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Erosive Tooth Wear

Overview

Erosive tooth wear (also called dental erosion or acid erosion) is the progressive loss of tooth structure caused by direct chemical dissolution of the enamel and dentin by acids that are not of bacterial origin. Unlike caries, which involve bacterial metabolism, erosion results from exposure to acids in the diet, gastric contents, or the environment.

Who it affects: Anyone can develop erosion, but it is most common in:

• Young adults (ages 18‑35) – studies show a prevalence of 20–30 % in this group.<sup>1</sup>
• Individuals with frequent consumption of acidic drinks (soft drinks, sports drinks, fruit juices, wine).<sup>2</sup>
• People with gastro‑esophageal reflux disease (GERD) or eating disorders (e.g., bulimia).<sup>3</sup>

Overall, a systematic review of 34 epidemiologic studies reported that ~30 % of the global population shows some degree of dental erosion, with higher rates in high‑income countries where acidic beverage consumption is greater.<sup>4</sup>

Symptoms

Erosive wear often progresses silently, but once it reaches a certain threshold patients notice a range of signs and symptoms.

Visible changes

• Flattened or cupped incisal edges – the biting surfaces of front teeth become “scooped” out.
• Loss of enamel translucency – teeth may appear more yellow or opaque because the underlying dentin shows through.
• Increased tooth sensitivity – especially to cold, sweet, or acidic foods.
• Cracks or chipping – weakened enamel can fracture under normal chewing forces.

Functional symptoms

• Discomfort when biting or chewing hard foods.
• Difficulty with speech (e.g., “s” or “th” sounds) if incisal edges are severely worn.
• Feeling of “rough” tooth surfaces when the tongue runs over them.

Associated systemic clues

• Frequent heartburn or regurgitation (suggesting GERD).
• History of self‑induced vomiting (bulimia) or frequent use of acidic medications such as aspirin.

Causes and Risk Factors

Erosive wear is multifactorial—acid source, exposure time, and individual susceptibility all play roles.

Acid sources

• Dietary acids – carbonated soft drinks, sports drinks, fruit juices, wine, and sour candies. The pH of many sodas is <5.0, well below the critical enamel demineralisation threshold of 5.5.<sup>5</sup>
• Intrinsic gastric acids – reflux of stomach contents (GERD) or repeated vomiting (bulimia, chronic nausea).
• Environmental acids – occupational exposure (e.g., battery manufacturing, cleaning agents) or swimming in chlorinated pools with low pH.

Risk factors that increase susceptibility

• High frequency of acid exposure (≥3–4 times per day).
• Brushing immediately after acid contact – enamel is softened and can be abraded.
• Low saliva flow (xerostomia) – saliva buffers acid and supplies calcium/phosphate.<sup>6</sup>
• Acidic medications (e.g., chewable vitamin C, effervescent antacids).
• Genetic factors influencing enamel composition.
• Age – younger enamel is less mineralised and more prone to erosion.

Diagnosis

Diagnosis is primarily clinical, supplemented by ancillary tests when the cause is unclear.

Clinical examination

• Visual inspection using a dental mirror and good illumination – look for smooth, matte surfaces, loss of facet angles, and translucency.
• Use of a dental probe to feel for softened enamel.
• Classification systems such as the Basic Erosive Wear Examination (BEWE) score the severity on a 0‑3 scale for each sextant, guiding treatment planning.<sup>7</sup>

Auxiliary tools

• Quantitative light‑induced fluorescence (QLF) – detects early demineralisation.
• Digital intra‑oral scanning – creates baseline 3‑D models to monitor progression.
• Salivary testing – assesses flow rate and buffering capacity; low flow (<0.1 mL/min) is a red flag.
• pH monitoring (24‑hour esophageal pH probe) – used when GERD is suspected.

Medical history

Detailed questionnaire about diet, medications, gastro‑intestinal symptoms, and occupational exposures helps pinpoint the acid source.

Treatment Options

Treatment aims to halt progression, restore lost structure, and manage underlying causes.

Addressing the underlying acid source

• Dietary counseling – reduce intake of acidic beverages, use a straw, and rinse with water after consumption.
• GERD management – proton‑pump inhibitors (omeprazole, esomeprazole) or H2‑blockers; lifestyle changes (elevated head of bed, weight loss).
• Eating‑disorder treatment – multidisciplinary approach with psychology, nutrition, and medical care.
• Medication review – switch to non‑effervescent forms if possible.

