Dental Erosion

Dental enamel, among other functions, covers and protects dentin. It is naturally affected by continuous processes of demineralization and remineralization, due to salivary pH and the influence of certain external factors and agents.

When the period of demineralization exceeds that of remineralization, progressive deterioration of the outer surface of the teeth occurs, increasing the risk of exposing the dentin to a whole series of dental problems, such as caries or sensitivity.

What is dental erosion?

This term refers to the progressive and irreversible loss of tooth enamel, that is, the outermost layer of the tooth, composed of calcium mineral salts, which has the function of covering and protecting the dentin, the softer and more sensitive tissue underneath.

When dentin is exposed and experiences contact with external agents, it becomes more prone to caries and other dental problems, such as hypersensitivity to thermal changes, acidic foods and sugary drinks.

Dental erosion - also called acid erosion - is therefore a not at all sudden phenomenon that can also affect children's teeth and consists of a slow loss of hard tooth tissue.

The consequence is that the teeth become less resistant to external substances and agents and, therefore, more susceptible to attack by the microorganisms that constitute dental biofilm, caries and even to the forces of chewing that can end up breaking the tooth.

Every time you eat or drink something with a high acid content, such as soft drinks, alcoholic beverages, and especially when it is done on a regular basis, the tooth enamel loses part of the mineral that makes it up.

Saliva helps to restore these minerals and partially neutralizes the acidity, but in the long term and in the absence of proper cleaning of the oral cavity, the mouth can no longer defend itself against repeated attacks by acidic substances.

Thus, it happens that the outer surface of the teeth slowly begins to deteriorate, with the risk of exposing the dentin if appropriate measures are not taken in time.

Causes

It is not only acids that cause tooth erosion. The condition discussed in this article, in fact, can be the result of several factors that usually have nothing to do with caries or enamel damage caused by the microbial action of biofilm.

Before listing the possible causes of tooth enamel erosion, it is good to distinguish between reasons related to individual behavior and habits and those related to patients' health conditions, including eating disorders such as reflux or bulimia.

Among the reasons related to behavior the most frequent are:

• Smoking and alcoholism.
• Frequent consumption of acidic foods and beverages, such as fruit juices, citrus fruits, carbonated and sweetened beverages.
• Using a toothbrush with bristles that are too hard or worn.
• The choice of excessively abrasive whitening toothpastes.
• Brushing teeth with too much force and intensity or incorrectly.

On the other hand, among the factors derived from a person's state of health are certain diseases, among them:

• Gastroesophageal reflux and hiatal hernia, in which acids rising from the stomach come into contact with the teeth.
• Dental malocclusion and chewing problems.
• Bulimia, in which the patient, by forcing vomiting to lose weight, can damage the enamel.
• Bruxism, i.e., teeth grinding that makes the enamel more sensitive to the action of acids.
• Reduced saliva flow, which occurs as a side effect of some medications.
• The natural aging process, whereby the gums begin to recede, exposing the root zone, where there is no enamel protection.

Symptoms of acid erosion

Due to its slow and stealthy progress, it is not easy to detect the symptoms of dental erosion in its first stage of advancement. In fact, the most obvious symptoms occur when, unfortunately, enamel erosion is already at an advanced stage.

However, there are certain characteristics that act as warning signs and may suggest the presence of a disorder, such as dental erosion.

Some of the milder signs that may allow you to stop enamel erosion early are darkening of the teeth near the gum line, increased sensitivity to heat and cold, tendency to break and/or chip, and decreased resistance to biofilm and decay.

Initially, dental erosion manifests itself as punctiform cavities that appear on the surface of the dental enamel.

Later, the dentin underneath the affected enamel will begin to become visible and, as a result, the teeth may become more sensitive to heat, cold and sugary foods and drinks.

In contrast, in the more advanced stage of dental erosion, the symptoms are much more noticeable and the lesions more visible.

Treatment

We have seen that the causes of dental erosion are mainly acidic agents.

For those related to the person's state of health, it is necessary to first consult a gastroenterologist and a psychiatrist (in the case of bulimia), as well as a dentist.

As for those related to behavior, it will be necessary to change eating habits, avoiding carbonated beverages and acidic foods or at least take some precautions:

• Drinking carbonated beverages with a straw, which should be placed on the roof of the mouth and not on the teeth, to avoid, at least, direct contact.
• Avoid brushing your teeth immediately after drinking these beverages, as tooth enamel is more vulnerable and scrubbing it with a toothbrush could remove or wear it away more easily.
• Use mouthwashes with fluoride.
• Increase consumption of calcium-based foods as much as possible.

The dentist will then perform a screening to evaluate etiological factors and establish a treatment for dental erosion.

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Prevention of dental enamel erosion

The risk of tooth enamel erosion and dentin exposure can be prevented by taking the following :

• Reduce consumption of acidic foods and beverages, such as carbonated beverages and citrus juices. If necessary, consume them only during meals to limit their effects on the enamel.
• Rinse mouth with water after consuming acidic beverages or foods.
• Drink carbonated beverages and fruit juices through a straw to limit the contact of the teeth with acidic substances. In any case, avoid keeping drinks in the mouth for a long time.
• Chew sugar-free xylitol gum to neutralize acids from food and meals.
• Drink more water throughout the day if you have dry mouth or poor salivation problems.
• Combat dry mouth with a product recommended by your dentist or ask your doctor about the possibility of substituting the medication causing the condition.
• Use a soft-bristled brush and avoid brushing your teeth too hard.
• Use fluoride toothpaste to protect teeth from decay.
• If the teeth have been exposed to acids from food or drink and are prone to erosion, it is necessary to wait several hours before using toothbrush and toothpaste.