Dental Erosion: Primary Causes & Treatment Types

What is Dental Erosion?

Dental erosion, also referred to as enamel erosion, occurs when acidic substances wear away tooth enamel. In short, it is a chemical process that results in the loss of dental tissue. This process does not involve bacteria.

The number of people affected by dental erosion differs between locations, countries, and age groups. However, the prevalence rate of the disease is highest in adolescents between 9 and 11 years of age (11 to 100 percent).

In the U.S., erosion is the second most common dental condition among adolescents. It also continues to be a growing problem around the world.

Dental caries (cavities), on the other hand, is the most common dental condition that affects children and adolescents. Dental caries is the process that results in tooth cavitation, also called decay. These lesions are limited to enamel only, so they can be “stopped” without a cavity filling.

dental erosion

Primary Cause of Erosion


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Excessive consumption of sugary foods and drinks that are high in acidity is attributed to dental erosion. These include, but are not limited to:

  • Soft drinks (soda), diet drinks, and other carbonated beverages.
  • Citric fruit juices, such as lemon, orange, and other fruit-flavored juices.
  • Sports drinks, energy drinks, and ciders.
  • Candy, ice cream, and white starches, such as certain kinds of pasta and bread
  • Acidic foods, such as citrus, berries, and apples.

All of these substances can also cause cavities over time, especially when brushing and flossing are neglected as well.

Erosion Process

When an erosive substance comes into contact with a tooth, the surface begins to dissolve. In particular, the acids from the substance demineralize the tooth’s enamel and tissues beneath the tooth (dentin), resulting in erosion.

anatomy of a tooth showing dentin and enamel

Step 1. Erosion of Enamel

The dental erosion process begins with the demineralization of enamel, which is the hard, mineralized surface of teeth.

During this process, acids disperse into the narrow pores on the surfaces of teeth, which reduces the strength of the outer layer of enamel. As erosion progresses over time, the outermost layer of enamel becomes demineralized. As a result, teeth begin to lose surface profile. The eroded teeth also become more translucent as the enamel wears away.

Step 2. Erosion of Dentin

Dentin, the second layer of a tooth that surrounds the dental pulp, has a different erosion process than enamel. During this process, the small crystals found in dentin dissolve very quickly because they are more soluble than enamel crystals.

Enamel erosion, on the other hand, causes a loss of surface tissue on the outer layer of teeth. Erosion also results in the demineralization of dentin and irreversible loss of tooth structure.

Additionally, when dentin becomes exposed, extreme tooth sensitivity and discoloration typically occur.

tooth damage

Types of Erosion

Enamel erosion can develop on the molars, premolars, canines, and incisors (front teeth). The most common types of enamel erosion include:

Occlusal Dental Erosion

This type of erosion forms on the biting surfaces of teeth, including the molars in the lower jaw and molars in the upper jaw. Canines and premolars in the upper and lower jaws can also develop occlusal erosion, but it is less common. Although, incisors are the least likely to develop occlusal erosion (less than 5 percent).

Palatal Dental Erosion

This type of erosion forms on the surfaces of teeth closest to the palate. In particular, palatal erosion typically affects the incisors, canines, and premolars in the upper jaw.

Advanced Dental Erosion

Advanced dental erosion occurs when the enamel wears away enough to reveal the underlying dentin (layer below the enamel). Although, this stage of enamel erosion can be time-consuming and expensive to treat.

trauma

Other Risk Factors & Causes

Dental erosion is associated with excessive consumption of sugars and substances with low pH levels. Frequent vomiting, acid reflux, medical conditions, and improper oral hygiene practices can also lead to erosion:

Sugar and Acidity

Studies have shown that soft drinks and energy drinks increase the risk of dental erosion 2.4-fold. Fruit juices, citrus, sports drinks, candy, ice cream, and ciders can also cause erosion.

Dry Mouth

Dry mouth, also called xerostomia, is a non-life-threatening oral condition that occurs when the salivary glands in the mouth do not produce enough saliva to keep the mouth wet. Some proteins and antibacterial agents found in saliva kill bacteria and dilute acids. As saliva production decreases, acids in the mouth are not diluted, which results in erosive wear.

Gastroesophageal Reflux Disease (GERD)

GERD is a more serious form of heartburn (GER) that occurs when the stomach contents come back up into the esophagus. The stomach contents are a mixture of gastric acid, small undigested food particles, pepsin, and bile acids. Depending on the pH level of the stomach contents and if the contents reach the mouth, tooth erosion can occur.

The most common symptom of GERD is burning chest pain after eating spicy or acidic foods. The burning sensation may also become worse when lying down.

Side Effect of Certain Drugs

Many prescription drugs list nausea and vomiting as side effects, including opiates and chemotherapy medications. In addition, other drugs that may induce vomiting in some people include aspirin and diuretics. Allergies associated with certain medications, such as antibiotics, may also cause vomiting.

