Dental Erosion – An Overview with Emphasis on Chemical and Histopathological Aspects

Abstract

The quality of dental care and modern achievements in dental science depend strongly on understanding the properties of teeth and the basic principles and mechanisms involved in their interaction with surrounding media. Erosion is a disorder to which such properties as structural features of tooth, physiological properties of saliva, and extrinsic and intrinsic acidic sources and habits contribute, and all must be carefully considered. The degree of saturation in the surrounding solution, which is determined by pH and calcium and phosphate concentrations, is the driving force for dissolution of dental hard tissue. In relation to caries, with the calcium and phosphate concentrations in plaque fluid, the ‘critical pH’ below which enamel dissolves is about 5.5. For erosion, the critical pH is lower in products (e.g. yoghurt) containing more calcium and phosphate than plaque fluid and higher when the concentrations are lower. Dental erosion starts by initial softening of the enamel surface followed by loss of volume with a softened layer persisting at the surface of the remaining tissue. Dentine erosion is not clearly understood, so further in vivo studies, including histopathological aspects, are needed. Clinical reports show that exposure to acids combined with an insufficient salivary flow rate results in enhanced dissolution. The effects of these and other interactions result in a permanent ion/substance exchange and reorganisation within the tooth material or at its interface, thus altering its strength and structure. The rate and severity of erosion are determined by the susceptibility of the dental tissues towards dissolution. Because enamel contains less soluble mineral than dentine, it tends to erode more slowly. The chemical mechanisms of erosion are also summarised in this review. Special attention is given to the microscopic and macroscopic histopathology of erosion.

Effect of foods and drinks on primary tooth enamel after erosive challenge with hydrochloric acid

“…The literature shows conflicting results regarding the erosive effect of yogurt. Whereas some authors state that yogurt, despite its low pH, does not have an erosive effect, 7,8,11 a report has shown yogurt significantly increases wear and reduces the hardness of dental enamel. 12 In a recent study, fermented milk drinks, which are rich in lactobacilli and bifidobacteria and are used in the prevention and treatment of gastrointestinal disorders, 13 produced enamel mineral loss after four cycles of demineralisation and remineralisation.…”

“…This is considered pathological when both intensity and frequency increase, causing GORD. 5 Although the hydrochloric acid (HCl) present in gastric juice induces the demineralisation and loss of dental hard tissues, 6 diet is the most important cause of dental erosion 7 due to individuals' high consumption of acidic foods and drinks. 8 The erosive potential of acidic drinks or foods depends on the pH, acid concentration, length of exposure, 9 titratable acidity, mineral content, clearance on tooth surface, and its calcium-chelating properties.…”

Protective effect of calcium nanophosphate and CPP-ACP agents on enamel erosion

“…1 Although erosive lesions have a multifactorial etiology, the increasing consumption of acidic food and soft drinks has become an important factor driving their development. [2][3][4] Many strategies have been developed for the prevention and treatment of erosion, and fluoride is the main agent used to enhance enamel remineralization.…”

The In Situ Effect of Titanium Tetrafluoride Gel on Erosion/Abrasion Progression in Human Dentin

“…Another possibility would be the degradation of the organic matrix by MMPs in dentin and saliva (22), activated by the fall and subsequent pH neutralization of the oral environment (22). Regardless the reason, with the removal of the protection conferred by collagen fibres, the partially demineralized layer beneath it is exposed and becomes susceptible to the action of acids, giving rise to the progression of mineral loss (1).…”

“…Dental erosion is a chemical process, characterized by chronic and pathological dissolution of dental hard tissues due to exposure to a variety of non-bacterial acids (1). Preventive and control measures to interrupt the progression of the erosive lesion have been proposed and include the strategy of increasing the acid resistance of dental hard tissues, which is the potential role of fluoride products.…”