TOOTH EROSION

Introduction
Etiology

Signs & Appearance

Treatment & Prevention

Conclusion

Introduction

What is Dental Erosion?

It is the irreversible loss of dental hard tissue due to a chemical process of acid dissolution but not involving bacterial plaque acid, and not directly

associated with mechanical or traumatic factors, or with dental caries.

Dissolution of mineralized tooth structure occurs upon contact with acids that are introduced into the oral cavity from intrinsic or extrinsic sources

The most frequently affected areas are the palatal surface of maxillary incisors and the occlusal surface of the mandibular first

molars in children and adolescents.

etiology

(1) Intrinsic Factors

(2) Extrinsic Factors

intrinsic Factors
Implies the presence of gastric acid in the oral cavity (Milosevic,

1988).
Sources are from vomiting, regurgitation, gastro-oesophageal reflux and rumination. Backflow of gastric content through esophageal tract.

The damage caused by vomiting is when the powerful stomach acid (pH

2.0) comes into contact with teeth, affecting mostly the lingual surface of
ant. teeth & buccal surface of post. teeth. The enamel is weaken (eroded) by the excess acid becomes thinner and

almost disappearing. Fluid with pH lower than 5.5 can dissolve HAP of enamel.

Vomiting & Eating Disorder

Causes of vomiting: Causes of eating disorder: Bulimia Nervosa

Chronic vomiting during

pregnancy Side effect of drugs Disorder of alimentary tract

Anorexia Nervosa

Vomiting & Eating Disorder

In the case of Bulimia Nervosa:

The patient has normal weight but fear of gaining

weight

After the patient eats, he/she feels guilty and

force themselves to vomit

Vomiting & Eating Disorder

In the case of Anorexia Nervosa:

Restriction of food intake or minimal consumption of food

by an underweight patient Self induced vomiting in order to get rid of what they eat to limit the weight gained Eat food that will make themselves vomit

Regurgition & Gastro-oesophageal Reflux

Involuntary passing of gastric content into esophagus & oral cavity

Due to laxity of lower esophageal sphincter, which allow the content of stomach into esophagus

Rumination
Voluntary regurgitation of gastric content into the mouth Commonly found in mental disabled
children or adult suffering from stress or psychological disturbance

The content of stomach are often held in the mouth leading to erosion of teeth

The voluntary reflux will lead to abrasion because in

order to make the taste of vomit disappear, the patient

will brush their teeth 10-15 times/day or sometimes

every 20 minutes.

Extrinsic Factors
Results from action of exogenous acids, acids entering the mouth from an external source.

Originating from environment, diets and medications.

Environmental Erosion Occurs when patients are exposed to acids in their work place or
during leisure activity. Most common in factory workers, long term swimmers in gas-chlorinated swimming pool and wine taster (ten Bruggen Cate, 1968; Centerwall et al, 1986; Petersen and Gormsen, 1991)

Medication s Frequent consumption can lead to dental erosion.

Examples are aspirin, vitamic C, Bricancyl (powder form) and

ventolin (aerosal form).

Almost all commonly used drugs have a pH less than 5.5. This could have a significant effect on tooth erosion (OSullivan and Curzon 1998b).

Acidic Drinks Acids mostly found in drinks are citric, malic, phosphoric and
carbonic (Milosevic, 1988)
Most frequently consumed are fruit juices, sports drinks, soft drinks and

alcoholic drinks with pH varying from 2.1 and 4.46 (Milosevic, 1997;

OSullivan and Curzon, 1998a)

Acidic Drinks
The erosive process is influenced by the way the beverage is

consumed and its frequency (OSullivan and Curzon, 2000,)

It was demonstrated in vitro by Rees and co-workers in 1998 that after
immersion of extracted tooth in alcoholic lemonades for an hour, the enamel surface loss was between 1.8 and 3.28 m

Acidic Food Less potential erosive effect than acidic drinks.

Acids are present in citric fruits (highest amount) tomato

sauces, baked beans, acidic berries and vinegar(acetic acid)

(Milosevic et al, 1994)

Lactovegetarians have higher erosion frequency than the general population

(Linkosalo and Markkanen, 1985)

Signs Of Dental erosion

Discoloration

Early Signs of Dental Erosion

yellowing of the teeth can occur as dentin is exposed The more dentin exposed, the more the teeth will become

Tooth Sensitivity
enamel that protect the teeth wears away

Rounded teeth

Early Signs of Dental Erosion

It is common for teeth to have rounded look during early stage of tooth erosion

Transparent or sand blasted appearance

It is not uncommon in the early stages of tooth erosion for the teeth to have a sand blasted look

Advanced Signs of Dental Erosion

Cracking The edge of the teeth starts to crack and has a rough texture Also known as cupping Appears on biting areas of the teeth

Dents

OWWW MUMMY!!

Extreme Sensitivity

The teeth will be extremely sensitive as the enamel continue to wear away

Prevention and treatment

USE SOFT TOOTHBRUSH AND FLUORIDATED TOOTHPASTE

MOUTH-RINSE AFTER ACIDIC MEAL BRUSH TEETH AFTER 1 HOUR

PREVENTION
CHEW SUGAR-FREE GUM REDUCED CARBONATED DRINK

SWALLOW ACIDIC MEAL QUICKLY

DRINK SWEET DRINKS WITH STRAW

TOOTH BONDING

DENTAL CROWN

TREATMENT
DENTAL FILLINGS DENTAL VENEERS

Conclusion

Dental erosion is a common condition in children and adults

Prolonged contact between extrinsic or intrinsic acids with tooth

surface will result in softening and dissolution of mineral sufaces

If not recognised and treated early may cause severe loss of enamel that adversely effect the function of mouth

Early innervation and high self-awareness is the key to effective prevention of tooth wear

Effective prevention of dental erosion includes measures that avoid

or reduce direct contact with acids, increase acid resistance of

dental hard tissues and minimise tooth brushing abrasion.