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Updated on January 6, 2023
8 min read

Enamel Erosion: Stages, Causes, Symptoms & Treatment

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What is Enamel Erosion?

Enamel erosion, also called dental erosion or tooth erosion, occurs when acidic substances wear away tooth enamel (the outer layer of teeth). 

Tooth erosion is a chemical process that exposes the more sensitive layers of a tooth, such as dentin. It does not involve bacteria.

In the U.S., enamel erosion is the second most common oral condition among adolescents. This is due to the frequent consumption of soft drinks, sports drinks, and fruit juices with low pH levels.6 Tooth decay (cavities) is the most common oral condition among adolescents.7

Types of Enamel Erosion

Enamel erosion can develop on both the back teeth (molars and premolars) and the front teeth (incisors and canines).

The most common types of enamel erosion include:

  • Occlusal enamel erosion — affects the biting surfaces of the back teeth, including the upper and lower molars
  • Palatal Enamel Erosion — develops on the surfaces of the teeth closest to the palate. Typically affects the front teeth
  • Advanced enamel erosion — reveals the underlying dentin

2 Stages of Enamel Erosion 

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 enamel erosion.

1. Enamel Erosion

In the early stages, dental erosion only affects the enamel. Tooth enamel is the hard, mineralized surface covering your teeth.

The acids attack your tooth enamel and reduce 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.

2. Dentin Erosion

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, tooth sensitivity and discoloration typically occur.

Symptoms of Enamel Erosion

Common symptoms of early enamel erosion may include:

  • Smooth, silky, or shiny spots on your teeth
  • Slightly clear or translucent teeth
  • Grooving on the biting areas of teeth
  • Rounded teeth (the ridges of enamel wear away, resulting in a flatter surface)

Common symptoms of advanced enamel erosion may include:

  • Yellow tooth discoloration (due to exposed dentin) 
  • Extreme tooth sensitivity to either hot, cold, or sweet substances 
  • Cupping on the biting surfaces of teeth (little dents)

What Causes Enamel Erosion?

Enamel erosion can be caused by intrinsic or extrinsic factors. 

  • Intrinsic erosion results from gastric acids regurgitating into the oral cavity
  • Extrinsic erosion is due to external factors that expose the teeth to acidic conditions

These factors include: 

  • Lifestyle
  • Diet
  • Environmental factors (pool water and airborne acids)
  • Occupational factors (fumes, batteries, and fertilizers)

Substances That Cause Enamel Erosion

Highly acidic, sugary substances can cause enamel erosion. These substances soften tooth enamel, which makes it easier for them to wear away by grinding (bruxism) or abrasion (erosion)

It is also important to avoid swishing or keeping acidic and abrasive substances in contact with your teeth. These foods and drinks include, but are not limited to:

  • Soft drinks (soda), diet drinks, and other carbonated beverages
  • Citric fruit juices, such as lemonade and orange juice
  • Other fruit drinks
  • Sports drinks, energy drinks, and ciders
  • Candy and ice cream 
  • White starches, such as certain kinds of pasta and bread
  • Acidic foods, such as citrus, berries, and apples
  • Citric acid, sodium citrate, and phosphoric acid
  • Chewable vitamin C tablets

All of these foods and drinks can also lead to cavity formation, especially when brushing and flossing are neglected.

Other Risk Factors for Enamel Erosion

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:

Dry Mouth

Dry mouth, also called xerostomia, is a non-life-threatening oral condition. It  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.

Gastroesophageal Reflux Disease (GERD)

GERD is a more serious form of heartburn that occurs when your stomach acids come back up into your esophagus. The stomach contains 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. Other drugs that may induce vomiting in some people include aspirin and diuretics. 

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
  • Central nervous system disorders, such as migraines
  • Cyclic vomiting syndrome
  • Psychogenic vomiting syndrome

Bulimia nervosa, a life-threatening eating disorder characterized by a cycle of binging and self-induced vomiting, can also lead to erosive wear.

Chronic Alcoholism

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.

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 also neglected.