Medical Conditions

Medical conditions associated with vomiting can also cause enamel erosion. Common conditions include gastrointestinal disorders (chronic gastritis), metabolic and endocrine disorders (diabetes), neurological disorders, and central nervous system disorders (migraines). Some syndromes, including cyclic and psychogenic vomiting syndrome, can also cause erosion. In addition, both syndromes involve recurrent vomiting and nausea. Bulimia, a life-threatening eating disorder characterized by a cycle of bingeing and self-induced vomiting, can also lead to erosive wear.

Chronic Alcoholism

Excessive, long-term alcohol consumption can induce dental erosion. In addition to erosion, alcoholism is also associated with cavities due to neglected oral hygiene. Bruxism and oral cancer are also common conditions associated with long-term alcohol use.

Further, enamel erosion associated with alcoholism can also be linked to frequent vomiting, regurgitation, or consuming alcoholic drinks high in acidity. For example, the pH levels in most wines are low, which may result in erosion over time.

Pregnancy-Induced Vomiting

Vomiting during the first 12 weeks of pregnancy is very common. It is typically nothing to worry about unless oral hygiene is neglected as well. If vomiting is prolonged or occurs during multiple pregnancies, there is a higher chance dental erosion will develop.

plaque tartar

Symptoms of Erosion

Common symptoms of early dental erosion may include:

  • Smooth, silky, and/or shiny spots on tooth enamel.
  • Slightly clear or translucent teeth.
  • Yellow tooth discoloration (due to exposed dentin, which is yellow).
  • Grooving on the biting areas of teeth.
  • Extreme tooth sensitivity to either hot, cold, or sweet substances. You may also notice sensitivity when consuming all three.
  • Rounded teeth (the ridges of enamel wear away, resulting in a flatter surface).

Common symptoms of advanced dental erosion may include:

  • Cracked or fractured teeth — partial fractures that appear on the crowns of teeth and may extend under the gums. Some tooth cracks may cause little to no pain. Most cause acute pain before or after biting down.
  • Extreme tooth sensitivity to either hot, cold, or sweet substances. You may also notice sensitivity when consuming all three.
  • Cupping on the biting surfaces of teeth (little dents).
dentist appointment

Dental Treatment for Tooth Erosion

Erosion, by definition, means the enamel has already been lost. Unfortunately, any loss of enamel is irreversible. To prevent this from happening, common at-home oral care techniques include brushing twice a day with fluoride toothpaste and rinsing regularly with mouthwash. You should also avoid substances high in acidity and sugar. However, if the dentin becomes exposed, restorative dental procedures are necessary.

For example, treatment options may include:

Dental Fillings (Minor Erosion)

If the erosion area is small, a composite resin filling is typically recommended. In short, composite is a tooth-colored, adhesive bonding material made of glasslike filler particles and acrylic resin. It is a durable and strong material that can last up to 15 years.

Veneers (Larger Erosion)

If the erosion only develops on one side of a tooth, such as the facial or chewing side, a porcelain veneer is typically recommended. In essence, veneers are thin shells of tooth-colored materials that fit over the front of teeth to improve their appearance and protect them from damage.

Dental Crowns (Severe Erosion)

If the erosion develops on more than one side of the tooth, a crown is usually necessary. In short, crowns are tooth-colored, gold, silver, or metal caps that fit over teeth and protect them from damage. They also restore the function, shape, and look of your natural teeth.

However, an inlay or onlay may be recommended instead of a crown, depending on the patient’s situation. These restorations are used when a cavity is too large for a dental filling.

Treatment Cost & Insurance

The cost of treatment depends on the type chosen and how many teeth need restorations. The prices below reflect the cost of common dental erosion procedures without insurance:

Dental Filling
$90-$300 (per tooth)
Porcelain Veneer
$925-$2500 (per tooth)
Dental Crown
Up to $3000 (per tooth)
Dental Inlay
$650-$1200 (per tooth)
Dental Onlay
$650-$1200 (per tooth)

Resources

Alsunni, Ahmed Abdulrahman. “Energy Drink Consumption: Beneficial and Adverse Health Effects.” International Journal of Health Sciences, vol. 9, no. 4, 2015, pp. 459–465., doi:10.12816/0031237.

“Definition & Facts for GER & GERD.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, 1 Nov. 2014, www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/definition-facts.

Amaechi, Bennett T. Dental Erosion and Its Clinical Management. SPRINGER INTERNATIONAL PU, 2015.

Lussi A, Ganss C (eds): Erosive Tooth Wear. Monogr Oral Sci. Basel, Karger, 2014, vol 25, pp 22-31. doi: 10.1159/000359935

Updated on: May 22, 2020
Author
Alyssa Hill
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Medically Reviewed: September 20, 2019
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Lara Coseo
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