Tooth Erosion

TOOTH EROSION
Introduction
Etiology
Signs & Appearance

Treatment & Prevention
Conclusion
Introduction
What is Dental Erosion?

It is the irreversible loss of dental hard tissue due to a chemical process of acid dissolution but not involving bacterial plaque acid, and not directly
associated with mechanical or traumatic factors, or with dental caries.
Dissolution of mineralized tooth structure occurs upon contact with acids that are introduced into the oral cavity from intrinsic or extrinsic sources
The most frequently affected areas are the palatal surface of maxillary incisors and the occlusal surface of the mandibular first
molars in children and adolescents.
etiology
(1) Intrinsic Factors
(2) Extrinsic Factors
intrinsic Factors
Implies the presence of gastric acid in the oral cavity (Milosevic,
1988).
Sources are from vomiting, regurgitation, gastro-oesophageal reflux and rumination. Backflow of gastric content through esophageal tract.
The damage caused by vomiting is when the powerful stomach acid (pH
2.0) comes into contact with teeth, affecting mostly the lingual surface of
ant. teeth & buccal surface of post. teeth. The enamel is weaken (eroded) by the excess acid becomes thinner and
almost disappearing. Fluid with pH lower than 5.5 can dissolve HAP of enamel.
Vomiting & Eating Disorder

Causes of vomiting: Causes of eating disorder: Bulimia Nervosa
Chronic vomiting during

pregnancy Side effect of drugs Disorder of alimentary tract
Anorexia Nervosa

In the case of Bulimia Nervosa:
The patient has normal weight but fear of gaining

weight
After the patient eats, he/she feels guilty and

force themselves to vomit

In the case of Anorexia Nervosa:
Restriction of food intake or minimal consumption of food

by an underweight patient Self induced vomiting in order to get rid of what they eat to limit the weight gained Eat food that will make themselves vomit
Regurgition & Gastro-oesophageal Reflux

Involuntary passing of gastric content into esophagus & oral cavity
Due to laxity of lower esophageal sphincter, which allow the content of stomach into esophagus
Rumination
Voluntary regurgitation of gastric content into the mouth Commonly found in mental disabled
children or adult suffering from stress or psychological disturbance
The content of stomach are often held in the mouth leading to erosion of teeth
The voluntary reflux will lead to abrasion because in
order to make the taste of vomit disappear, the patient

will brush their teeth 10-15 times/day or sometimes
every 20 minutes.
Extrinsic Factors
Results from action of exogenous acids, acids entering the mouth from an external source.
Originating from environment, diets and medications.
Environmental Erosion Occurs when patients are exposed to acids in their work place or
during leisure activity. Most common in factory workers, long term swimmers in gas-chlorinated swimming pool and wine taster (ten Bruggen Cate, 1968; Centerwall et al, 1986; Petersen and Gormsen, 1991)
Medication s Frequent consumption can lead to dental erosion.

Examples are aspirin, vitamic C, Bricancyl (powder form) and
ventolin (aerosal form).

Almost all commonly used drugs have a pH less than 5.5. This could have a significant effect on tooth erosion (OSullivan and Curzon 1998b).
Acidic Drinks Acids mostly found in drinks are citric, malic, phosphoric and
carbonic (Milosevic, 1988)
Most frequently consumed are fruit juices, sports drinks, soft drinks and
alcoholic drinks with pH varying from 2.1 and 4.46 (Milosevic, 1997;
OSullivan and Curzon, 1998a)
Acidic Drinks
The erosive process is influenced by the way the beverage is
consumed and its frequency (OSullivan and Curzon, 2000,)

It was demonstrated in vitro by Rees and co-workers in 1998 that after
immersion of extracted tooth in alcoholic lemonades for an hour, the enamel surface loss was between 1.8 and 3.28 m
Acidic Food Less potential erosive effect than acidic drinks.

