical conditions like GERD, bulimia, etc. Get treated for reduced salivation. Increase the acid resistance of teeth by fluoride therapy (varnish, mouthwash, topical gel, toothpaste).
Have fizzy drinks, pops, and sodas, just at mealtimes, as it helps to reduce the number of acid attacks on the teeth.
Do not hold the drink in the mouth or swish it around the mouth as it can cause long contact with the teeth.
Always end a meal with milk or cheese, as it can help cancel out the acid.
Chew a piece of sugar-free gum after eating as it will help to produce more saliva to help cancel out the acids present in the mouth after eating.
Wait at least an hour after drinking or eating anything acidic before brushing the teeth, as it gives the teeth time to rebuild the mineral content again.
Brush the teeth at night and at least one other time during the day with a small-headed brush with soft bristles and fluoridated toothpaste.
Children up to three years should use toothpaste with a fluoride level of at least 1000 ppm (parts per million). Children above 3 years should use toothpaste of 1300 ppm to 1500 ppm.
Spit out the foam after brushing, and do not rinse the mouth so that the fluoride stays in the teeth for a longer period.
Identification of the etiology is the first step in the management of erosion. When excessive dietary intake of acidic foods or beverages is discovered, then patient education and counseling are important. When the patient has symptoms of GERD (gastroesophageal reflux disease), then he or she should be referred to a physician for complete evaluation and institution of therapy if indicated. A patient with salivary hypofunction may be given sugarless chewing gums or mints to increase the residual salivary flow.
In some cases, the etiological factors are not identifiable, and in other cases, the causative factor is difficult to control, such as alcoholism. Regardless of the cause, it is important to follow the preventive measures of erosion, and one of the important preventive measures is patient education. Much erosion prevention depends on the patient's compliance with dietary modifications, use of an occlusal splint, use of topical fluorides, etc.
Two ways of treating dental erosion are:
- Tooth bonding, a cosmetic procedure, can be used in milder cases where the resin is tinted, matching the color of the teeth is applied over the affected enamel, and once set, it is bonded to the teeth following trimming and polishing.
- Crown can be placed on the damaged tooth in more severe cases to restore its function.
The dentist will suggest dental bonding if you are experiencing the earlier signs of enamel erosion. This is a relatively conservative restorative procedure. The dentist will place a tooth-colored resin on your teeth that will bond with your teeth and form a protective layer over the enamel before it began to erode. But in more severe cases, the dentist will suggest a veneer or a crown to your damaged teeth to prevent further decay or erosion.
Tooth erosion commonly occurs at the gum line, leading to exposure of the root surface and the nerve endings of the teeth. For mild erosion with sensitivity, the dentist will suggest desensitizing toothpaste or a filling with tooth-colored material. Still, with exposure of nerve endings in severe cases, the dentist may recommend a veneer or a crown to fix it.
Acids consumed from food items like citrus fruits, vinegar, or soft drinks can dissolve or erode the enamel off teeth by the washing or bathing action. The acid will cause the tooth surface to lose minerals from surface. We cannot reverse acid erosion, but people can take steps to protect their teeth against further progression. The portion of enamel lost cannot be replaced naturally, but it requires restorative dentistry.
In case of enamel erosion, the teeth may look yellow or especially shiny, with increased sensitivity to hot, cold, or sweet foods and roughness around the teeth' edges.
- The leading cause of enamel erosion are acids found in the foods and liquids that are consumed.
- Regularly consumed foods and drinks with a pH below 5.7 may induce dental erosion.
- Improper brushing technique.
- The acid secreted in the stomach during the digestive process can dissolve any food, including bone and teeth.
Coffee is an acidic beverage that could help bacteria within the mouth to produce acids, leading to enamel erosion.
To restore enamel naturally, you need to:
- Stop snacking.
- Avoid refined sugar and grains in your diet.
- Consume fat-soluble vitamins.
- Consume enough minerals.
- Support nutrient assimilation.
Acids can wear down the teeth while increasing the chances of stains setting in. The foods that can cause staining are:
- Candies and sweets.
- Citrus fruits.
- Soft drinks.
- Red wine.
- Tomato sauce.
- Balsamic vinegar.
Studies show that between 47 and 93 percent of bulimia nervosa patients who vomit exhibit damage to tooth enamel. If you engage in self-induced vomiting, you should be aware that bringing acidic contents of your stomach into your mouth may cause erosion of the enamel surface of your teeth.
To fix acid erosion on teeth, you can use fluoride toothpaste and mouth rinse to replace the damage in milder cases or with dental fillings, veneers, or crowns in severe cases. To avoid further damage, you can:
- Drink plenty of water after consuming the acidic food or drink.
- Use a straw for drinking acidic beverages to reduce their contact with the teeth.
- Replace carbonated drinks with water, milk, or tea.
Last reviewed at:
10 Nov 2021 - 5 min read
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