Tooth Wear
 

What is Erosion?

When strong chemicals (usually acids) come into contact with your teeth on frequent occasions, they will over time begin to dissolve your teeth. This process is called 'Erosion', and it is becoming an increasing problem and common cause of tooth wear.


Erosion doesn't involve any bacteria like the plaque in decay, it is caused by chemicals attacking your teeth. We can split it up into three types, based on the source of the offending chemicals. These are:

- Dietary erosion

- Regurgitation erosion

- Industrial erosion


We will discuss each of them in turn below.

What is Dietary Erosion?

This is big trouble and we are seeing it more and more frequently in our patients across the world. It is commonly referred to in the media as 'acid wear', for obvious reasons.

Acidic foods and drinks are anything with a low pH. If you are having these too often, it will soon start to take its toll on your teeth. This includes:
  • Citrus fruits - (lemon, orange etc.), other fruits and fruit juices (contain citric acid)
  • Carbonated drinks- (contain carbonic acid)
  • Pickles and anything containing vinegars, salad dressings etc. (contain acetic acid)
Fruit juices, sodas, pops, fizzy drinks, diet versions of things like cola or lemonade are all erosive and the amount you drink should be kept to a minimum. Sports drinks and liption teas are also very erosive and often have a high sugar content.


Now don't go stressing because you have spotted something in that list that you often have. This is another ongoing battle between your teeth, saliva, and the chemical process doing the damage.

The first thing to determine is if acid wear is a problem for you. If it is not, then simply being aware of the risks and taking a few steps to minimize the effects will be great a step moving forward. I will show you some of the cardinal sins, but ultimately you need to get yourself to a dentist and be checked.

Identifying the early signs of acid wear is crucial before things become a real problem and the complexity of treatment increases exponentially.

In the same way that sugar near bedtime does the most damage in terms of decay, so does acid in terms of erosion. So stay away from acidic food and drinks before you are going to sleep- it is really important.

Similarly, saliva provides defense against dental caries and it helps neurtalise acids protecting us from erosion. If you have a lack of saliva or less good quality saliva (Xerostomia), the effects of erosion are likely to be more pronounced.

Infants who have juices in feeding cups, expose their teeth to acid for prolonged periods and this can cause a lot of damage.

What are the Signs of Dietary Acid Wear?

Most often dietary erosion affects the occlusal (top) surfaces of the lower molar teeth and the labial (lip side) and buccal (cheek side) surfaces of the upper anterior (front) teeth. Because enamel is much more resistant than dentine to acid attack once dentine is exposed it will wear much more quickly and this leaves these little dips, or saucer shaped lesions on the cusps of your molar teeth.

In its earliest stages the affected teeth start to look smoother and a little more shiny. Remember finding a piece of glass that has been washed up on the beach which has gone from being a sharp fragment to resembling a round smooth coloured pebble- that sort of thing.

Later we see the colouring of the dentine starting to show through and eventually the enamel disappears altogether and the dentine becomes the top surface layer.

You may see fillings that stand proud after the tooth surface has been eroded away.

If you rinse, or swill with acidic drinks before swallowing, (a habit that seems a little bizarre to me), then erosion will affect the backs of the front teeth- (the palatal surfaces) and look very similar to erosion caused by gastric acid through vomiting.

If you frequently drink and eat acidic food then you are at risk of dietary erosion and steps should be taken to prevent acid wear.


What is Reguritation Erosion?

As you probably know your stomach contains a mix of acids- largely hydrochloric acid which helps to break down your food and release nutrients for your body to use. This acidic enviroment is crucial to your stomach, but not really suitable for your mouth and repeated episodes of vomiting and regurgitation will take its toll on your teeth.

What does this type of erosion look like?

Commonly this affects the palatal surfaces (backs) of your upper anterior teeth and over time the occlusal and buccal surfaces of your lower posterior teeth will show signs of wear too.

All types of erosion have similar appearances and progress along the same path, (shiny enamel- eventually dissolving to reveal the dentine underneath). However the site of the wear differs depending on where the acid is coming from. Entering in through the front of the mouth affects different teeth compared to acid coming from the back of the throat.

