Dr Ben Atkins: Analysing Dental Erosion

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Dr Ben Atkins, Clinical Director at Revive Dental Care, discusses the causes of dental erosion

Dental erosion is caused by the long-term attack of either intrinsic or extrinsic acids on the teeth, leading to irreversible damage to the tooth structure. Prolonged exposure from acids on the tooth surface results in the softening and dissolution of surface minerals to expose the darker, yellower dentine underneath the enamel, giving a shorter, older appearance to the teeth.

Dental erosion can be identified by hollows in the teeth, or in more general cases, wearing away of the tooth surface and biting edges. If it is not diagnosed and treated early it can cause irreversible loss of hard dental tissue, a drastic reduction in oral health and a negative visual impact.

Extrinsic dental erosion is preventable. It is caused by environmental factors, usually diet, and can be mitigated with some simple lifestyle changes. When acidic food or drink is consumed, the enamel on the teeth is temporarily demineralised. Saliva naturally counterbalances this and eventually neutralises the acid and helps to remineralise the tooth surface.

However, if the teeth are continually bombarded by acidic products, the teeth do not have time to repair and over time small pieces of enamel are brushed away causing damage to the surface of the teeth.

The increasing popularity of sports and energy drinks, fizzy pop and even the ceaselessly popular Prosecco are all contributing to an increase in extrinsic dental erosion, as do processed foods (particularly those high in sugar) fruit and also fish, and even certain dairy products are high in acid content.

Particular culprits for dental erosion include snacking on things like salt and vinegar crisps and even seemingly innocuous herbal teas. Research has shown that regularly sipping diet drinks or fruit teas between meals can leave people up to 11 times more likely to suffer from tooth erosion – with hot water and lemon being one of the worst combinations [1].

Other environmental factors such as medications and lifestyle could also be having an impact. For example, exposure to acid fumes by workers in factories without proper safeguards, and swimming pools with low pH due to inadequate maintenance have also been implicated [2].

Intrinsic (from the inside) erosion is harder to identify and treat and can often be an indication of a wider problem. This type of erosion is usually caused by medical factors, such as stomach acid, entering the mouth and eroding the teeth. It is often seen in patients with gastric reflux issues, who are regurgitating stomach acid.

In fact, gastro-oesophageal reflux is a common condition, which has become increasingly prevalent in Western communities and affects up to 60% of the general population [3].

Preventing dental erosion

Early intervention is key to effective prevention. Therefore, as part of oral health guidance, dental professionals should discuss: reducing direct contact with acids through dietary advice, increasing salivary flow to neutralise the acids by chewing sugar-free gum, and minimising toothbrush abrasion with personalised oral health education.

Simple things such as avoiding snacking and drinking acidic drinks between meals can help by allowing tooth surfaces enough time to remineralise and heal naturally.
It is easier to communicate and relay preventive dental advice when we use images and now there is an exciting new way of delivering personal information to patients to motivate and encourage them to improve their oral health.

The CALCIVIS® imaging system is a cutting-edge device that uses a luminescent (light emitting) photoprotein, which produces a very short, low-level flash of light in the presence of free calcium ions released from actively demineralising tooth surfaces. An integrated intraoral sensor then detects this light and a live, map of active demineralisation, is displayed at the chair side.

The CALCIVIS imaging system is the ideal patient communication and learning tool. It engages patients with glowing images and helps them to understand their oral health more easily, but also, shows them the areas they need to really focus on.

CALCIVIS helps dental professionals visualise the previously invisible. It provides an early detection system to enable first-response preventive treatment and manage dental erosion at its very earliest, most reversible stages.

Dental erosion does not always need to be treated. With regular check-ups, monitoring and advice, problems can be prevented from becoming worse. However, if a tooth does need treatment, it is important to protect the enamel and the dentine underneath to prevent sensitivity. Usually, simply bonding a filling onto the tooth will be enough to repair it, but in more severe cases it may be necessary to fit veneers or crowns as often more than one tooth is involved.

There have been some marked improvements in the options available for treating erosion in recent years; however, prevention will always be better than cure.

Author:
Dr Atkins has a specialist interest in restorative dentistry and is passionate about educating patients. Ben was one of the clinicians who assessed and reviewed the CALCIVIS imaging system during the beta testing stage and was one of the first users to invest in the system when it was launched in March 2018. For more information about CALCIVIS visit www.CALCIVIS.com or call 0131 658 5152

References:
1] O’Toole S, Mullan F. The role of the diet in tooth wear. Br Dent J. 2018 Mar 9; 224(5):379-383. https://www.ncbi.nlm.nih.gov/pubmed/29471309 [Accessed 6th June 2018]

2] Zero D.T. Etiology of dental erosion – extrinsic factors. Eur J Oral Sci. 1996 Apr; 104(2 (Pt 2): 162-77. https://www.ncbi.nlm.nih.gov/pubmed/8804884 [Accessed 6th June 2018]

3] Fariborz Mansour-Ghanaei, et al. The epidemiology of gastroesophageal reflux disease: a survey on the prevalence and the associated factors in a random sample of the general population in the Northern part of Iran. Int J Mol Epidemiol Genet. 2013; 4(3): 175–182. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773569/ [Accessed 6th June 2018]