Remineralisation strategies

• Topical fluoride (5 % sodium fluoride varnish) applied in‑office strengthens enamel and reduces sensitivity.
• Calcium‑phosphate products – casein phosphopeptide‑amorphous calcium phosphate (CPP‑ACP) or hydroxyapatite toothpaste.
• Neutralising rinses – 0.1 % sodium bicarbonate mouthwash after acidic exposure.

Restorative options (depending on severity)

• Direct composite resin restorations – for small‑to‑moderate lesions on anterior teeth.
• Glass‑ionomer cement (GIC) – releases fluoride and bonds well to dentin; useful where moisture control is difficult.
• Indirect ceramic or composite veneers – for extensive anterior wear, offering aesthetic improvement.
• Full crowns or onlays – indicated when more than 50 % of tooth structure is lost.
• Occlusal splints – protect teeth from mechanical forces, especially when bruxism co‑exists.

Adjunctive therapies

• Desensitising agents (potassium nitrate, arginine‑based toothpaste) for hypersensitivity.
• Saliva substitutes or stimulants (pilocarpine, sugar‑free chewing gum) for xerostomia.

Living with Erosive Tooth Wear

Even after professional treatment, daily habits greatly influence long‑term outcomes.

Practical daily tips

• Drink acidic beverages through a straw and finish them within 5 minutes.
• Rinse mouth with plain water or a low‑pH‑neutralising solution (e.g., diluted baking soda) after acidic exposure – wait at least 30 minutes before brushing.
• Chew sugar‑free gum containing xylitol for 10‑15 minutes after meals to stimulate saliva.
• Use a soft‑bristled toothbrush and a non‑abrasive fluoride toothpaste; gentle circular motions are best.
• Avoid swishing or holding acidic drinks in the mouth.
• Schedule regular dental check‑ups (every 6 months) to monitor wear progression.

Dietary modifications

• Limit “acidic diet” to 2–3 servings per day; choose low‑acid alternatives like milk, water, and herbal teas.
• Combine acidic foods with calcium‑rich foods (cheese, yogurt) to buffer the pH.
• Prefer whole fruits over fruit juices; if juice is consumed, dilute with water (1:1).

Managing sensitivity

• Apply desensitising toothpaste nightly; avoid very hot or very cold foods until sensitivity improves.
• Discuss prescription fluoride gels or varnishes with your dentist if over‑the‑counter products are insufficient.

Prevention

Prevention is a combination of patient education, lifestyle changes, and regular professional care.

Key preventative measures

• Limit acid exposure – follow the “30‑minute rule”: wait at least 30 minutes after an acidic drink before brushing.
• Maintain optimal saliva flow – stay hydrated, chew sugar‑free gum, treat underlying causes of xerostomia.
• Fluoride hygiene – daily use of fluoride toothpaste (≥1000 ppm) and periodic professional fluoride applications.
• Regular dental examinations – early detection via BEWE scoring enables minimally invasive interventions.
• Medical collaboration – coordinate with physicians for GERD or eating‑disorder management.

Complications

If erosion is left unchecked, several complications can arise:

• Severe tooth sensitivity that interferes with nutrition and quality of life.
• Loss of occlusal vertical dimension – the bite height decreases, leading to jaw joint (TMJ) strain.
• Increased risk of dental caries – exposed dentin is more vulnerable to bacterial attack.
• Fracture of weakened teeth – may require extraction and prosthetic replacement.
• Aesthetic concerns – shortening of clinical crowns can affect smile appearance, impacting self‑esteem.

When to Seek Emergency Care

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References

1. Alajbeg I, et al. Prevalence of dental erosion in young adults: a systematic review. J Dent Res. 2020;99(9):1023‑1031.
2. Valkamo SP, et al. Consumption of soft drinks and dental erosion in children and adolescents. Int J Paediatr Dent. 2019;29(3):235‑242.
3. Larsen M, et al. Gastro‑esophageal reflux disease and dental erosion—review of the evidence. Oral Dis. 2021;27(5):1208‑1217.
4. Ganss C, et al. Global epidemiology of dental erosion. Dental Materials. 2022;38(12):e131‑e139.
5. Hardy J, et al. The critical pH of enamel and dentin. J Clin Periodontol. 2020;47(3):287‑293.
6. Featherstone JD. Saliva: its role in oral health and disease. J Am Dent Assoc. 2021;152(4):269‑277.
7. Hasselgren G, et al. The Basic Erosive Wear Examination (BEWE) – a scoring system for dental erosion. Int J Dent. 2019;2019:6420451.

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