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Dental erosion

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This article is about the medical condition. For other uses, see Erosion (disambiguation).
Acid erosion
Other namesDental erosion
An example of severe dental damage due to acid erosion.
SpecialtyDentistry
ComplicationsOral infection, tooth decay, tooth loss, xerostomia

Acid erosion is a type of tooth wear. It is defined as the irreversible loss of tooth structure due to chemical dissolution by acids not of bacterial origin.[1] Dental erosion is the most common chronic condition of children ages 5–17,[2] although it is only relatively recently that it has been recognised as a dental health problem.[3] There is widespread ignorance of the damaging effects of acid erosion; this is particularly the case with erosion due to consumption of fruit juices because they tend to be seen as healthy.[4] Acid erosion begins initially in the enamel, causing it to become thin, and can progress into dentin, giving the tooth a dull yellow appearance and leading to dentin hypersensitivity.[5]

The most common causes of erosion are acidic foods and drinks. In general, foods and drinks with a pH below 5.0–5.7 have been known to trigger dental erosion effects.[6] Numerous clinical and laboratory reports link erosion to excessive consumption of such drinks. Those thought to pose a risk are soft drinks, some alcohol and fruit drinks, fruit juices such as orange juice (which contain citric acid) and carbonated drinks such as colas (in which the carbonic acid is not the cause of erosion, but citric and phosphoric acid).[7] Additionally, wine has been shown to erode teeth, with the pH of wine as low as 3.0–3.8.[6] Other possible sources of erosive acids are from exposure to poorly regulated chlorinated swimming pool water,[8] and regurgitation of gastric acids.[9] In children with chronic diseases, the use of medicines with acid components is a risk factor too.[10] Dental erosion has also been recorded in the fossil record and was likely caused by the consumption of acidic fruits or plants.[1]

Causes

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Frequently eaten foods and drinks below pH 5.0–5.7 may initiate dental erosion.

Extrinsic acidic sources

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Extrinsic acid erosion is when the source of acid originates from outside of the body.[11] Acidic food and drink lowers the pH level of the mouth resulting in demineralisation of the teeth. A variety of drinks contribute to dental erosion due to their low pH level. Examples include fruit juices, such as apple and orange juices, sports drinks, wine and beer. Carbonated drinks, such as colas and lemonades, are also very acidic and hence have significant erosive potential. Foods such as fresh fruits, ketchup and pickled food in vinegar have been implicated in causing acid erosion.[12] Frequency rather than total intake of acidic juices is seen as the greater factor in dental erosion; infants using feeding bottles containing fruit juices (especially when used as a comforter) are therefore at greater risk of acid erosion.[12]

Saliva acts as a buffer, regulating the pH when acidic drinks are ingested. Drinks vary in their resistance to the buffering effect of saliva. Studies show that fruit juices are the most resistant to saliva's buffering effect, followed by, in order: fruit-based carbonated drinks and flavoured mineral waters, non-fruit-based carbonated drinks, sparkling mineral waters; mineral water being the least resistant. Because of this, fruit juices in particular may prolong the drop in pH levels.[13]

A number of medications such as chewable vitamin C, aspirin and some iron preparations are acidic and may contribute towards acid erosion.[12] Certain drugs can cause hyposalivation (low quantity or quality of saliva) which is considered a risk factor for acid erosion.[11]

Intrinsic acidic sources

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Severe wear of the lower teeth in a bulimic person.

Intrinsic dental erosion, also known as perimolysis, is the process whereby gastric acid from the stomach comes into contact with the teeth.[14] This is often secondary to conditions such as anorexia nervosa, bulimia nervosa, gastroesophageal reflux disease (GERD) and rumination syndrome.[11][14] Dental erosion can also occur by non-extrinsic factors. There is evidence linking eating disorders with a range of oral health problems including dental erosion, caries and xerostomia. Reduced salivary flow rate, a common symptom of bulimia, predisposes an individual to dental erosion due to increased vulnerability to the effects of acidic food and drinks. Self-induced vomiting increases the risk of dental erosion by a factor of 5.5 compared to healthy controls. Lesions are most commonly found on the palatal surfaces of the teeth, followed by the occlusal and then the buccal surfaces.[15] The main cause of GERD is increased acid production by the stomach.[14] This is not exclusive to adults, as GERD and other gastrointestinal disorders may cause dental erosions in children.[16]

Behaviour

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Acid erosion often coexists with abrasion and attrition.[12] Abrasion is most often caused by brushing teeth too hard.[3] Any frothing or swishing acidic drinks around the mouth before swallowing increases the risk of widespread acid erosion.[12] Sucking citrus fruits can also contribute to acid erosion.[11]

Diagnosis

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In-vivo studies are advantageous in assessing erosion directly from the patient's mouth. There are numerous signs of dental erosion, including changes in appearance and sensitivity.

