|Severe tooth wear of the lower teeth in a bulimic person.|
|Classification and external resources|
Acid erosion, also known as dental erosion, is a type of tooth wear. It is defined as the irreversible loss of tooth structure due to chemical dissolution by acids not of bacterial origin. Dental erosion is the most common chronic disease of children ages 5–17, although it is only relatively recently that it has been recognised as a dental health problem. There is generally widespread ignorance of the damaging effects of acid erosion; this is particularly the case with erosion due to fruit juices, because they tend to be seen as healthy. Acid erosion begins initially in the enamel, causing it to become thin, and can progress into dentin, giving the tooth a dull yellow appearance and leading to dentin hypersensitivity.
The most common cause of erosion is by acidic foods and drinks. In general, foods and drinks with a pH below 5.0–5.7 have been known to trigger dental erosion effects. Numerous clinical and laboratory reports link erosion to excessive consumption of drinks. Those thought to pose a risk are soft drinks, some alcohol and fruit drinks, fruit juices such as orange juice (which contain citric acid) and carbonated drinks such as colas (in which the carbonic acid is not the cause of erosion, but citric and phosphoric acid). Additionally, wine has been shown to erode teeth, with the pH of wine as low as 3.0–3.8. Other possible sources of erosive acids are from exposure to chlorinated swimming pool water, and regurgitation of gastric acids.
- 1 Causes
- 2 Diagnosis
- 3 Prevention and management
- 4 See also
- 5 Further reading
- 6 References
- 7 External links
Extrinsic acidic sources
Extrinsic acid erosion is when the source of acid originates from outside of the body. Acidic food and drink lowers the pH level of the mouth resulting in demineralisation of the teeth. A variety of drinks contribute to dental erosion due to their low pH level. Examples include fruit juices, such as apple and orange juices, sports drinks, wine and beer. Carbonated drink, such as colas and lemonades are also very acidic and hence have significant erosive potential. Foods such as fresh fruits, ketchup and pickled food in vinegar have been implicated in causing acid erosion. Frequency rather than total intake of acidic juices is seen as the greater factor in dental erosion; infants using feeding bottles containing fruit juices (especially when used as a comforter) are therefore at greater risk of acid erosion.
Saliva acts as a buffer, regulating the pH when acidic drinks are ingested. Drinks vary in their resistance to the buffering effect of saliva. Studies show that fruit juices are the most resistant to saliva's buffering effect, followed by, in order: fruit-based carbonated drinks and flavoured mineral waters, non-fruit-based carbonated drinks, sparkling mineral waters; Mineral water being the least resistant. Because of this, fruit juices in particular, may prolong the drop in pH levels.
A number of medications such as chewable vitamin C, aspirin and some iron preparations are acidic and may contribute towards acid erosion. Certain drugs can cause hypo-salivation which is considered a risk factor for acid erosion.
Intrinsic acidic sources
Intrinsic dental erosion, also known as perimolysis, is the process whereby gastric acid from the stomach comes into contact with the teeth. This is often secondary to conditions such as anorexia nervosa, bulimia nervosa, gastroesophageal reflux disease (GERD) and rumination syndrome. Dental erosion can occur by non-extrinsic factors too. There is evidence linking eating disorders with a range of oral health problems including dental erosion, caries and xerostomia. Reduced salivary flow rate, a common symptom of bulimia, predisposes an individual to dental erosion due to increased vulnerability to the effects of acidic food and drinks. Self-induced vomiting increases the risk of dental erosion by a factor of 5.5 compared to healthy controls. Lesions are most commonly found on the palatal surfaces of the teeth, followed by the occlusal and then the buccal surfaces. The main cause of GERD is increased acid production by the stomach. This is not exclusive to adults, as GERD and other gastrointestinal disorders may cause dental erosions in children.
