Dental Erosion

Dental Health


Dental erosion: the term conjures up images of ocean waves crashing on a sandy shore, wearing away at your dental dunes. But unlike the physical environmental problem of coastline erosion, dental erosion is a chemical process, and it's becoming a bigger and bigger problem in our society. We all know that Australia has an ageing population, and thanks to great living standards more people are keeping more of their teeth for life. So what exactly causes erosion, and what are the consequences?

Erosion cuts out the middle man. What do I mean by that? The process of tooth decay involves bacteria, (found in plaque), digesting the sugar we eat and turning it into acid. This acid then dissolves tooth structure, resulting in the holes we know as tooth decay. Erosion happens when acid finds its way directly into the mouth without the germs even needing to get involved. Enamel starts to dissolve at a pH of 5, so if the oral environment is consistently at a pH below that the result is widespread softening and eventual loss of enamel and dentine. This can present in many forms such as generalised "divots" in the teeth at the gum line, as overall wear on the biting surfaces of the teeth, as thinned out enamel, as "scooped out" areas on the biting surfaces of teeth, or even just as generalised hypersensitivity to hot and cold.

There's a multitude of ways acid can end up on teeth, but we can break it down into two main categories.

External acid sources

This is rarely anything but food and drinks. There's the obvious things which we know are acidic, like citrus fruit, soft drink, fruit juice, beer, and wine. There's a few sneaky ones though that people don't normally think of as being acidic. Isotonic sports drinks are notorious for causing erosion, especially because they're often consumed when you're exercising and have a dried out mouth, so there's less saliva to protect your teeth.

Sparkling water, soda water, and tonic water are the other big offenders. Yes, they're a great alternative to soft drink in terms of general health due to the 0 calorie factor, but they sit at a pH of around 3-4. That's more than sufficient to start dissolving enamel, so if you're replacing tap water with something a little bubblier, you're putting your teeth at risk.

A good rule to follow is that if it's bubbly, it's acidic. The carbon dioxide dissolved in the drink to make it fizzy forms carbonic acid, so as long as it's fizzing, it's acidic.

Internal acid sources

Stomach acid has a pH of 1.5-3.5, and unfortunately it sometimes doesn't stay put in the stomach. More than 2 million Australians are affected by gastro-oesophageal reflux disease (GORD), which is characterised by stomach contents making its way backwards up the oesophagus, sometimes reaching the mouth. It can cause symptoms such as heartburn, a bad taste in the mouth, bad breath, and can contribute to dental erosion.

Another way that teeth can be exposed to stomach acid is due to frequent vomiting. People who are chronically unwell and have this as a symptom, are undergoing long periods of chemotherapy, or who suffer from an eating disorder will be at risk of dental erosion.

Treatment of dental erosion is primarily about detection and prevention. Once your dentist has picked up that it's happening, the best thing to do it stop it in its tracks. Where possible, the cause should be limited or eliminated. This might mean an alteration in diet, or seeing your GP about reflux investigation and treatment. Once the cause has been addressed, your dentist can recommend changes to your oral hygiene routine to minimise the effects of any future acid exposure. This could involve something simple like making a change in the timing of your brushing, as the worst time is immediately after acid exposure when enamel is softened. There are also products on the market that contain CPP-ACP, which is a milk protein and calcium complex designed to remineralise teeth after acid exposure. As always, for the best advice relating to you individual needs your dentist is the best person to ask.

Once dental erosion has caused significant damage it's very difficult to repair. In extreme cases, a full mouth reconstruction consisting of fillings and/or crowns may be required to restore the tooth structure lost to acid. If you think you might be at risk of dental erosion, speaking to your dentist will help you work out what changes you can make to ensure you keep your teeth in good condition for life.

Dr Emma


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Important: This article is general advice only. For further advice or information on this topic, please consult your health professional.

 

Category: Dental Health

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