What is Dental Erosion?
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.
Causes of Dental Erosion
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:
- 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, ice cream, and 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 substances can also lead to cavity formation, especially when brushing and flossing are also neglected.
Stages of Dental 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 dental erosion.
Stage 1 — Enamel 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.
Stage 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, extreme tooth sensitivity and discoloration typically occur.
Types of Tooth 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 tooth erosion include:
Occlusal Dental Erosion
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
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
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.
Other Risk Factors of Dental 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:
Sugars and Acidic Foods
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.
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 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. 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:
- 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 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.
Symptoms of Erosion
Common symptoms of early dental erosion may include:
- Smooth, silky, or shiny spots on your teeth
- 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 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
- Cupping on the biting surfaces of teeth (little dents)
Dental Treatment for Tooth 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 fluoride toothpaste
- Rinse regularly with mouthwash
- Visit your general dentist for check-ups and professional teeth cleanings at least twice a year
- Buy a prescription enamel strengthening toothpaste
- Avoid substances high in acidity and sugar. If the dentin is already exposed, restorative dental treatment is necessary.
- Use sugar-free chewing gum after eating food to promote salivary flow
Dental erosion treatment options may include:
Cavity Fillings (Minor Dental Erosion)
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.
Veneers (Larger Dental Erosion)
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.
Dental Crowns (Advanced Dental Erosion)
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.
Treatment Costs & Insurance
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:
|Dental 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)|