Dental erosion

O A wide spectrum of diseases may affect the tissues

of the oral cavity including dental caries tooth wear,
periodontal diseases, salivary gland diseases,
mucosal ulceration, oral cancer and other mucosal
dysplasis.
O ental erosion is the dissolution of the tooth tissues by
acids of extrinsic(dietary) or intrinsic (gastro-
oesophageal reflux)
7idemiologyClobal Prevalence
O
O rosive tooth wear is a common condition in the
developed contries showing a high prevalence
particulary among children and teenagers.
O uropean studies suggest prevelence of:
a) Up to 50% of all preschool children
b) Between 24% to 60% of school-aged children
c) As high as 82% in 18 to 88 years old
O rosion is more common in urope than in North-
America, the reason might be because uropean
dentists are recognising acids as a cause of tooth
wear more than their North-American Colleagues.
O For instances a cervical wear lesion is considered by
some to be erosive, others to be abasive or
abfractive or a combination of all of them.
Dental rosion : Diagnosis
O iagnosis is the intellectual course that integrates
information obtained by clinical examination of the
teeth, use of diagnostic aids, conversation with the
patient and bilogical knowledge. A proper diagnosis
can not be performed without inspection of the teeth
and the immediate surroundings.
O Check the list to view the etiological factors for
erosion
Diagnosis risk factors
O %here are many factors which are involved in the
erosive tooth wear process.
O Chemical, biological and behavioural factors interect
with the tooth surfaces and over time may either
wear it away or indeed protect it.
Dental rosion:
Diagnosis
nteraction of the different
factors for the development of
erosive tooth wear
From: Lussi A. Dental Erosion: From Diagnosis to Therapy. arger; 2006.
Diagnosis Clinical a77erance
O arly form of erosive tooth wear may be
easily overlooked and not diagnosed as it
is accompanied by few clinical signs and
rare by any symptoms.
O %here is no device available in routine
dental practice for the specific detection of
dental erosion.
O Change and clinical appereance is the
most important feature for dental
profesionals to diagnose dental erosion.
Diagnosis Signs
O $mooth silky glazed sometimes dull
enamel.
O Absence of perikymata
O ntact enamel along the gingival margin
O Cupping and grooving on ocluzal surfaces
Advanced stages
O Flattening of the surface
O Prononced concavity in the enamel
O %ooth sufraces of patients with
active(unstained) erosion have no caries
Diagnosis : Nultifactorial
O Chemical factors-> erosive potential of
intrinsic and extrinsic acids
O Biological factors-> involved properties and
characteristics of the oral cavity
O Behavioral factors-> personal and oral
habits
Diagnosis: Chemical Factors
O pH and buffering capacity of the product
O %ype of acid-> intrinsic (gastric origin)
-> extrinsic (environmental)
O Adesion of the products to the dental surface
O Chelating properties of the products
O Calcium concentration
O Flouride concentration
O $aliva: flow rate, composition, buffering, capacity,
and stimulation capacity
O Acquired pellicle: diffusion-limiting properties,
composition, maturation, and thickness
O %ype of dental substrate (permanent and primary
enamel, dentin) and composition (eg, fluoride
content as FHAp or CaF
2
-like particles)
O ental anatomy and occlusion
O Anatomy of oral soft tissues in relationship to the
teeth
O Physiologic soft tissue movements
BioIogicaI Factors
Dental rosion: Diagnosis
O Unusual eating and drinking habits
O Healthy lifestyle: diets high in acidic fruits and vegetables
O Unhealthy lifestyle: frequent consumption of "alcopops and
designer drugs
O Alcoholic disease
O xcessive consumption of acidic foods and drinks
O Nighttime baby bottle feeding with acidic beverages, including
milk
O Oral hygiene practices: frequent toothbrushing, abrasive oral
care products
BehavioraI Factors
Dental rosion: Diagnosis
Dental erosion : rosion in Children
O rosive tooth wear in children is a common
condition.