Acid erosion often coexists with abrasion and attrition. Abrasion is most often caused by brushing teeth too hard. Any frothing or swishing acidic drinks around the mouth before swallowing increases the risk of widespread acid erosion. Sucking citrus fruits can also contribute to acid erosion.
Diagnosis based on clinical findings
In-vivo studies are advantageous in assessing erosion directly from the patient's mouth. There are numerous signs of dental erosion, including changes in appearance and sensitivity.
Change in color
One of the physical changes can be the color of teeth. Dental erosion can lead to two major tooth colour change - the first being a change of color that usually happens on the cutting edge of the central incisors. This causes the cutting edge of the tooth to become transparent. A second sign is a yellowish tint on the eroded tooth. This occurs because the white enamel has eroded away to reveal the yellowish dentin beneath. On top of clinical examination, the dentist may take intra-oral photographs to monitor the extent and progress of erosion. Clinical photographs lead to comparable results to a visual examination, however both may result in an underestimation of the extent of tooth wear.
Change in shape
A change in shape of the teeth is also a sign of dental erosion. Teeth will begin to appear with a broad rounded concavity, and the gaps between teeth will become larger. There can be evidence of wear on surfaces of teeth not expected to be in contact with one another. If dental erosion occurs in children, a loss of enamel surface characteristics can occur. Amalgam restorations in the mouth may be clean and non-tarnished. As tooth substance around restorations erodes away, fillings may also appear to be rising out of the tooth. The teeth may form divots on the chewing surfaces when dental erosion is occurring. This mainly happens on the first, second, and third molars. To monitor the change in shape over time, dentists can create and retain accurate, serial study casts. Dentists may also employ dental indices to guide their diagnosis and management of the condition. A new scoring system referred to as Basic Erosive Wear Examination (BEWE) grades the appearance or severity of wear on the teeth by the extent of hard tissue loss. It is noted that indices are useful in monitoring the most severe clinical changes in tooth wear. However, they lack comprehensiveness as they cannot measure the rate of progression and cannot monitor all teeth affected by erosion. There is also a lack of an index which is universally accepted and standardised.
One of the most severe signs of dental erosion is cracking, where teeth begin to crack off and become coarse. Other signs include pain when eating hot, cold, or sweet foods. This pain is due to the enamel having been eroded away, exposing the sensitive dentin.
Diagnosis based on optical properties
Based on the optical changes induced in eroded tissue by the lesions, in 2015 Koshoji et al. also demonstrated in a novel method that using laser speckle images (LSI) it is possible to acquire information on the microstructure of the enamel and detect minimal changes, such as early non-carious lesions. To produce the erosion, the samples were divided into four groups and immersed in 30 ml of a cola-based beverage (pH approximately 2.5) at room temperature. A representative image of the samples under white and laser illumination shows that although there are visible stains in the left portion of each sample due the dye from the cola beverage, structural changes are difficult to assess with the naked eye.
To differentiate the sound and eroded tissues, contrast analysis was performed of the speckle patterns in the images. Since this analysis is, in its essence, the ratio of the standard deviation and average intensity, the LASCA map of the lesion is generally higher than in sound tissue. This phenomenon is demonstrated in the LASCA maps which show the greater prevalence of dark blue on the right side, indicating sound tissue, and lower prevalence on the left side, indicating eroded tissue. The contrast ratio of the LASCA maps demonstrates that laser speckle images are sensitive to even small changes in the microstructure of the surface.
Erosion is highly prevalent in people of all ages. However, an objective diagnostic procedure is still needed, thus the study of the laser speckle imaging for tooth enamel may provide the first low cost objective diagnostic method for this disease. The analysis of laser speckle imaging in the spatial domain is a powerful diagnostic technique that provides information on the surface microstructure of tooth enamel after an acid etching procedure using patterns and LASCA maps. In an erosion model, these patterns are associated with mineral loss from the enamel. This method has proven sensitive to 10 minutes of acid etching on tooth enamel, which is a lesion so incipient that is not likely to be detected in clinical practice even by a trained dentist, besides it is also sensitive to the erosion progression.