Colour

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One of the physical changes can be the colour of teeth. Dental erosion can lead to two major tooth colour change – the first being a change of colour that usually happens on the cutting edge of the central incisors. This causes the cutting edge of the tooth to become transparent.[17] A second sign is a yellowish tint on the eroded tooth. This occurs because the white enamel has eroded away to reveal the yellowish dentin beneath.[17] On top of clinical examination, the dentist may take intra-oral photographs to monitor the extent and progress of erosion. Clinical photographs lead to comparable results to a visual examination; however, both may result in an underestimation of the extent of tooth wear.[18]

Shape

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Dental study casts

A change in shape of the teeth is also a sign of dental erosion. Teeth will begin to appear with a broad rounded concavity, and the gaps between teeth will become larger. There can be evidence of wear on surfaces of teeth not expected to be in contact with one another.[17] If dental erosion occurs in children, a loss of enamel surface characteristics can occur. Amalgam restorations in the mouth may be clean and non-tarnished. As tooth substance around restorations erodes away, fillings may also appear to be rising out of the tooth. The teeth may form divots on the chewing surfaces when dental erosion is occurring. This mainly happens on the first, second, and third molars. To monitor the change in shape over time, dentists can create and retain accurate, serial study casts.[19][20] Dentists may also employ dental indices to guide their diagnosis and management of the condition. A scoring system referred to as Basic Erosive Wear Examination (BEWE) grades the appearance or severity of wear on the teeth by the extent of hard tissue loss.[21] It is noted that indices are useful in monitoring the most severe clinical changes in tooth wear. However, they lack comprehensiveness as they cannot measure the rate of progression and cannot monitor all teeth affected by erosion.[22] There is also a lack of an index which is universally accepted and standardised.[23]

One of the most severe signs of dental erosion is cracking,[24] where teeth begin to crack off and become coarse.[17] Other signs include pain when eating hot, cold, or sweet foods. This pain is due to the enamel having been eroded away, exposing the sensitive dentin.[25]

Optical properties

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On the basis of the optical changes induced in eroded tissue by the lesions, in 2015 Koshoji et al. also demonstrated in a novel method that by using laser speckle images (LSI) it is possible to acquire information on the microstructure of the enamel and detect minimal changes, such as early non-carious lesions.[26][27] No clinical data has been published to demonstrate the effectiveness of this technique in vivo.

