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Erosion, otherwise known as acid erosion, is the 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 5–17.¹ Erosion is found initially in the enamel and, if unchecked, may proceed to the underlying dentin.

Frequently consumed foods and drinks below pH 5.0–5.7 may intitiate dental erosion.

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.² Numerous clinical and laboratory reports link erosion to excessive consumption of drinks. Those thought to pose a risk are soft drinks 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 3.0–3.8.² Other possible sources of erosive acids are from exposure to chlorinated swimming pool water, and regurgitation of gastric acids.

Causes

Acidic drinks and foods lower the pH level of the mouth so consuming them causes the teeth to demineralise. Furthermore, sugars contained in food and drink also turn to acid, which further erodes the teeth.³ Drinks low in pH levels that cause dental erosion include fruit juices, sports drinks, and carbonated drinks. Orange and apple juices are common culprits among fruit juices. Carbonated drinks such as Coca-Cola are also very acidic.³

Dental erosion can occur by non-extrinsic factors too. Intrinsic dental erosion is known as perimolysis, whereby gastric acid from the stomach comes into contact with the teeth.⁴ People with diseases such as anorexia nervosa, bulimia, and gastroesophageal reflux disease often suffer from this. GERD is quite common and an average of 7% of adults experience reflux daily.³ The main cause of GERD is increased acid production by the stomach.³

Signs

There are many signs of dental erosion, including changes in appearance and sensitivity. One of the physical changes can be the color of teeth. There are two different colors teeth may turn if dental erosion is occurring, 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.⁵ A second sign is if the tooth has a yellowish tint. This occurs because the white enamel has eroded away to reveal the yellowish middle layer of the tooth called dentin.⁵ 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.⁵ 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. Fillings may also appear to be rising out of the tooth, the appearance being caused when the tooth is eroded away leaving only the filling. The teeth may form divots on the chewing surfaces when dental erosion is occurring. This mainly happens on the first, second, and third molars. One of the most severe signs of dental erosion is cracking⁶, where teeth begin to crack off and become coarse.⁵ 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.⁷

Prevention

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Once enamel has been lost, it cannot reform which is why prevention is so important. You should limit your intake of drinks such as fruit juices that contain acid and always wash your mouth with water after drinking and eating so that food or drink doesn't remain on the teeth. It is also important to use a straw with acidic drinks so that the liquid doesn't come into contact with the teeth. Chewing (on something non-acidic) is beneficial because it produces saliva which raises the ph of the mouth and so neutralises the acid. Once the ph of the mouth has returned to normal then remineralisation can occur. Leave brushing of teeth for at least one hour after consuming acidic food or drink as this is when the enamel is at its weakest. Do not brush too hard and it may be helpful to use a soft toothbrush so that you don't damage the enamel. It is recommended you use a fluoride toothpaste as fluoride is thought to strengthen the enamel. Many communities, particularly in the USA, fluoridate their water^{citation needed}; in which case there may be a risk excessive fluoride consumption which can lead to fluorosis, so it is advisable to consult your dentist on this matter.⁸⁹

See also

• Abrasion
• Abfraction
• Attrition
• Bruxism

References

1. ^ U.S. Department of Health and Human Services (8 August 2007), Preventing Chronic Diseases: Investing Wisely in Health, National Center for Chronic Disease Prevention and Health Promotion 
2. ^ ^{a b} Mandel, Louis. "Dental erosion due to wine consumption". American Dental Association. Retrieved on 2008-01-03.
3. ^ ^{a b c d} Truelove, Edmond L. (15 November 1999), Diagnosis and Management of Dental Erosion, The Journal of Contemporary Dental Practice, http://www.thejcdp.com/issue001/gandara/gandara.htm, retrieved on 1 March 2008 
4. ^ Truelove, Edmond L. (15 November 1999), Diagnosis and Management of Dental Erosion, The Journal of Contemporary Dental Practice, http://www.thejcdp.com/issue001/gandara/gandara.htm, retrieved on 1 March 2008 
5. ^ ^{a b c d} Acid Attack., Academy of General Dentistry., 6 February, 2008, http://64.233.167.104/search?q=cache:YJ69EnrlwcUJ:www.agd.org/public/OralHealthFacts/files/pdfgenerator.aspx%3Fpdf%3DFS_ToothErosion.pdf+teeth+erosion&hl=en&ct=clnk&cd=7&gl=us, retrieved on 9 March 2008 
6. ^ Dental Health: Tooth Sensitivity, WebMD, http://www.webmd.com/oral-health/tooth-sensitivity?page=2, retrieved on 9 March 2008 
7. ^ Davenport, Tammy (14 September 2007), Signs and Symptoms of Tooth Erosion., About.com, http://dentistry.about.com/od/toothmouthconditions/a/teetherosionsym.htm, retrieved on 9 March 2008 
8. ^ aciderosion.co.uk Acid erosion and abrasion:Prevention
9. ^ Goss, Lisa (May 2005), [www.kidshealth.org/kid/feel_better/things/fluoride.html How Does Fluoride Work?], www.kidshealth.org/kid/feel_better/things/fluoride.html, retrieved on 9 March 2008 

• The Journal of Contemporary Dental Practice
• Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001. ISBN 0-86715-382-2.

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