Prevention and management
Preventive and management strategies include the following:
- Reducing the frequency of acidic and sweet food and beverage intake. This decreases the sugar/acid exposure time and allows the eroded tooth surface to reharden.
- Modifying the pH of the food or beverage contributing to the problem, or changing lifestyle to avoid the food or beverage.
- Drinking through a straw to reduce contact between erosive fluids and teeth. Likewise, drinks should not be held in the mouth or sipped for a long time.
- Avoiding abrasive forces. Use a soft bristled toothbrush and brush gently. Avoid brushing immediately after consuming acidic food and drink as teeth will be softened. Leave at least half an hour of time in between. Rinsing with water is better than brushing after consuming acidic foods and drinks.
- Using a remineralizing agent, such as sodium fluoride solution in the form of a fluoride mouthrinse, tablet, or lozenge, immediately before brushing teeth. Sodium fluoride application can also help prevent further demineralisation if erosion has already occurred.
- Applying fluoride gels or varnishes can increase enamel hardness and increase resistance to softening.
- Drinking milk and other dairy products causes increased mineral deposition on the tooth surface allowing it to reharden.
- Applying dentine bonding agents to areas of exposed dentin can prevent further damage 
- Using a neutralizing agent, such as antacid tablets in suspension, as they have the potential to reduce enamel erosion after vomiting.
- Treating any underlying medical conditions or diseases which are causing regurgitation of acids.
- Adrian Lussi. Dental Erosion: From Diagnosis to Therapy. Karger Publishers, 2006. (ISBN 9783805580977)
- ten Cate, J. M.; Imfeld, T. (April 1996). "Dental erosion, summary". European Journal of Oral Sciences. 104 (2 ( Pt 2)): 241–244. ISSN 0909-8836. PMID 8804892.
- Dugmore, C.R; Rock W.P (13 March 2004). "A multifactorial analysis of factors associated with dental erosion" (PDF). British Dental Journal. 196 (5): 283–6;discussion: 273. doi:10.1038/sj.bdj.4811041. PMID 15017418. Retrieved 2009-05-21.
- "'Health juices' harm baby teeth". BBC News Online. 2 August 2007. Retrieved 2009-05-21.
- Guignon, Anne (September 2013). "Dental Erosion: An Increasingly Common Cause of Dentin Hypersensitivity" (PDF). Colgate Dental Aegis.
- Mandel, Louis (2005). "Dental erosion due to wine consumption". American Dental Association. 136: 71–5. doi:10.14219/jada.archive.2005.0029. PMID 15693499.
- British Dental Journal. Publ. online 2002, available from: http://www.nature.com/bdj/journal/v193/n10/full/4801628a.html (last reviewed: 19/05/17)
- Buczkowska-Radlińska, J.; Łagocka, R.; Kaczmarek, W.; Górski, M.; Nowicka, A. (March 2013). "Prevalence of dental erosion in adolescent competitive swimmers exposed to gas-chlorinated swimming pool water". Clinical Oral Investigations. 17 (2): 579–583. doi:10.1007/s00784-012-0720-6. ISSN 1432-6981. PMC . PMID 22476450.
- Paryag, A; Rafeek, R (2014-9). "Dental Erosion and Medical Conditions An Overview of Aetiology, Diagnosis and Management". The West Indian Medical Journal. 63 (5): 499–502. doi:10.7727/wimj.2013.140. ISSN 0043-3144. PMC . PMID 25781289. Check date values in:
- Kaidonis, J. A. (August 2012). "Oral diagnosis and treatment planning: part 4. Non-carious tooth surface loss and assessment of risk". British Dental Journal. 213 (4): 155–161. doi:10.1038/sj.bdj.2012.722. ISSN 1476-5373.