If vomiting is prolonged or occurs during multiple pregnancies, there is a higher chance dental erosion will develop.

Exercise

Physical activity can decrease salivary flow and cause dehydration. This can increase the risk of enamel erosion when combined with highly acidic fruit and sports drinks. Intense workouts may also increase the possibility of gastroesophageal reflux.

Treatment Options for Enamel Erosion

There are different treatment options for dental erosion. However, if the dentin is already exposed, restorative dental treatment is necessary. 

Dental erosion treatment options may include:

Can Enamel Grow Back?

Tooth enamel is the hardest tissue in the body. Unfortunately, it’s not living tissue, so it can’t naturally regenerate. Once the enamel is eroded, it won’t grow back, even with a special toothpaste.

However, your teeth can be treated and remineralized.8

How to Remineralize Teeth

Remineralization is a natural process that keeps your teeth strong and healthy. The process takes calcium and phosphate minerals from your saliva and deposits them into your enamel.8

Over time, teeth will lose minerals due to the foods and drinks we consume; this is called demineralization. The main benefit of remineralization is that it can help prevent enamel erosion and dental infections. 

Here are a few ways to remineralize teeth:

  • Practice good oral hygiene (brush twice a day and floss daily)
  • Regular teeth cleanings at the dentist (twice a year)
  • Avoid sugary or starchy foods
  • Limit or avoid acidic drinks like coffee, energy drinks, fruit juice, and alcohol
  • Get professional fluoride treatments at the dentist
  • Use fluoride toothpaste

How to Prevent Enamel Erosion

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:

  • Brush your teeth twice a day with a fluoridated toothpaste
  • Rinse regularly with mouthwash
  • Visit your general dentist for regular check-ups
  • Buy a prescription enamel strengthening toothpaste
  • Avoid substances high in acidity and sugar
  • Use sugar-free chewing gum after eating food to promote salivary flow
  • Avoid snacking frequently between meals
  • Drink non-water liquids with a straw to minimize contact with teeth
  • Drink water while eating and rinse the mouth with water after consuming acidic drinks, or foods
  • Rinse with water rather than brushing teeth immediately after consuming acidic beverages

How Much Does it Cost to Restore Teeth Damaged by Enamel Erosion?

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:

Cavity Filling $90-$300 (per tooth)
Porcelain Veneer $925-$2,500 (per tooth)
Dental Crown Up to $3,000 (per tooth)
Dental Inlay $650-$1,200 (per tooth)
Dental Onlay $650-$1,200 (per tooth)

Summary

Enamel erosion is one of the most common oral conditions in America. There are different stages and types of erosion.

Enamel erosion can be caused by gastric acids (intrinsic) or external factors (extrinsic). Some different substances and conditions can cause enamel erosion.

There are treatment options for enamel erosion, but your enamel won’t grow back. However, it can be remineralized. The best way to prevent enamel erosion is by maintaining oral hygiene, avoiding certain foods/drinks, and visiting a dentist regularly.

Last updated on January 6, 2023
8 Sources Cited
Last updated on January 6, 2023
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
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  2. Definition & Facts for GER & GERD.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services,2014. 
  3. Amaechi, B. Dental Erosion and Its Clinical Management. SPRINGER INTERNATIONAL PU, 2015.
  4. Lussi A, Ganss C. “Erosive Tooth Wear. Monogr Oral Sci. Basel,” Karger, 2014.
  5. Schmidt, J., and Boyen H., “Awareness and knowledge of dental erosion and its association with beverage consumption: a multidisciplinary survey.” BMC oral health, 2022.
  6. Skalsky, M., et al. “Dental erosion, prevalence and risk factors among a group of adolescents in Stockholm County.” European archives of pediatric dentistry: official journal of the European Academy of Paediatric Dentistry, 2018.
  7. Sugars and Dental Caries.” World Health Organization, 2017.
  8. Arifa, M., et al. “Recent Advances in Dental Hard Tissue Remineralization: A Review of Literature.” International journal of clinical pediatric dentistry, 2019.
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