All about Dental Erosion | causes and prevention about dental erosion

Erosion is the loss or wear of dental hard tissue by acids not caused by bacteria.
Erosion may be caused by intrinsicfactors (e.g., excessive vomiting or acid reflux in case of G.E.R.D) and/or extrinsicv factors (e.g., diet) .
Soft drinks, particularly carbonated sodas ( eg. coca cola,pepsi ) and sports drinks (e.g gatorade), appear to be the most significant extrinsic cause of erosion.
Drinks containing high concentrations of calcium, like milk, may reduce risk of erosion.

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1. Introduction Dental Erosion also known as Acid Erosion is a type of tooth wear. It is the loss of dental hard tissue caused by intrinsic or extrinsic acid that is not produced by bacteria . Dental erosion does not begin as a subsurface enamel lesion that is conducive to remineralization, as in the caries process. It is often widespread and may involve the entire dentition. Dental hard tissue loss associated with erosion is almost always complicated by other forms of tooth wear such as attrition and abrasion .

2. Dental erosion results in tooth surface softening, which inevitably accelerates tissue loss caused by tooth-to-tooth contact while chewing and grinding ( attrition ) or by abrasive wear while mechanically brushing or cleaning tooth surfaces ( abrasion ). At Dr.Sachdeva’s Dental Clinic , we tell our patients that if Dental Erosion is not managed effectively, it may result in substantial loss of enamel and subsequent exposure of the underlying dentin , which can, in turn, lead to dentin sensitivity , loss of vertical height and esthetic problems .  

3. What is dental erosion ? Dental Erosion is the loss of tooth enamel caused by acid attack. Enamel is the hard, protective coating of the tooth, which protects the sensitive dentine underneath. When the enamel is worn away, the dentine underneath is exposed, which may lead to pain and sensitivity .

4. Besides erosion, other types of tooth wear can be described : Attrition : This type of tooth wear is caused by natural tooth-to-tooth friction. This can happen while clenching or grinding your teeth, for example in cases of  bruxism , which often occurs involuntarily during sleep . Abrasion : This is physical wear and tear of the tooth surface that happens with brushing teeth too hard or using an improper toothbrush , improper flossing or biting on hard objects (such as fingernails, bottle caps, or pens).

5. Abfraction :  Is a theoretical concept explaining a loss of tooth structure not caused by  tooth decay  (non-carious cervical lesions). It is suggested that these lesions are caused by forces placed on the teeth during biting, eating, chewing and grinding; the enamel, especially at the  cementoenamel junction (CEJ), undergoes large amounts of stress, causing micro fractures and tooth tissue loss.

6. What causes Dental Erosion ? Dental Erosion is caused by sustained direct contact between tooth surfaces and acidic substances ; Acidic foods and drinks The most common cause of dental erosion is due to acidic foods and drinks . Drinks low in pH levels that cause dental erosion include fruit juices (mainly orange and apple), sports drinks, wine, beer and carbonated drinks (such as colas or lemonades).

7. A diet high in sugars can also cause erosion. Frequency rather than total intake of acidic juices or foods is seen as the greater factor in dental erosion . Saliva  acts as a buffer , regulating the pH when acidic drinks are ingested and protecting the enamel from demineralization (which is the loss of its mineral content ). However, if acid attacks happen too often, the buffering capability of saliva decreases and the enamel does not have a chance to repair itself. Over time, you start to lose the surface of your teeth.  

8. 2. General conditions People with  bulimia  or  gastro esophageal reflux disease (GERD)  are all at higher risk of dental erosion because the gastric acid from the stomach comes into contact with the teeth . For example, bulimia is a condition where patients make themselves sick so that they lose weight . Frequent vomiting erodes tooth enamel and can lead to cavities.

9. 3 . Other causes Other causes include: A number of medications such as vitamin C , aspirin or antihistamines Dry mouth or low salivary flow (also known as  xerostomia ), because the buffering capability of saliva is not present to counterbalance the acidic environment Genetic or inherited conditions Environmental factors such as friction, wear and tear, stress etc.  

10. Signs of Erosion Recognizing erosion signs is an important first step in solving the problem. We at Dr.Sachdeva’s Dental Clinic , help our patients recognize these signs. Sensitivity In the early stage of enamel erosion , there may be an increased sensitivity when eating hot , cold , or sweet foods . In later stages, teeth become extremely sensitive to temperatures and sweets . The enamel gets eroded away, exposing the sensitive dentin and making it more vulnerable

11. Discoloration   Enamel is white . Dentin, the sensitive tissue located below the enamel, is yellow. So if your teeth develop more of a yellow tinge, it may be due to enamel loss . The first change of color usually happens on the cutting edges of the central incisors as they become transparent . In later stages, the enamel erodes and more dentin is exposed. This will cause the teeth to appear yellow.

