As the description above suggests, erosion is slow and can go undetected until the patient becomes conscious of sensitivity to temperature and/or sweetness, or the fracture of thinned incisal edges. Unlike most dental caries, erosion occurs even on plaque-free sites. Today’s lifestyles appear to promote the consumption of erosive soft drinks and fruit juices. Some individuals suffer from psychosomatic eating disorders, or gastro-intestinal problems, leading to increased contact using acidic gastric contents on the dentition.

Saliva is known to have many properties that can provide a protective function against erosion:

• Dilutes and clears potentially erosive agents from the mouth
• and buffers dietary acids
• Maintains a super-saturated state next to the tooth surface, due to the presence of calcium and phosphate from saliva
• Formation of the acquired pellicle, which has the ability to protect the enamel surface from demineralization by dietary acids
• Providing calcium and phosphate necessary for remineralization

The dental team need to be aware of the potential for erosion to occur and the risk factors for each patient. Dental erosion may become more prevalent making oral health promotion even more important.

The dental team need to be aware of a range of factors, including:

• Low unstimulated salivary flow rates can lead to a much higher risk of dental erosion
• Excessive consumption of acidic fruits and drinks
• Eating disorders
• Gastro-intestinal problems

Erosion is termed either:

Extrinsic - from exogenous acids

Intrinsic - from endogenous acids

Idiopathic - unknown source

Extrinsic

• Excessive consumption of dietary acids - fruit acids, phosphoric acid from fresh fruit, fruit juice and soft drinks
• Ascorbic acid (vitamin C) from many sorts of drinks, sports drinks and candies
• Oral administration of acid medications
• Airborne acidic contaminates of the working environment or industrial acids
• Acidic water from swimming pools - side effect of chlorination
• Vinegar conserves

Intrinsic

• Gastric acid contacting the teeth through recurrent vomiting, regurgitation or reflux
• Eating disorders such as nervous vomiting, anorexia nervosa or bulimia, causing regurgitation
• Morning sickness from pregnancy
• Alcoholism
• Gastro-intestinal disorders

Areas to cover when recording the case history of a patient suffering from erosion

Diet

• Citrus fruit/juices
• Other fruit/juices
• Pickled foods (i.e. gherkins)
• Salad dressings
• Vinegar
• Sports drinks
• Soft drinks
• Acidic beverages
• Fruit berries
• Acidic candies
• Herbal tea
• Other acidic food
• Alcohol
• Effervescent vitamin C tablets

Gastro symptoms

• Vomiting
• Belching
• Acid taste from the mouth
• Gastric pain (especially on awakening)
• Stomach ache
• Any sign of anorexia

Drugs

• Tranquillizers
• Anti-emetics
• Antihistamines
• Lemonade tablets

Saliva

• Flow rate
• Buffering capacity
• pH
• X-ray therapy from the head and neck region
• Salivary gland disorders

Oral hygiene habits

• Toothbrushing (type, technique, frequency)

Use of acidic mouthwashes

Also consider work environment i.e. professional exposure to acidic environments

Saliva plays an important role from modifying the potential erosive effects of dietary foods and beverages. Both the quantity and quality of saliva may account for observed differences from the extent of dental erosion.

Saliva stimulation

• Research has proven that chewing sugarfree gum, such as ORBIT, stimulates the production of saliva by up to 10 times the normal rate from the first few minutes of chewing. At the same time, the composition of saliva changes, making it even more effective at replacing lost minerals.
• Even patients using a low salivary flow of varying aetiology for example, using xerostomia, have found that chewing sugarfree gum, such as ORBIT, can stimulate saliva by up to 7 times, providing relief from the symptoms and protection from clinical complications.

Neutralizing acids

• Chewing ORBIT for 20 minutes after eating and drinking increases bicarbonate from saliva and helps patients to neutralize acids from the mouth.

• Soft or medium-type toothbrush
• Low abrasive fluoride-containing toothpaste
• No toothbrushing immediately before, or following an acid challenge
• Regular visits to the dentist
• Chew sugarfree chewing gum, such as ORBIT, after an acid challenge

• Diminish frequency of consumption of acid foods and beverages
• Restrict acid foods to main meals
• Finish meal using neutral food rather than acid food
• Drink acid beverages quickly or through a straw, do not sip or swish around
• Rinse using water after acid consumption
• Apply preventive measures above