There are many non carious lesions, dental erosion is one of them.Rare but true!Dental erosion is the progressive irreversible loss of dental hard tissue that is chemically etched away from the tooth surface by extrinsic and/or intrinsic acids and/or chelation by a process that does not involve bacteria.
It is often associated with other forms of tooth wear such as abrasion and attrition (from overzealous brushing and grinding of teeth etc). Erosion reduces the sizes of teeth and in severe cases leads to total tooth destruction.
Erosion can be classified based on:
- On etiology:
- Extrinsic erosion as a result of exogenous acids.
- Intrinsic erosion as a result of endogenous acids.
- Idiopathic erosion as a result of acids of unknown origin, i.e. an erosion-like pathology where neither tests nor anamnesis are capable of providing an etiologic explanation.
- On clinical severity :
- Class I-Superficial lesion, involving enamel only
- Class II-Localized lesion, < 1/3 of surface involving dentin
- Class III-Generalized lesion, >1/3 of surface involving dentin
- On pathogenetic activity :
- Manifest erosion is an actively progressing erosion.It is clinically diagnosed by its enamel border zones.
- Latent or inactive erosions which, through a change in the etiologic factor, are no longer subject to further decalcification.
- On localization: Perimolysis which is an intrinsic erosion of the lingual-palatal aspect of the anterior maxillary teeth
Erosion is multifactorial in nature.The causes are as follows:
- Intrinsic acids from vomiting and regurgitation in conditions including disorders of the upper alimentary tract, metabolic and endocrine disorders, medication side‐effects and drug abuse, pregnancy (hyperemesis gravidarum)and certain psychosomatic disorders, e.g. stress‐induced psychosomatic vomiting( anorexia and bulimia nervosa or rumination)
- Extrinsic acids from a combination of dietary, lifestyle, environmental or occupational factors expose teeth to acids in beverages or inorganic acid vapors released into the environment. For e.g. citric acid, phosphoric acid, ascorbic acid, malic acid, tartaric acid and carbonic acids found in fruits and fruit juices, soft drinks—both carbonated and still, some herbal teas, dry wines and vinegar-containing foods.
The critical pH of enamel is, 5.5 and these drinks or food lowers the pH causing erosion.
- Poor salivary flow or salivary deficiencies: Saliva acts as a buffer resisting pH changes in the oral cavity.Thus,low salivary flow rate leads to inadequate buffering capacity exacerbating erosion
Erosion is the most common chronic disease of children ages 5–17 affecting mostly incisors and molars.It initially begins in the enamel reducing its thickness causing it to become thin and can progress to dentin, giving the tooth a dull yellow appearance leading to dentinal hypersensitivity.
Here,teeth will begin to appear with a broad rounded concavity,smooth and glossy.Also, the gaps between teeth will become larger.There will be evidence of wear on surfaces of teeth not expected to be in contact with one another.
Tooth substance around the restorations may erode away, making the restoration appear to be rising out of the tooth. The teeth may form divots on the chewing surfaces when dental erosion is occurring.
The most severe signs of dental erosion is cracking, where teeth begin to crack off and become coarse disturbing the soft tissue in the oral cavity. Other signs may include pain when eating hot, cold, or sweet foods.
This pain is due to the enamel having been eroded away, exposing the sensitive dentin. Erosion is a caries look-a- like lesion.In cases of true erosion, tooth enamel is demineralized by direct contact with acids whereas caries is a disease that occurs under the action of acids produced by microorganisms in the plaque biofilm.
On the clinical level, erosion is mainly a surface phenomenon, while caries generally begins as a demineralization of the underlying surface of the enamel structure,consequently a surface cavitation on the tooth.
Prevention and management
Dental erosion is an irrevocable process thus its prevention should be more focused followed by its management.Some studies have found that milk and yogurt products (unsweetened) may have a protective effect against erosion because of their calcium and phosphate content.
Adding calcium to the acidic beverages can be an alternative to carbonated drinks whose studies are still going on. Fluoride is an effective remineralizing agent but its use as prevention for erosion is still a questionmark.
Management includes modification of lifestyle and dietary changes,if necessary, restoration can be done to halt progression of erosive lesions.
Finally,erosion is a dental problem.Knowing sufficiently about it and acting accordingly is important.
Reminder for prevention of erosion are:
- Avoid acidic beverages, particularly swishing or straining the liquid between the teeth, or holding the liquid in the mouth.Use of a straw positioned behind the front teeth is recommended to lessen the contact of teeth with the acid.
- Drink water while eating, or rinse the mouth with water after consuming acidic drinks or candies.
- After vomiting, rinse the mouth with water, a sodium bicarbonate rinse, or milk
- Saliva helps buffer and remove acids; chewing gum may help protect teeth from erosion by promoting saliva flow.
- Drink milk along with acidic meals or beverages, which contributes to remineralization and helps neutralize acids.
- Avoid brushing teeth immediately after eating or drinking acidic beverages.Some researchers also suggest waiting a half hour to one hour after eating, drinking, or vomiting.
- Brush teeth using a soft bristle brush and fluoride toothpaste that carry the ADA Seal of Acceptance.