Dental erosion is the process of losing tooth structure and mineralization from acidic exposures. Your teeth are exposed to acid in two different ways- from your body (an intrinsic exposure) or from what you are putting in your body (an extrinsic exposure). When teeth are exposed to an acidic environment, it can begin to degrade teeth. High frequency and duration of acidic exposure makes it hard for saliva, our mouth’s natural defense, to keep up with protecting our teeth.
The main cause of intrinsic acid erosion is gastroesophageal reflux disease known as “GERD”. This is a condition when stomach acids are frequently brought back into the oral cavity, often times after consuming a meal. GERD symptoms can include the feeling of heartburn, stomach pain, acidic taste, difficulty swallowing, difficulty talking, or voice hoarseness. Other intrinsic exposures could come from bulimia, alcoholism, or pregnancy when there is repeated exposure to gastric contents from vomiting or regurgitation.
Diet is the large contributor to extrinsic erosion. Consumption of acidic beverages such as sodas, sports drinks, energy drinks, or juices in high frequency is a main disposing factor. Sometimes a habitual food can also be a culprit- for instance repeated consumption of citrus fruits or a habit of sucking on sour candies.
Our saliva is a natural protector of our teeth. It helps to neutralize acids and remineralize tooth structure. However, when these acidic exposures are frequent our saliva is not able to keep up with buffering the acid. When the pH inside the mouth is kept at this lower value the teeth will begin to demineralize and tooth structure will degrade over time.
Erosion is something to consider when you or your dentist notice that your teeth have lost some of their structure. Eroded teeth often will look cupped out with an overall smooth glassy appearance to the surface. This characteristic appearance can lead a dentist to suspect an erosive process.
Figures 1-3. Different severities of dental erosion
A tooth has multiple layers. The outermost layer of the tooth is the enamel which is the hardest and most mineralized part of the tooth. While enamel is very resilient, it can only take so much repeated drop in pH before it starts to become affected. The next layer of the tooth is the dentin which is bit softer than the hard outer shell of enamel. If erosion reaches the dentin then this softer structure has a harder time standing up to a low pH. The innermost layer of the tooth is the pulp which contains the nerves and blood vessels of the tooth.
Figure 4. Anatomy of a tooth
As these outer layers of enamel and then dentin are lost the pulp loses protection from the environment. This is why sometimes erosion can lead to teeth feeling sensitive to changes in the environment such as temperature of food and drinks or a chill from the air.
When dental erosion is suspected by appearance or symptoms, the dental team will complete a thorough history. It is important to identify the cause of the erosion so that the process can be stopped. First it needs to be determined if the cause is intrinsic, extrinsic, or both. This may include a diet analysis and a referral to your primary care to evaluate possible gastric reflux concerns. Frequent consumption of highly acidic food/drinks need to be significantly reduced to protect the teeth. If your PCP diagnoses you with GERD then lifestyle modifications with also the consideration of medications may be needed.
If dental erosion is caught early enough then usually removing the predisposing factor and close monitoring may be the only treatment needed. In cases where loss of tooth structure is more severe then teeth may require fillings or crowns to replace what was lost and keep the teeth supported.
Here are some tips to protect teeth from erosion:
- Avoiding highly acidic foods and beverages is the most important. The less the teeth are exposed to a low pH, the less chance there is for demineralization. However if you are wanting to treat yourself to something like a soda or candy on occasion then enjoying quickly is better. Have the treat and then be done with it. Sipping on a soda over the course of a few hours or sucking on a sour candy for a long period of time keeps the teeth bathed in a low pH (and exposed to sugar) for too long.
- Water consumption is important. Drinking water during meals and rinsing your mouth out with water after exposing it to something with a higher acidity can help clean off the teeth and dilute the acid in the mouth.
- Avoid brushing your teeth immediately after an acid exposure. Rinsing the mouth out with water first is best to remove the acid, then let the pH in your mouth return to normal before using a brush. When it is time to brush your teeth later on it is important to use a soft bristle toothbrush (electric is often recommended), and a low abrasive toothpaste with fluoride.
- Your dentist may also consider recommending a higher prescription fluoride toothpaste than what is found over the counter. This extra fluoride boost can help to remineralize tooth structure and also protect against cavities.
- Make sure to stay up to date with your dental check ups and cleanings. Often times you may not realize erosion is happening to your teeth so it’s important to see your dental team regularly. They can monitor for potential signs of teeth erosion and help solve the problem before it progresses too far.
For more information on dental erosion check out the American Dental Association's article