Erosion—diagnosis and risk factors

Abstract

Dental erosion is a multifactorial condition: The interplay of chemical, biological and behavioural factors is crucial and helps explain why some individuals exhibit more erosion than others. The erosive potential of erosive agents like acidic drinks or foodstuffs depends on chemical factors, e.g. pH, titratable acidity, mineral content, clearance on tooth surface and on its calcium-chelation properties. Biological factors such as saliva, acquired pellicle, tooth structure and positioning in relation to soft tissues and tongue are related to the pathogenesis of dental erosion. Furthermore, behavioural factors like eating and drinking habits, regular exercise with dehydration and decrease of salivary flow, excessive oral hygiene and, on the other side, an unhealthy lifestyle, e.g. chronic alcoholism, are predisposing factors for dental erosion. There is some evidence that dental erosion is growing steadily. To prevent further progression, it is important to detect this condition as early as possible. Dentists have to know the clinical appearance and possible signs of progression of erosive lesions and their causes such that adequate preventive and, if necessary, therapeutic measures can be initiated. The clinical examination has to be done systematically, and a comprehensive case history should be undertaken such that all risk factors will be revealed.

Dentin hypersensitivity: pain mechanisms and aetiology of exposed cervical dentin

“…There are extrinsic and intrinsic causes of erosion. Extrinsic factors are not only mainly acidic food and beverages but also medicines and oral hygiene products [120]. Intrinsic erosion is caused by gastric juices, possibly caused by, for example, reflux disease, eating disorders, chronic alcoholism and pregnancy.…”

“…Erosive tooth wear is not caused solely by acid challenge and chelating agents themselves. In vitro studies show that a few micrometres of tissue is lost due to the influence of an erosive challenge (once the surface is softened, it might be easily abraded by oral soft tissues), toothbrushing with dentifrices or coarse food stuff [120, 122]. Potential routes for deep acid penetration into the dentin are afforded by the dentin tubules where clearance and salivary buffering are less effective.…”

Evidence summary: how can dietary advice to prevent dental erosion be effectively delivered in UK general dental practice?

“…8 Diet plays an important role in the prevention of oral diseases. 9,10 Dietary factors, particularly acidic food and drinks, contribute to the development of dental erosion.…”

The erosive potential of candy sprays

“…This means that the demineralising effect of citric acid is exceptionally great and may even continue after the pH at the tooth surface has increased. 18,31,32 Our in vivo results are based on a single administration of candy spray to adult volunteers. However, candy sprays are frequently used by children during the day 26 and the volume of saliva in children is smaller than in adults.…”