dental instruments and oral health

What is Dental Erosion?

Dental erosion, also referred to as enamel erosion, erosive wear, or tooth erosion, occurs when acidic substances wear away tooth enamel. It is a chemical process that results in the loss of dental tissue and does not involve bacteria. The number of people affected by dental erosion differs between locations, countries, and age groups. The prevalence rate of the disease is highest in adolescents between 9 and 11 years of age (11 to 100 percent).

Erosion is the second most common dental condition among adolescents and 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.

Primary Cause of Erosion

Excessive consumption of sugary foods and drinks that are high in acidity is attributed to dental erosion, including:

  • 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.
  • Acidic foods, such as citrus, berries, and apples.

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. 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, resulting in complete loss of surface profile.

Step 2. Erosion of Dentin

Dentin, the second layer of teeth that surrounds the dental pulp, has a different erosion process than enamel. For example, the small crystals found in dentin dissolve very quickly because they are more soluble than enamel crystals. Enamel erosion 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. When dentin becomes exposed, extreme tooth sensitivity and discoloration typically occur.

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.

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. Common risk factors of erosive wear include:

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 due to dry mouth, acids in the mouth are not diluted, resulting 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.

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. Alcoholism is associated with cavities due to neglected oral hygiene, alcohol-stimulated bruxism, and oral cancer. 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.

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 hot or cold substances.
  • 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 hot or cold substances.
  • Cupping on the biting surfaces of teeth (little dents).

Dental Treatment for Tooth Erosion

Erosion, by definition, means enamel has already been lost and any loss of enamel is irreversible. Although, common at-home preventions include brushing twice a day with fluoride toothpaste, rinsing regularly with mouthwash, and avoiding substances high in acidity and sugar. 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.

Veneers (Larger Erosion)

If the erosion only develops on one side of the tooth, such as the facial or chewing side, porcelain veneers are typically recommended.

Dental Crowns (Severe Erosion)

If the erosion develops on more than one side of the tooth, a crown is usually necessary. Although, an inlay or onlay may be recommended instead of a crown, depending on the patient’s situation.

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)