Acids are present in citric fruits (highest amount) tomato
sauces, baked beans, acidic berries and vinegar(acetic acid)

(Milosevic et al, 1994)
Lactovegetarians have higher erosion frequency than the general population

(Linkosalo and Markkanen, 1985)
Signs Of Dental erosion
Discoloration
Early Signs of Dental Erosion
yellowing of the teeth can occur as dentin is exposed The more dentin exposed, the more the teeth will become
Tooth Sensitivity
enamel that protect the teeth wears away
Rounded teeth
Early Signs of Dental Erosion
It is common for teeth to have rounded look during early stage of tooth erosion
Transparent or sand blasted appearance

It is not uncommon in the early stages of tooth erosion for the teeth to have a sand blasted look
Advanced Signs of Dental Erosion

Cracking The edge of the teeth starts to crack and has a rough texture Also known as cupping Appears on biting areas of the teeth
Dents
OWWW MUMMY!!
Extreme Sensitivity
The teeth will be extremely sensitive as the enamel continue to wear away
Prevention and treatment
USE SOFT TOOTHBRUSH AND FLUORIDATED TOOTHPASTE
MOUTH-RINSE AFTER ACIDIC MEAL BRUSH TEETH AFTER 1 HOUR
PREVENTION
CHEW SUGAR-FREE GUM REDUCED CARBONATED DRINK
SWALLOW ACIDIC MEAL QUICKLY
DRINK SWEET DRINKS WITH STRAW
TOOTH BONDING
DENTAL CROWN
TREATMENT
DENTAL FILLINGS DENTAL VENEERS
Conclusion
Dental erosion is a common condition in children and adults
Prolonged contact between extrinsic or intrinsic acids with tooth
surface will result in softening and dissolution of mineral sufaces
If not recognised and treated early may cause severe loss of enamel that adversely effect the function of mouth
Early innervation and high self-awareness is the key to effective prevention of tooth wear
Effective prevention of dental erosion includes measures that avoid

or reduce direct contact with acids, increase acid resistance of
dental hard tissues and minimise tooth brushing abrasion.

Tooth Erosion

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TOOTH EROSION

Signs & Appearance

What is Dental Erosion?

associated with mechanical or traumatic factors, or with dental caries.

molars in children and adolescents.

(1) Intrinsic Factors

(2) Extrinsic Factors

Vomiting & Eating Disorder

Chronic vomiting during

Vomiting & Eating Disorder

The patient has normal weight but fear of gaining

After the patient eats, he/she feels guilty and

Vomiting & Eating Disorder

Restriction of food intake or minimal consumption of food

Regurgition & Gastro-oesophageal Reflux

The voluntary reflux will lead to abrasion because in

order to make the taste of vomit disappear, the patient

Originating from environment, diets and medications.

Medication s Frequent consumption can lead to dental erosion.

ventolin (aerosal form).

OSullivan and Curzon, 1998a)

consumed and its frequency (OSullivan and Curzon, 2000,)

Acidic Food Less potential erosive effect than acidic drinks.

sauces, baked beans, acidic berries and vinegar(acetic acid)

Lactovegetarians have higher erosion frequency than the general population

Signs Of Dental erosion

Early Signs of Dental Erosion

Early Signs of Dental Erosion

Transparent or sand blasted appearance

Advanced Signs of Dental Erosion

Prevention and treatment

USE SOFT TOOTHBRUSH AND FLUORIDATED TOOTHPASTE

MOUTH-RINSE AFTER ACIDIC MEAL BRUSH TEETH AFTER 1 HOUR

SWALLOW ACIDIC MEAL QUICKLY

DRINK SWEET DRINKS WITH STRAW

Dental erosion is a common condition in children and adults

Prolonged contact between extrinsic or intrinsic acids with tooth

surface will result in softening and dissolution of mineral sufaces

Effective prevention of dental erosion includes measures that avoid

dental hard tissues and minimise tooth brushing abrasion.

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