- O'Sullivan, E.; Milosevic A. (November 2008). "UK National Clinical Guidelines in Paediatric Dentistry: diagnosis, prevention and management of dental erosion" (PDF). International Journal of Paediatric Dentistry. 18 (Supplement 1): 29–38. doi:10.1111/j.1365-263X.2008.00936.x. PMID 18808545. Retrieved 2009-05-21.
- Edwards, M.; Creanor S.L.; Foye R.H.; Gilmour W.H. (December 1999). "Buffering capacities of soft drinks: the potential influence on dental erosion". Journal of Oral Rehabilitation. 26 (12): 923–927. doi:10.1046/j.1365-2842.1999.00494.x. PMID 10620154. Retrieved 2009-05-21.
- Gandara, B.K; E.L Truelove (October 1999). "Diagnosis and management of dental erosion". Journal of Contemporary Dental Practice. 1 (1): 16–23. PMID 12167897. Archived from the original on 2010-12-15. Retrieved 2009-05-21.
- Rosten, A.; Newton, T. (October 2017). "The impact of bulimia nervosa on oral health: A review of the literature". BDJ. 223 (7): 533–539. doi:10.1038/sj.bdj.2017.837. ISSN 1476-5373.
- Monagas, J; Suen A; Kolomensky A; Hyman PE (November 2013). "Gastrointestinal issues and dental erosions in children". Clinical Pediatrics. 52 (11): 1065–1066. doi:10.1177/0009922812460429. PMID 22984193. Retrieved 2014-02-08.
- Acid Attack. Academy of General Dentistry. 6 February 2008.
- Al-Malik, M. I.; Holt, R. D.; Bedi, R.; Speight, P. M. (February 2001). "Investigation of an index to measure tooth wear in primary teeth". Journal of Dentistry. 29 (2): 103–107. ISSN 0300-5712. PMID 11239584.
- Carlsson, G. E.; Johansson, A.; Lundqvist, S. (May 1985). "Occlusal wear. A follow-up study of 18 subjects with extensively worn dentitions". Acta Odontologica Scandinavica. 43 (2): 83–90. ISSN 0001-6357. PMID 3863449.
- Fareed, K.; Johansson, A.; Omar, R. (August 1990). "Prevalence and severity of occlusal tooth wear in a young Saudi population". Acta Odontologica Scandinavica. 48 (4): 279–285. ISSN 0001-6357. PMID 2220336.
- Bartlett, D.; Ganss, C.; Lussi, A. (March 2008). "Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs". Clinical Oral Investigations. 12 Suppl 1: S65–68. doi:10.1007/s00784-007-0181-5. ISSN 1432-6981. PMC . PMID 18228057.
- Bardsley, Penny Fleur (2008-3). "The evolution of tooth wear indices". Clinical Oral Investigations. 12 (Suppl 1): 15–19. doi:10.1007/s00784-007-0184-2. ISSN 1432-6981. PMC . PMID 17701430. Check date values in:
- Joshi, Mahasweta; Joshi, Nikhil; Kathariya, Rahul; Angadi, Prabhakar; Raikar, Sonal (2016-10). "Techniques to Evaluate Dental Erosion: A Systematic Review of Literature". Journal of Clinical and Diagnostic Research : JCDR. 10 (10): ZE01–ZE07. doi:10.7860/JCDR/2016/17996.8634. ISSN 2249-782X. PMC . PMID 27891489. Check date values in:
- The Cleveland Clinic Department of Dentistry. Dental Health: Tooth Sensitivity. WebMD. Retrieved 2008-03-09.
- Davenport, Tammy (14 September 2007). "Signs and Symptoms of Tooth Erosion". About.com. Retrieved 2008-03-09.
- Koshoji, Nelson H.; Bussadori, Sandra K.; Bortoletto, Carolina C.; Prates, Renato A.; Oliveira, Marcelo T.; Deana, Alessandro M. (2015-02-13). "Laser Speckle Imaging: A Novel Method for Detecting Dental Erosion". PLoS ONE. 10 (2): e0118429. doi:10.1371/journal.pone.0118429. PMC . PMID 25679807.
