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Dental Erosion: Causes, Symptoms & Treatment

Dental erosion is the chemical dissolution of tooth enamel caused by acids, without bacterial involvement. It can lead to tooth sensitivity and permanent tooth structure loss.

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Things worth knowing about "Dental erosion"

Dental erosion is the chemical dissolution of tooth enamel caused by acids, without bacterial involvement. It can lead to tooth sensitivity and permanent tooth structure loss.

What is Dental Erosion?

Dental erosion refers to the progressive, irreversible loss of hard tooth tissue – primarily tooth enamel and the underlying dentine – caused by chemical acids. Unlike dental caries, dental erosion does not involve bacteria. Instead, acids directly dissolve the minerals in tooth enamel, leading to permanent structural damage over time.

Causes

The causes of dental erosion are typically divided into two categories: extrinsic (from outside the body) and intrinsic (from within the body) acid sources.

Extrinsic Causes

Frequent consumption of acidic beverages such as soft drinks, fruit juices, energy drinks, and wine
Regular intake of acidic foods such as citrus fruits, vinegar, and pickles
Occupational acid exposure (e.g., in chemical industries)
Certain medications with a low pH (e.g., effervescent vitamin C tablets, aspirin)

Intrinsic Causes

Gastroesophageal reflux disease (GERD): Stomach acid reaches the oral cavity and attacks the teeth
Bulimia nervosa: Frequent self-induced vomiting leads to repeated acid exposure of the teeth
Chronic vomiting from other medical conditions
Reduced saliva production (xerostomia), as saliva normally neutralises oral acids

Symptoms

In the early stages, dental erosion is often asymptomatic and is typically identified during a dental examination. As the condition progresses, the following symptoms may develop:

Tooth sensitivity to cold, hot, sweet, or acidic stimuli
Changes in tooth colour (yellowing due to exposed dentine)
Rounding and smoothing of tooth surfaces
Visible enamel defects and hollowing (known as cupping) on chewing surfaces
Altered bite position in severe cases
Increased risk of cavities due to weakened enamel

Diagnosis

Dental erosion is diagnosed by a dentist through a clinical examination. Typical features such as enamel loss, changes in tooth shape, and exposed dentine are assessed. To classify the severity, the internationally recognised BEWE Index (Basic Erosive Wear Examination) is commonly used. Dietary habits and medical history are also reviewed to identify the underlying cause.

Treatment

Treatment of dental erosion depends on the extent of damage and the underlying cause.

Prevention and Conservative Measures

Reducing consumption of acidic foods and beverages
Using a high-fluoride toothpaste to support enamel remineralisation
Rinsing with fluoridated water after acid exposure
Chewing sugar-free gum to stimulate saliva production
Waiting at least 30–60 minutes before brushing teeth after acid exposure
Using a straw when drinking acidic beverages

Treating the Underlying Condition

For GERD: pharmacological treatment (e.g., proton pump inhibitors)
For eating disorders: psychotherapy and medical support

Dental Restoration

Composite resin fillings for moderate tooth structure loss
Crowns and veneers for severe damage to tooth surfaces
Occlusal splints to protect teeth in cases of concurrent bruxism (teeth grinding)

References

Lussi A., Jaeggi T. - Erosion: Diagnosis and risk factors. Clin Oral Investig. 2008;12 Suppl 1:S5-13. PubMed.
Bartlett D., Ganss C., Lussi A. - Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs. Clin Oral Investig. 2008;12 Suppl 1:S65-68.
Shellis R.P., Addy M. - The interactions between attrition, abrasion and erosion in tooth wear. Monogr Oral Sci. 2014;25:32-45. Karger.

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