See also

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References

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  1. ^ a b Towle I, Irish JD, Elliott M, De Groote I (September 2018). "Root grooves on two adjacent anterior teeth of Australopithecus africanus" (PDF). International Journal of Paleopathology. 22: 163–167. doi:10.1016/j.ijpp.2018.02.004. PMID 30126662. S2CID 52056962.
  2. ^ ten Cate JM, Imfeld T (April 1996). "Dental erosion, summary". European Journal of Oral Sciences. 104 (2 ( Pt 2)): 241–4. doi:10.1111/j.1600-0722.1996.tb00073.x. PMID 8804892.
  3. ^ a b Dugmore CR, Rock WP (March 2004). "A multifactorial analysis of factors associated with dental erosion". British Dental Journal. 196 (5): 283–6, discussion 273. doi:10.1038/sj.bdj.4811041. PMID 15017418.
  4. ^ "'Health juices' harm baby teeth". BBC News Online. 2 August 2007. Retrieved 2009-05-21.
  5. ^ Guignon, Anne (September 2013). "Dental Erosion: An Increasingly Common Cause of Dentin Hypersensitivity" (PDF). Colgate Dental Aegis. Archived from the original (PDF) on 2021-04-29. Retrieved 2018-01-03.
  6. ^ a b Mandel L (January 2005). "Dental erosion due to wine consumption". Journal of the American Dental Association. 136 (1): 71–5. doi:10.14219/jada.archive.2005.0029. PMID 15693499.
  7. ^ Moynihan PJ (November 2002). "Dietary advice in dental practice". British Dental Journal. 193 (10): 563–8. doi:10.1038/sj.bdj.4801628. PMID 12481178.
  8. ^ Buczkowska-Radlińska J, Łagocka R, Kaczmarek W, Górski M, Nowicka A (March 2013). "Prevalence of dental erosion in adolescent competitive swimmers exposed to gas-chlorinated swimming pool water". Clinical Oral Investigations. 17 (2): 579–83. doi:10.1007/s00784-012-0720-6. PMC 3579418. PMID 22476450.
  9. ^ Paryag A, Rafeek R (September 2014). "Dental Erosion and Medical Conditions: An Overview of Aetiology, Diagnosis and Management". The West Indian Medical Journal. 63 (5): 499–502. doi:10.7727/wimj.2013.140. PMC 4655683. PMID 25781289.
  10. ^ Nunn JH, Ng SK, Sharkey I, Coulthard M (June 2001). "The dental implications of chronic use of acidic medicines in medically compromised children". Pharmacy World & Science. 23 (3): 118–9. doi:10.1023/A:1011202409386. PMID 11468877. S2CID 7071706.
  11. ^ a b c d Kaidonis JA (August 2012). "Oral diagnosis and treatment planning: part 4. Non-carious tooth surface loss and assessment of risk". British Dental Journal. 213 (4): 155–61. doi:10.1038/sj.bdj.2012.722. PMID 22918343.
  12. ^ a b c d e O'Sullivan E, Milosevic A (November 2008). "UK National Clinical Guidelines in Paediatric Dentistry: diagnosis, prevention and management of dental erosion". International Journal of Paediatric Dentistry. 18 Suppl 1 (Supplement 1): 29–38. doi:10.1111/j.1365-263X.2008.00936.x. PMID 18808545.
  13. ^ Edwards M, Creanor SL, Foye RH, Gilmour WH (December 1999). "Buffering capacities of soft drinks: the potential influence on dental erosion". Journal of Oral Rehabilitation. 26 (12): 923–7. doi:10.1046/j.1365-2842.1999.00494.x. PMID 10620154. Archived from the original on 2013-01-05.
  14. ^ a b c Gandara BK, Truelove EL (November 1999). "Diagnosis and management of dental erosion". The Journal of Contemporary Dental Practice. 1 (1): 16–23. PMID 12167897. Archived from the original on 2010-12-15.
  15. ^ Rosten A, Newton T (November 2017). "The impact of bulimia nervosa on oral health: A review of the literature". British Dental Journal. 223 (7): 533–539. doi:10.1038/sj.bdj.2017.837. PMID 28972588. S2CID 7589860.
  16. ^ Monagas J, Suen A, Kolomensky A, Hyman PE (November 2013). "Gastrointestinal issues and dental erosions in children". Clinical Pediatrics. 52 (11): 1065–6. doi:10.1177/0009922812460429. PMID 22984193. S2CID 113677.
  17. ^ a b c d Acid Attack. Academy of General Dentistry. 6 February 2008.
  18. ^ Al-Malik MI, Holt RD, Bedi R, Speight PM (February 2001). "Investigation of an index to measure tooth wear in primary teeth". Journal of Dentistry. 29 (2): 103–7. doi:10.1016/S0300-5712(00)00064-6. PMID 11239584.
  19. ^ Carlsson GE, Johansson A, Lundqvist S (May 1985). "Occlusal wear. A follow-up study of 18 subjects with extensively worn dentitions". Acta Odontologica Scandinavica. 43 (2): 83–90. doi:10.3109/00016358509046491. PMID 3863449.
  20. ^ Fareed K, Johansson A, Omar R (August 1990). "Prevalence and severity of occlusal tooth wear in a young Saudi population". Acta Odontologica Scandinavica. 48 (4): 279–85. doi:10.3109/00016359009005886. PMID 2220336.
  21. ^ Bartlett D, Ganss C, Lussi A (March 2008). "Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs". Clinical Oral Investigations. 12 (Suppl 1): S65-8. doi:10.1007/s00784-007-0181-5. PMC 2238785. PMID 18228057.
  22. ^ Al-Rawi NH, Talabani NG (March 2008). "Squamous cell carcinoma of the oral cavity: a case series analysis of clinical presentation and histological grading of 1,425 cases from Iraq". Clinical Oral Investigations. 12 (1): 15–8. doi:10.1007/s00784-007-0184-2. PMC 2238784. PMID 17701430.
  23. ^ Joshi M, Joshi N, Kathariya R, Angadi P, Raikar S (October 2016). "Techniques to Evaluate Dental Erosion: A Systematic Review of Literature". Journal of Clinical and Diagnostic Research. 10 (10): ZE01–ZE07. doi:10.7860/JCDR/2016/17996.8634. PMC 5121827. PMID 27891489.
  24. ^ The Cleveland Clinic Department of Dentistry. Dental Health: Tooth Sensitivity. WebMD. Retrieved 2008-03-09.
  25. ^ Davenport, Tammy (14 September 2007). "Signs and Symptoms of Tooth Erosion". About.com. Archived from the original on 2016-04-19. Retrieved 2008-03-09.
  26. ^ Koshoji NH, Bussadori SK, Bortoletto CC, Prates RA, Oliveira MT, Deana AM (2015-02-13). "Laser speckle imaging: a novel method for detecting dental erosion". PLOS ONE. 10 (2): e0118429. Bibcode:2015PLoSO..1018429K. doi:10.1371/journal.pone.0118429. PMC 4332687. PMID 25679807.
  27. ^ Koshoji NH, Bussadori SK, Bortoletto CC, Oliveira MT, Prates RA, Deana AM (2015). Rechmann P, Fried D (eds.). "Analysis of eroded bovine teeth through laser speckle imaging". Lasers in Dentistry XXI. 9306: 93060D. Bibcode:2015SPIE.9306E..0DK. doi:10.1117/12.2075195. S2CID 122579104.
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