- Koshoji, Nelson H.; Bussadori, Sandra K.; Bortoletto, Carolina C.; Oliveira, Marcelo T.; Prates, Renato A.; Deana, Alessandro M. (2015). "Analysis of eroded bovine teeth through laser speckle imaging". Lasers in Dentistry XXI. doi:10.1117/12.2075195.
- Magalhães, Ana Carolina; Wiegand, Annette; Rios, Daniela; Honório, Heitor Marques; Buzalaf, Marília Afonso Rabelo (April 2009). "INSIGHTS INTO PREVENTIVE MEASURES FOR DENTAL EROSION". Journal of Applied Oral Science. 17 (2): 75–86. doi:10.1590/S1678-77572009000200002. ISSN 1678-7757. PMC . PMID 19274390.
- Edwards, M.; R A Ashwood; S J Littlewood; L M Brocklebank & D E Fung (12 September 1998). "A videofluoroscopic comparison of straw and cup drinking: the potential influence on dental erosion". British Dental Journal. 185 (5): 244–249. doi:10.1038/sj.bdj.4809782. PMID 9785633. Retrieved 2009-05-21.
- Johansson, Ann-Katrin; Lingström, Peter; Imfeld, Thomas; Birkhed, Dowen (December 2004). "Influence of drinking method on tooth-surface pH in relation to dental erosion". European Journal of Oral Sciences. 112 (6): 484–489. doi:10.1111/j.1600-0722.2004.00172.x. ISSN 0909-8836. PMID 15560830.
- "Dental erosion: possible approaches to prevention and control". Journal of Dentistry. 33 (3): 243–252. 2005-03-01. doi:10.1016/j.jdent.2004.10.014. ISSN 0300-5712.
- Attin, T.; Zirkel, C.; Hellwig, E. (1998). "Brushing abrasion of eroded dentin after application of sodium fluoride solutions". Caries Research. 32 (5): 344–350. doi:10.1159/000016470. ISSN 0008-6568. PMID 9701659.
- O'Toole, Saoirse; Mistry, Miten; Mutahar, Mahdi; Moazzez, Rebecca; Bartlett, David (December 2015). "Sequence of stannous and sodium fluoride solutions to prevent enamel erosion". Journal of Dentistry. 43 (12): 1498–1503. doi:10.1016/j.jdent.2015.10.003. ISSN 1879-176X. PMID 26454222.
- Sorvari, R.; Meurman, J. H.; Alakuijala, P.; Frank, R. M. (1994). "Effect of fluoride varnish and solution on enamel erosion in vitro". Caries Research. 28 (4): 227–232. doi:10.1159/000261970. ISSN 0008-6568. PMID 8069877.
- Gedalia, I.; Dakuar, A.; Shapira, L.; Lewinstein, I.; Goultschin, J.; Rahamim, E. (June 1991). "Enamel softening with Coca-Cola and rehardening with milk or saliva". American Journal of Dentistry. 4 (3): 120–122. ISSN 0894-8275. PMID 1863431.
- C Youngson, Callum (2004-03-27). "Research Summary: Do adhesive resins protect dentine from erosion by acids?". British Dental Journal. 196: 339–339. doi:10.1038/sj.bdj.4811081.
- Turssi, Cecilia P.; Vianna, Lídia M. F. F.; Hara, Anderson T.; do Amaral, Flávia L. B.; França, Fabiana M. G.; Basting, Roberta T. (August 2012). "Counteractive effect of antacid suspensions on intrinsic dental erosion". European Journal of Oral Sciences. 120 (4): 349–352. doi:10.1111/j.1600-0722.2012.00972.x. ISSN 1600-0722. PMID 22813226.
|Wikimedia Commons has media related to Acid erosion.|