12. Changes in shape Teeth may show a broad rounded concavity and the gaps between teeth can become larger . Indentations may appear on the surface of the teeth. The edges of teeth become more rough and irregular as enamel erodes . In later stages of dental erosion, teeth begin to crack off and become coarse. Your teeth may appear thinner or smaller than normal . Also, the lower portion of your front teeth can look transparent as opposed to opaque . Either of those conditions is an indication of dental erosion.

13. Though dental erosion often coexists with attrition and abrasion , it has some distinctive characteristics in location, appearance and morphology. The most frequently affected areas are the palatal surface of maxillary incisors and the occlusal surface of the mandibular first molars in adolescents. Early signs of erosion often include smooth and flat facets on facial or palatal surfaces, and shallow and localized dimpling on occlusal surfaces. Without intervention , erosive wear will progress, leading to deep cupping lesions with exposed dentin and eventual loss of occlusal morphology .

14. What can I do to prevent Dental Erosion ? Dentists in North Delhi , suggest these few simple steps to prevent Dental Erosion ; Reduce the frequency of acidic and sweet food and beverage intake. This decreases the sugar/acid exposure time and allows the eroded tooth surface to harden. Have acidic food and drinks , and fizzy drinks , sodas and pops , just at mealtimes. This will reduce the number of acid attacks on your teeth . Drink quickly, without holding the drink in your mouth or ‘ swishing ' it around your mouth. Or use a straw to help drinks go to the back of your mouth and avoid long contact with your teeth

15. Chew sugar-free gum after eating. This will help produce more saliva to help cancel out the acids which form in your mouth after eating . Brush your teeth last thing at night and at least one other time during the day, with fluoride toothpaste. Use a small-headed brush with medium to soft bristles. Wait for at least one hour after eating or drinking anything acidic before brushing your teeth (this gives your teeth time to build up their mineral content). If you can, rinse your mouth immediately with clear water after eating acidic foods or drinking acidic drinks

16. Use fluoride toothpaste . Fluoride acts as a remineralizing agent for the enamel. You can also apply fluoride gels or varnishes to the teeth . Children up to three years old should use a toothpaste with a fluoride level of at least 1000ppm (parts per million). Three-year-olds to adults should use toothpaste that contains 1350ppm to 1500ppm. 

17. Clinical interventions Apply fluoride varnish to tooth surfaces susceptible to erosion: A protective film containing fluoride will reduce direct contact between tooth surfaces and acids and deliver fluoride to strengthen the enamel surfaces. 2. Treat underlying diseases associated with the presence of intrinsic acids intraorally: This includes GERD , bulimia , regurgitation . It is often necessary to establish close consultation with the patient’s physicians when an intrinsic cause of erosion is suspected.

18. 3. Treat conditions causing salivary hypofunction; When low saliva flow rate is established as a factor for erosion in a specific patient, measures should be taken to improve saliva flow, where possible. This may include consultation with the patient’s physicians on adjustment of medications causing dry mouth, and referrals for evaluation and treatment of autoimmune diseases such as Sjogren’s syndrome

19. Prevention and management If no effective intervention occurs at an early stage, the eventual outcome of dental erosion is severe loss of dental hard tissues that adversely affects function and esthetics . In patients with extensive dentin exposure, transient and persistent pain due to dentin sensitivity and pulp pathology may further reduce quality of life. Severe erosive tooth wear can be managed restoratively. Composite resins and ceramics can be used for partial and full coverage restorations to restore the esthetics and function of the teeth.

20. However , if the restored teeth continue to be subjected to severe erosive challenges, the restorations may fail in due course following marginal deterioration and continued loss of surrounding dental hard tissues. Therefore , preventive measures for dental erosion are not only essential for early intervention and primary prevention of erosive tooth wear, but they are also important for secondary prevention of erosion around restorations.

21. For more information, you can book an appointment at Dr Sachdeva's Dental Aesthetic And Implant Institute, I 101, Ashok Vihar Phase 1, Delhi- 110052 Contact us at Phone : [phone] Our Websites: www.sachdevadentalcare.com www.dentalclinicindelhi.com www.dentalimplantindia.co.in www.dentalcoursesdelhi.com www.facialaestheticsdelhi.com

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