Dental erosion, also called enamel erosion or tooth erosion, occurs when acidic substances wear away your enamel (tooth surface). It is a chemical process that results in the loss of dental tissue. Enamel erosion 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., dental erosion is the second most common oral condition among adolescents. Tooth decay (cavities) is the most common.
Highly acidic, sugary substances can cause dental erosion. These substances soften your tooth enamel, which makes it easier for them to be worn away by grinding (bruxism) or abrasion (erosion). It is also important to avoid swishing or straining acidic substances between your teeth.
Abrasive foods and drinks include, but are not limited to:
All of these substances can also lead to cavity formation, especially when brushing and flossing are also neglected.
When an erosive substance (e.g., sugar or acidity) comes in contact with your tooth, the tooth's surface will begin to dissolve. The acids from this substance demineralize the enamel and the tissues beneath the tooth (also called dentin). This process leads to dental erosion.
In the early stages, dental erosion only affects the enamel. Tooth enamel is the hard, mineralized surface covering your teeth.
First, the acids attack your tooth enamel, which reduces the strength of your teeth. Over time, the outermost layer of your teeth begins to wear away. Your teeth also become more translucent and erosive lesions develop as the enamel thins out.
Dentin (the second layer of your teeth) has a different erosion process than enamel.
Enamel erosion causes a loss of surface tissue on the outer layer of teeth. Erosion also results in the demineralization of dentin and the permanent loss of tooth structure.
The small crystals in dentin dissolve quickly because they are more soluble than enamel crystals. When the dentin becomes exposed, extreme tooth sensitivity and discoloration typically occur.
Enamel erosion can develop on both the back teeth (molars and premolars) and the front teeth (incisors and canines).
The most common types of tooth erosion include:
Occlusal dental erosion forms on the biting surfaces of your back 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. Incisors (front teeth) are the least likely to develop occlusal erosion (less than 5 percent).
Palatal dental erosion develops on the surfaces of the teeth closest to the palate (roof of the mouth). Palatal erosion typically affects the front teeth (incisors and canines) and the premolars in the upper jaw.
Advanced dental erosion occurs when the enamel wears away enough to reveal the underlying dentin (layer below the enamel). This form of tooth erosion can be difficult and expensive to treat.
Dental erosion is typically caused by sugars and substances with low pH levels (acidic foods and drinks). Frequent vomiting, acid reflux, medical conditions, and improper oral hygiene practices can also lead to tooth erosion:
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 lead to enamel erosion.
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 erosion.
GERD is a more serious form of heartburn that occurs when your stomach acids come back up into your 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.
Many prescription drugs list nausea and vomiting as side effects, including opiates and chemotherapy medications. 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 associated with vomiting can also cause enamel erosion. Common conditions include:
Bulimia nervosa, a life-threatening eating disorder characterized by a cycle of bingeing and self-induced vomiting, can also lead to erosive wear.
Long-term alcohol consumption can induce dental erosion. In addition to erosion, alcoholism is also associated with cavities. Bruxism and oral cancer are also common conditions associated with long-term alcohol use.
Enamel erosion associated with alcoholism can also be linked to frequent vomiting, regurgitation, or consuming alcoholic drinks high in acidity. The pH levels in most wines are low, which may result in erosion over time.
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.
Common symptoms of early dental erosion may include:
Common symptoms of advanced dental erosion may include:
Erosion, by definition, means the enamel has already worn away. Unfortunately, any loss of enamel is irreversible.
To help prevent tooth erosion, common at-home oral care techniques include:
Dental erosion treatment options may include:
If the erosion area is small, a composite resin filling is typically recommended. Composite is a tooth-colored, adhesive bonding material made of glass-like filler particles and acrylic resin. It is a durable and strong material that can last up to 15 years.
If erosion only develops on one side of your tooth, a porcelain veneer may be recommended. Veneers are thin shells of tooth-colored materials that fit over the front of teeth to improve their appearance and protect them from damage.
In severe cases, if the erosion develops on more than one side of your tooth, a crown is usually necessary. Dental crowns are tooth-colored, gold, silver, or metal caps that fit over teeth and protect them from damage. They restore the function, shape, and look of your natural teeth.
A dental inlay or onlay may be recommended instead of a crown. Inlays and onlays are used when a cavity is too large for a dental filling.
The cost of treatment depends on the type of restoration you need and how many teeth require treatment.
The prices below reflect the cost of standard dental erosion treatments without insurance:
$90-$300 (per tooth)
$925-$2,500 (per tooth)
Up to $3,000 (per tooth)
$650-$1,200 (per tooth)
$650-$1,200 (per tooth)
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