Dental Erosion

While many people have had cavities, known as dental caries, there is also a high incidence of dental erosion.  Dental erosion is destruction of the enamel by chemical sources, which can lead to significant loss of tooth structure, dental sensitivity and an increased risk of caries.  Initially, erosion may be noticed as shallow cupping on the cusps (bumps) of the back teeth (molars or premolars).

Causes of Erosion:

Erosion is caused by several chemical sources that are grouped into 3 main areas.  Dietary sources, such as carbonated beverages (soda pop), citrus fruits and other acidic foods are common.  Stomach acid will also cause erosion in someone who has gastric reflux (GERD – gastroesophageal reflux disorder) and also in individuals with certain eating disorders such as bulimia.

Erosion of many teeth from “pop swishing”

When erosion starts, it can make the tooth surface softer so that your teeth will wear down faster from chewing, bruxism (grinding your teeth while sleeping) or brushing your teeth.  If the cause of the erosion is identified and removed, the process will stop.  Small areas of minor erosion may be fine without any treatment.  Much larger areas will need to be restored to protect the tooth as well as the alignment of the surrounding teeth, particularly when the underlying dentin is exposed.

Gastric reflux is a common cause of dental erosion.  Often this is managed after a medical assessment and if GERD is diagnosed, possible medications to control the acid from the stomach.

Many people do not know that they have damage from erosion until they are shown as there may not be any sensitivity, even in severe cases.  Treatment ranges from a simple filling (restoration) for a smaller affected area to a full crown (cap) for more severe situations.  Levels of acidity that cause erosion of enamel can also affect dental work such as ceramic crowns.  Erosion will remove the glazed surface from the crown and eventually erode the porcelain on the crown.  Erosion of enamel around a filling (amalgam or composite restoration) will eventually make the restoration appear to pop out from the tooth.

Severe erosion with staining (suspected occupational cause)

There are a wide range of dietary sources of acid-causing erosion.  When the acid level in your mouth drops below pH 5.5, erosion of dental enamel begins.  The lower the pH, the more acidic the food or drink is and the more harmful to your teeth.  Some carbonated beverages, such as a cola, can be as low as pH of 2.7.  The pH of fruit juice (orange, apple, and several others) as well as whole fruit (lemon is pH 1.8) is also low making it very acidic and harmful to your teeth if consumed too often.  Coffee and Iced Tea are also very acidic, and although tea is less acidic (the pH is much higher) so erosion does not occur as easily as it would with soda. (YF Ren 2011)

Severe dental erosion before restoring with full crowns

Early detection of dental erosion is important to find the cause of the acid attack before severe damage occurs that can weaken teeth.  As shown in the picture on the left, this erosion has destroyed much of the tooth on the tongue side of the teeth and is starting to encroach on the pulp (nerve) space.    This patient wanted veneers to hide the brown on the front of the teeth.

Before crowns – dental erosion with staining

Crowns were placed to replaced the missing parts of the teeth and protect the pulp space.

Crowns to restore severe dental erosion

The patient was very happy to have a beautiful smile in the end.

If you think that your teeth may be affected by erosion, make an appointment to see your dentist right away.  If you need a dentist in the area of Dartmouth, Nova Scotia, Dr. Carol Simpson would like to welcome you to call her office at Lake Loon Family Dentistry to set up an appointment for your first visit.