Dental erosion is a form of tooth wear – where enamel and then dentin is worn down (the other forms, abrasion and attrition are discussed here). It is defined as irreversible damage to the teeth caused from chemicals (usually acids).
This acid can come from outside sources (e.g. food and drink) or from inside the body; these are explained below.
Common Causes of Erosive Damage
1. Outside Sources of Acids:
Acid is present in lots of foods and drinks, e.g.:
- Fruits and fruit juices, in particular citrus fruits such as oranges and lemons. Common cause in children
- Sodas/fizzy drinks, including ‘diet’ soft drinks. A major cause!
- ‘Sports drinks’.
- Alcohol consumption, including wine and ‘alcopops’.
- Medicines such as iron supplements and chewable vitamin C.
Rarer sources include factories with acids in the air and chlorine from swimming pools.
2. Inside Sources of Acid:
The acid that causes erosion may also come from stomach fluids inside the body. Acid reflux is where stomach fluids come up towards the throat and mouth. It is often felt as ‘heartburn’ after eating. There are several gastric disorders that can lead to reflux.
Vomiting will also expose the mouth to gastric acid. Frequent episodes of vomiting through illness, alcoholism or eating disorders such as bulimia can cause enamel erosion. Pregnancy may also increase the risk of damage through acid reflux and vomiting associated with morning sickness.
How To Prevent Damage
As with most types of dental diseases, tooth erosion can usually be prevented. The following tips contain general advice on how to prevent the problem. If you have damage already, you will need to pay particular attention to the causes of it, and avoid what is causing it!
- Reduce the overall amount of acidic food and drinks you consume. Also limit these to mealtimes only, if you do consume them. This is to reduce the amount of time that your mouth is under acid-attack each day.
- If taking acidic drinks, best to drink them quickly, again to limit the time your mouth is under attack. Don’t whirl the drink around your mouth or hold the drink in your mouth for long. The use of a straw can help keep the acid away from the teeth better (also good for reducing risk of decay). Chilling acidic drinks also reduces the harm they do.
- After taking an acidic food or drink; drinking milk, water or rinsing your mouth out with water (or a fluoride mouthwash) can help neutralize the acid quicker.
- Chewing sugar-free gum after eating can have a similar effect, by increasing saliva flow which helps neutralize acids.
- Do not brush your teeth immediately after taking acidic foods or drinks. Wait for at least 30 minutes, otherwise you will be increasing damage by brushing when tooth surfaces are ‘softer’ from the chemical attack.
- The same advice as above applies to what to do after any vomiting episodes. In particular, rinse your mouth out after vomiting but do not brush for at least 30 minutes.
- Brush your teeth gently twice a day using fluoride toothpaste. Some new formulations of toothpaste are available for enamel repair. Tooth mousse is similar to toothpaste, but is a little stronger. However these are not a ‘miracle’ cure for dental erosion; the key message is to eliminate whatever is causing the damage.
Dental Erosion Symptoms
The symptoms can vary depending on what type of tooth-wear you have, but common signs include:
- Appearance. The effect will depend on the type of tooth wear, but can include chipping away of the edges and increased transparency of the tips of front teeth. The surfaces may appear smooth, rounded and ‘polished’ (see image above).
- Sensitivity to hot and cold. This can occur when the outer protective enamel wears away exposing the more sensitive dentine. Sensitivity does not always occur, especially if the wear is progressing slowly.
- Changes to your bite.
- Fillings may stand out from the surrounding tooth surfaces- a classic diagnosis marker.
- Gum recession and wearing down of the teeth at the gum-margin (in abrasion and abfraction).
- Overall flattening of the teeth (with attrition).
Dental Erosion Treatment
If you think you have this, or some other form of tooth-wear, visit your dentist. Your dentist will help you to first identify the sources of any damage (via a risk assessment) and advise you on how to eliminate these causes.
Treatment is not always needed, particularly if any enamel wear is minor. In this case, preventive measures are all that is needed, but these are very important. Keep attending the dentist for check-ups and follow any advice given. Regular check-ups allow your dentist to monitor the progression of any damage and best diagnose if and when any therapy is needed.
Treatment will be needed if enamel wear has caused significant loss of the tooth structure and/or is causing problems such as sensitivity and cosmetic defects. Any treatment will depend on the extent and position of any damage.
Treatment aims are to:
- Repair cosmetic appearance if this has been affected.
- Reduce sensitivity by protecting and covering the dentine.
- Help reduce further damage from tooth-wear.
Treatment options may include:
- To help treat sensitivity the dentist may place fluoride gels or varnishes and advise fluoride toothpastes and mouthwashes.
- Repairing tooth enamel loss with white filling materials.
- In the case of extensive damage, fixing veneers or crowns may be necessary.
- Replace missing teeth.
- You may need a bite guard if bruxism is also a factor.
If in any doubt contact your dentist. If left untreated, tooth-wear can cause severe damage. Tooth surface loss from dental erosion and other tooth wear can be very difficult to treat.