Enamel loss or dental erosion is a prevalent condition that occurs worldwide as a result of exposure of the enamel and dentin to non-bacterial acids present within our body and acids present in the food we consume, which cause mineral loss from the surface of the teeth. Enamel is the hard, protective coating of the tooth that protects the sensitive dentine below. When the enamel wears away, the dentine underneath is exposed, causing pain and sensitivity.
In medical terminology, dental erosion is defined as the pathological, chronic, localized and painless loss of hard tooth tissue that occurs primarily due to non-bacterial chemical attack, and usually involving acidic substances.1
1. Intrinsic Causes
In people who have eating disorders such as bulimia nervosa or anorexia) and other gastrointestinal disturbances with frequent gastric acid reflux, the gastric juice frequently enters the oral cavity and this increases the risk of dental erosion. 2 3 Extrinsic and intrinsic acids cause dental erosion. Keeping the oral cavity free of acids is dependent on the saliva secretion and flow rate and the saliva’s capacity to fight against germs. Low saliva flow rate and poor buffering capacity cause the extrinsic and intrinsic acids to remain in the mouth for a longer duration, which accelerates the erosion.4
2. Extrinsic Causes
These external causes include the consumption of beverages, acidic fruits and fruit juices, acids in chewing gums, and exposure to acid contaminants.
Soft Drinks And Beverages
Excessive soft drink and sports drink consumption can damage the enamel as they contain high levels of phosphoric and citric acids. Likewise, certain acidic fruit drinks are said to contain some acids that are more erosive than acid in a battery. Frequent consumption of citrus fruits can also significantly increase the risk for dental erosion.5
Sugar And Sour Candies
The sugar in the candies remains in the oral cavity even after several hours after consumption. This creates a conducive environment for cavity-causing bacteria to thrive and multiply. Sugar is not the only culprit; sour candies are worse than sugar candies for your teeth as they contain high acid levels. Some candies also utilize organic acids such as lactic, citric and malic acid, in order to develop the characteristic sour flavor. Anything with a pH of less than 7 is considered acidic. Sour candies usually contain low pH, making them the real culprits. Many of these confectioneries are said to have a pH level close to that of battery acid.6
This is something we all do but most of us do it wrong. Some people brush their teeth for too long, and some for not long enough. Some use the wrong type of brush or paste while some others move their hand incorrectly. The timing of brushing the teeth, stiffness of the bristles of the toothbrush and abrasiveness of toothpaste can all cause erosion and abrasion of the enamel. To prevent dental erosion, the toothpaste we use must have low abrasivity and the toothbrush must have bristles that are soft or medium in stiffness. Brushing the teeth before consuming erosive drinks can help prevent the damage. Studies provide adequate evidence to summarize that abrasion during brushing the teeth can cause erosion of the enamel. 7
3. Environmental Causes
Corrosion of the enamel can be caused by many other factors such as friction, wear and tear, stress, and corrosion. Even a combination of one or more of these factors can cause erosion of the tooth surface. Some people clench or grind their teeth, often involuntary during sleep, causing intense friction between the teeth. This is called bruxism (a pathological activity that involves tooth grinding and clenching during para-functional jaw movements. Clinical signs of bruxism are mostly related to dental wear and muscular and joint discomforts).8 It is similar to the kind of physical wear and tear of the teeth surface that occurs while brushing teeth with incorrect brush or paste.
Biting Hard Objects
Sometimes, some people who feel nervous or anxious have the habit of chewing on anything they can get their hands on. It could be fingernails, bottle caps, or pens or chewing tobacco. This causes stress fractures in the tooth such as cracks from flexing or bending of the tooth. Subjecting the teeth to damage from such hard objects can result in permanent damage to the enamel.
Medications, vitamin C, iron preparations, and aspirin are acidic in nature. 9 The acidic constituents and other factors like regular and frequent ingestion, consumption of medication during bedtime and between meals consumption, high viscosity and the collateral effect of reduced salivary flow, may contribute to increase the risk for medication-induced dental erosion.
Prolonged exposure of the tooth surface to extrinsic or intrinsic acids will cause the softening and dissolution of surface minerals. If not identified and treated early, erosion may cause severe loss of dental hard tissues that adversely affects esthetics and normal function of the mouth. 10 Being aware of and staying away from drinks and foods that cause erosion and abrasion is crucial to protect the enamel. Consult your dentist to find the most suitable type or oral hygiene techniques to preserve your pearly whites.
References [ + ]
|1, 3, 6.||↑||Torres, Carolina Paes, Michelle Alexandra Chinelatti, Jaciara Miranda Gomes-Silva, Fátima Aparecida Rizóli, Maria Angélica Hueb de Menezes Oliveira, Regina Guenka Palma-Dibb, and Maria Cristina Borsatto. “Surface and subsurface erosion of primary enamel by acid beverages over time.” Brazilian dental journal 21, no. 4 (2010): 337-345.|
|2.||↑||Uhlen, Marte-Mari, Anne Bjørg Tveit, Kjersti Refsholt Stenhagen, and Aida Mulic. “Self-induced vomiting and dental erosion–a clinical study.” BMC oral health 14, no. 1 (2014): 92.|
|4, 5, 7, 10.||↑||Yan-Fang Ren, D. D. S. “Dental erosion: etiology, diagnosis and prevention.” (2011).|
|8.||↑||Machado, Naila Aparecida de Godoi, Rodrigo Borges Fonseca, Carolina Assaf Branco, Gustavo Augusto Seabra Barbosa, Alfredo Júlio Fernandes Neto, and Carlos José Soares. “Dental wear caused by association between bruxism and gastroesophageal reflux disease: a rehabilitation report.” Journal of Applied Oral Science 15, no. 4 (2007): 327-333.|
|9.||↑||Hanif, Ayesha, Haroon Rashid, and Mustafa Nasim. “Tooth surface loss revisited: Classification, etiology, and management.” Journal of Restorative Dentistry 3, no. 2 (2015): 37.|