dentistry Dominic Thorncroft

How Can A Dentist Recognise And Treat Dental Erosion

Treating Dental Erosion

Dental erosion is defined as the loss of surface tooth structure due to acid other than from bacterial plaque.

The two most common diseases in the mouth are dental caries and periodontal disease. They are both caused by bacteria in plaque. Dental caries result of tooth erosion but hard tooth structure is also lost by three other methods. Tooth surface loss encompasses abrasion, attrition and erosion.

Abrasion and attrition are caused by mechanical tooth wear but erosion is caused by chemical wear. The critical pH for enamel erosion to take effect is when it dips below 5.5. This is because saliva has an inherent buffering capacity.

In dental erosion the source of acid is extrinsic or extrinsic.

Intrinsic acid is due to recurrent vomiting from psychological diseases such as anorexia and bulimia. Intrinsic acid may also be due to acid reflux in gastric disorders. The acid travels from the stomach, up into the oesophagus and into the oral cavity. It is worse at night when the person is lying flat.

Extrinsic acid is usually due to acidic foods and acidic drinks. In the past, exposure to acid in the atmosphere due to industrial processes used to occur  but not anymore.

When acid is introduced into the mouth, the saliva is extremely important due to its rinsing and due to its buffering effect.

The rinsing effect of saliva is due to the constant salivary flow rate and helps to wash the acid away quickly after swallowing. In addition, the buffering effect of the saliva helps to neutralize the acids before a low pH can cause demineralization hence it cannot cause damage to the enamel and dentine.

Common foods which are acidic are all citric foods such as apples, oranges and especially lemons. In addition berries and pickles.

Common acidic drinks are soft drinks, energy drinks, sports drinks, vinegar and pure fruit drinks.

Research shows that the critical frequency for fruits is “3 exposures or more.” This means that you are allowed to have 2 meals or snacks in a day containing acids and this is safe but above this amount, you will suffer acid erosion.

The critical exposure with drinks is only more than once daily. This also depends on how long the drink is in the mouth because it is known that children and young people often swish the drink around their mouth and they may even use fizzy sweets to produce a crackling effect. If the food or drink also contains sugar, this also additionally contributes to dental caries. And if the plaque control is inadequate, periodontal diseases will also take hold.

Many of these acidic drinks described above have a pH of less than 4.

The acid inside these drinks is in the form of citric acid, phosphoric acid, malic acid, and carbonic acid.

The effects of acid erosion on teeth causes sensitivity, affects the appearance and finally the loss of enamel reduces resistance to dental caries.

The effects of chewing gum has been extensively researched and it is known that chewing gum immediately after eating removes 90% of food debris within a few minutes.

The chewing of gum also increases the salivary flow rate. This causes an increase in bicarbonate and calcium ions which help to remineralize the tooth enamel and also to neutralise plaque or dietary acids.

It is important to note that unlike dental caries, dental erosion does not undergo a process of remineralisation because the actual process is different. During dental erosion, the surface of the enamel becomes soft and then it is lost permanently.

This is why it is also important to advise patients not to brush my teeth immediately after they have consumed acidic foods or drinks because they will literally be spitting their teeth down the sink. They should wait at least 20 minutes so that the effects of saliva can protect properly.

In many patients, the effects of acid erosion, abrasion, attrition, dental caries and periodontal disease often occur in combination.  Often as a dentist, you are trying to to battle the ravages of acid erosion abrasion attrition, dental caries and periodontal disease simultaneously.

Always, you must take a good  dental history,  a thorough medical history and the examination then leads on to a correct diagnosis. Once the diagnosis has been established, you can then formulate a treatment plan for the patient. The treatment plan will consist of distinct stages which include prevention, immediate temporization, medium-term restorative treatment and long-term monitoring.

Consent must also always be gained and the consent must be valid. The patient must be able to understand what you have communicated to them and be able to make a decision that they feel best suits them. Consent therefore is an ongoing process as the treatment plan progresses from one stage to the next stage.

dentistry Dominic Thorncroft

How A Dentist Can Recognise Dental Erosion

Here are three photographs taken from patients diagnosed as suffering from dental erosion.

Picture Number 1

Picture Number 1

This picture shows a porcelain fused to metal crown on the upper right 2 tooth. Although the crown appears longer than the other teeth, it in fact is and was the correct length. It looks too long because the adjacent teeth have become shorter due to acid erosion effects. Going into more detail we can report on the following.

Incisal edges of the upper left 1 tooth and the upper right 1 tooth surfaces appear grey. This grey appearance is commonly characteristic of enamel tooth substance loss. As that enamel thins down, the incisal edges which are already partially translucent and when the thickness of enamel decreases, the translucency increases and the reason for the appearance of the incisors looking grey.

The surfaces of the upper left 1 tooth and the upper right 1 tooth appear yellow. This is because the overlying enamel has become fine due to tooth erosion. From the thinner layer of overlying enamel, the dentine becomes more apparent and we know that dentine has a distinct yellow colour.

This explains why both of those two teeth appear more yellow. Looking at the upper left 1 tooth, on the buccal surface near the cervical margin, there is no enamel left at all. Furthermore, this exposes the softer dentine which is then more susceptible to abrasion and dental caries. The lower central incisors have chipped due to loss of enamel structure.

Picture Number 2

Picture Number 2

This is a picture of a patient’s anterior teeth. It is a younger patient of 16 years age. This picture shows that all four conditions are present as dental erosion, attrition abrasion, dental caries and periodontal disease.

Caries: There are extensive dental caries in the upper left 1 tooth mesially. The dental caries have infiltrated the dental pulp and a pulp polyp is now apparent. Needless to say, this tooth is non vital. The adjacent upper right one has secondary caries under and around the buccal composite restoration.

The upper right 2 tooth has buccal caries around the cervical margin. There is also a front of demineralised enamel which has a white chalky appearance. The upper left 2 has secondary or recurrent caries around the restoration. Finally, there is marginal gingivitis due to a lack of inadequate oral hygiene measures.

The patient was drinking 5 to 6 cans of Coca-Cola every single day. He would sit down on his gaming computer and sip coca cola continuously. Both his parents would be away at work and without any cooked meals he would just rely on snacks such as Mars bars and Milky way’s.

This trend contributed to his dental caries. He would play on his gaming computer until 4am in the morning and needless to say, he’d want to just go straight to bed as he could not be bothered to brush his teeth. In the morning, or rather in the afternoon, he would get up and give his teeth a 10-second brush and look for snacks for his breakfast.

Sometimes during the day when his parents were out, one of his friends would come around with amphetamines and this also contributed to him grinding his teeth causing further damage to his teeth.