O Chemical, biological and behavioural factors and
their interplay are possible reasons for the condition.
O Factors are: consumption of erosive foods stuffs and
drinks, the intake of medicaments and vomiting.
O Lots of studies have been made in children erosion
O A study of 987 children in $outh-Arabia aged
between 2-5 years from 17 kindergarten schools
showed that 309 (31%) had evidence of erosion and
123 (13%) of them showed involvment of dentin or
pulp
O Children and adolescence consume significant
amounts of erosive beverages and so they risk to
develope dental erosions
Loss of tooth surface is a multifactorial
process and education
is the first step in the line of defense.
PREVENTION
Dental rosion: Diagnosis
Dental erosion: Prevention
O nowing the risk factors and patient symptoms
juxtapose with the wishes, hopes and possiblities of
the individual patient, enables the dentist to initiate
adequate preventive and therapeutic measures
O t's important to evaluate the different aetiological
factors that may lead to erosion in order to identify
persons at risk from erosion
O Offten patients do not seek treatment until the
condition is at an advanced stage when teeth
become hypersensitive or when the aesthetics are
affected
O When dental erosion is detected by a dentist or
when there are indications for an increased risk
detailed patient assessment should be undertaken
ental rosion: Prevention
O %he first stage in any management is to diagnose
the cause and then start preventive advice
ietary factors
W Avoid radical changes in dietary habits
W #educe acid exposure by reducing frequency and contact
time of acid
W Avoid acidic foods and drinks late at night
W Avoid high-acidity liquids via baby bottle for infants
W Avoid low pH values in food and beverages
Dental rosion:
Nanagement/tiological Factors
BehavioraI/habits
O o not hold or swish acidic drinks in your
mouth
O Avoid sipping acidic drinksuse a straw
O Avoid toothbrushing immediately after an
erosive challenge (vomiting, acidic diet)
O Avoid toothbrushing immediately before an
erosive challenge, as the acquired pellicle
provides protection against erosion
O Use a soft toothbrush
areness/ssociation/Education
Dental rosion:
Nanagement/tiological Factors
BehavioraI/Habits
15
O Use a low-abrasion fluoride-containing
toothpaste; high-abrasive toothpaste may
destroy pellicle
O Avoid toothpastes or mouthwashes with too-low
pH
O After acid intake, stimulate saliva flow with
chewing gum or lozenges
O Use chewing gum to reduce postprandial reflux
O #efer patients or advise them to seek
appropriate medical attention when intrinsic
causes are involved
areness/ssociation/Education
astroesophageaI Origin
O Heartburn and other symptoms
of reflux
O #egurgitation
O ysphagia
O Asthma
O #umination
O ating disorders (anorexic or
bulimia)
Dental rosion:
Nanagement/tiological Factors
areness/ssociation/Education
edicinaI factors associated ith dentaI erosion
O $ome medicines can potentially induce G#
O theophyIine
O progesterone
O anti-asthmatics
O caIcium channeI bIockers
O Aspirin (especially in chewable format)
O Medicines that decrease salivary flow
O antihistamines
O antichoIinergics
O antidepressants
O antipsychotics
areness/ssociation/Education
Dental rosion:
Nanagement/tiological Factors
Dental rosion: Conclusions
O %ooth wear is a multifactorial process
O #ecognising the early signs of wear and
erosion should stimulate the need for
prevention in an endeavour to prolong the
life of teeth
Dental rosion/Toothwear
Prevention is better than a cure.
ducation is the key!
Bibliography
O Smith and L Sha "Mild dehydration:a risk factors for dental disease
O drian Lussi, arkus Schaffner and Thomas aeggi "ental erosion:
diagnos is and prevention in children and adults
O avid W BartIett - "%he role of erosion in tooth wear: aetiology, prevention
and management
O IFE Erosion "%ooth Wear ducational %eaching #esource