Acid erosion

8th April 2015

Acid erosion

Acid erosion is a big worry for our dentist as daily we see how overconsumption of acidic foods and drinks can cause untold damage to our patients teeth. When acidic foods and drinks briefly touch teeth, the body’s saliva can protect the teeth preventing tooth wear. If there is excess acid from the stomach (heart burn) or with the overconsumption of juices or acidic fizzy drinks, this can cause irreversible damage to the teeth causing tooth wear. Please note that tooth wear is the loss of tooth surface that is not caused by decay or trauma. Tooth wear can affect the enamel, dentine or pulp of a tooth.

Tooth wear is nearly always a combination of factors and they are listed below:

Attrition

This is the mechanical wearing down of the chewing surfaces of teeth caused by excessive tooth to tooth contact such as in bruxism. Attrition causes teeth to lose their cusps and become flat and unsightly and sensitive to sweets & hot and cold drinks.

Treatment for Attrition

• Bruxism should be investigated as it can cause severe damage to teeth, fillings and crowns. If bruxism exists, then either a soft or hard night guard should be made depending on the clinical situation.
• The damage to teeth should be repaired carefully by using composite white fillings, onlays or crowns to restore the patients bite stop the tooth sensitivity and improve the aesthetics of the teeth.

Abrasion

Abrasion is the wearing down of tooth surface by incorrect brushing technique and perhaps through the use of a hard brush.

Abrasion causes the gums to recede and exposes the dentine on the root surfaces of teeth which is unsightly as its yellow in colour and can make the teeth more sensitive to air.

Treatment of Abrasion

• The patients tooth brushing technique should be assessed and modified where necessary. Switching to a soft brush or an electric toothbrush can also help to reduce abrasion.
• Where the root surface is exposed and sensitive to air, it should be covered by composite resin fillings to stop the dentine sensitivity.

Erosion

Erosion is the loss of tooth through exposure to acidic substances which dissolve away the surface of tooth. Fizzy drinks and citrus fruit juices have high acid content and can cause erosion. Acidic fruits such as oranges, lemons and grapefruits can also cause erosion.

Certain medical problems also cause erosion. These conditions are:

1. Heartburn or acid reflux
2. Anorexia nervosa or bulimia
3. Excessive alcohol intake

Treatment of Erosion

1. The patient’s diet and medical history should be analysed so that the cause of the erosion can be identified. Where dietary factors are causing the erosion, this should be pointed out to the patient and stopped. Where medical problems have caused erosion, medical advice should be sought.
2. Saliva production should be encouraged to neutralise the acids that cause erosion. Saliva production is increased by the use of sugar free gum.
3. Deep Erosion cavities should be repaired by composite resin fillings or crowns. Root canal treatment may become necessary if the erosion cavities have exposed the pulp of the tooth.

With tooth wear, it’s very important that the cause of the tooth wear is correctly identified. For example, If the patient suffers from gastric induced Erosion but this is incorrectly identified as Attrition, then the use of night guard treatment can cause more damage to the teeth by holding gastric acids on the tooth surface for a longer time.

Also some patients suffer from more than one type of tooth wear. Their tooth wear may be caused by a combination of factors. Simply treating one type of wear and ignoring the other types at work, will not stop the damage to the patients teeth.