Who gets Reguritation Erosion?

Regurgitation (vomiting) can be the result of:
  • Eating disorders such as bulimia or anorexia- this is most common in young adolescent females but increasing in males.
  • Alcoholism
  • Morning sickness during pregnancy
  • Hiatius hernia, gastric oseophageal disease (GORD ) and some other digestive disorders. This is often associated with heart burn (pain along your oesophagus, worsened by lying down or after a big meal) . Most symptoms are self limiting; they just go away on their own. For some it is rare for acid to come all the way up into the mouth, for others this regurgitation is more common. If you have not seen a doctor regarding this pain, or have bought antacids over the counter this could indicate you are more at risk; your dentist can help rule this out.

What is Perimolysis?

This is a fancy word to describe the process by which small little saucer shaped dips or potholes form in the cusps of your molar teeth.

When acid, from whatever source, be it dietary, or gastric contacts your teeth, the tooth becomes etched, (in the same way that we etch enamel for bonding in composite fillings). This makes the surface brittle and susceptible to breaking down from tooth to tooth contact ,say during grinding, or even from the act of toothbrushing.

Over time, more and more tooth in that area is lost and visible cupping, which often gets sensitive because the dentine is exposed, can be seen.

What is slightly strange is that whilst these conditions are present in many people's mouths, only a very small percentage actually seem susceptible to this process.

How Does a Dentist Tell if You Have Acid Wear?

Your dentist will diagnose acid wear on the look of your teeth and the characteristic appearances that erosion, attrition and abrasion cause. They will then ask you various questions to try and get to the source of the problem so that further damage can be prevented.

Often acid wear may have been a problem previously, during a particular phase of your life (such as when you where staying up late drinking energy drinks as a student) and has not progressed much since. However, since the effects are irreversible, depending on how much wear has occurred, it means you are that bit further down the erosion path and so more vulnerable to future problems.

Some questions that dentist may ask you:

Do you suffer from any gastric regurgitation from your stomach?

Most patients will notice this- if they do- because of the taste, but sometimes it can be occurring at night, so you may be unaware of this.

Are you often sick?

If you were to say" Yes", they may ask some more probing questions about pregnancy, alcoholism and eating disorders including anorexia and bulimia to try an establish the cause of the acid.

How much alcohol do you have a week?

Most alcoholic drinks are quite acidic particularly the sweet sugary tasting ones.

Obviously anything with a mixer, be it orange juice, coca cola, lemonade, cranberry juice, are all going to be acidic, so if you are take them regularly this could be a problem. Have you ever made a Mojiio? If you have, you know what I am talking about- in fact all cocktails tend to be very acidic. Heavy binge drinking could also be associated with vomiting. If you regularly get to that point - just be aware.

Do you have a high intake of acidic foods and drinks?

You may not know what these are- check our acidic food and drink list to find out (coming soon). The dentist may ask you questions about your diet and go through some of the most common and most damaging things, just to see if they ring any bells.

Diets can be a bit tricky to recall off the top of your head and so the dentist may suggest a diet diary, (the same as is used for dental caries) .That is all food and drink over a week or a 4 day period, including two weekdays and the weekend. What? When? And how much? should be recorded. All food and drink should be recorded. There's a big tendancy to become healthy for the period you are recording, which is good, (as long as you keep it up), but it may hide the true source of the problem.

Are you aware of grinding or clenching your teeth either during the day or at night?

Any type of what we call 'parafunctional habits', meaning abnormal motions that you frequently and automatically do without thinking, may damage your teeth and can cause significant tooth wear. This includes:
  • Bruxism (grinding)
  • Clenching
  • Rocking your teeth back and forwards
  • Chewing on pencils or fingernails

What is Industrial Erosion?

This is something we see much less frequently, (nowadays at least), but still we should mention it.

Occasionally, in places that have an abundance of acidic fumes, dust or droplets, we find workers with wear and pitting on the front surfaces of their upper teeth. Adequate protection- face masks etc. has largely made this a thing of the past.