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It’s true what they say…a picture is worth a thousand words. The accompanying images are the result of chemical wear of the enamel. This is caused by:
• Acids – most commonly citric acid found in lemons, limes and oranges.
• Soft drinks, tea and coffee.
Erosion occurs most often in:
• Bulimic individuals: They are at a high risk of erosive wear due to repeated exposure of the teeth to stomach acids.
• Individuals who have a low salivary ph (acidic): As the highly acidic saliva is what causes the wear.
• Those who have a condition known as G.E.R.D (gastro esophageal reflux disease): Acids that are regurgitated from the stomach.
Intra Oral Signs of Erosion:
Changes in appearance and sensitivity of the teeth. For instance:
1. An increase in the transparency of the edges of the teeth. This occurs most often to the central incisor teeth, which are the two most front teeth in the mouth; you can actually see through the edges.
2. Yellowing of the teeth. Since the enamel is now thinner because of the erosion, the yellowish color of the dentin becomes more apparent.
3. Change in the shape of the teeth. We often see concavities on the tooth surfaces and existing gaps between the teeth become even larger. Amalgam (silver) filling material does not erode from the acids, so when the tooth structure wears away, one can see a difference in the levels between the tooth and filling material.
4. Sensitivity and pain to hot, cold sweets, due to exposed dentin. The dentin has nerve endings which may react to thermal stimuli.
In cases of severe dental erosion, one often sees teeth with enamel that has cracked off…there is often a coarseness left on the tooth’s surface.
Treatment for Erosion Lesions:
• Try drinking acidic beverages through a straw…in this way, the fluid won’t come in contact with the teeth.
• Treat the medical problem. If the problem is G.E.R.D (see above), then what is occurring is that stomach acids are being regurgitated into the oral cavity. Often, patients are not even aware that this is occurring as it often happens at night when they are sleeping.
As a dentist, if I see signs of tooth erosion that cannot be explained by a certain behavior, it is often the result of some acid reflux that is causing the wear.
*Avoid eating or drinking the food that is causing the problem.
For areas that are already affected, try not to brush right after eating or drinking the acidic food. At these times, the teeth are softer due to the recent acid attack, so if we brush them, they will wear even more.
Instead, it may be better to rinse your mouth with water or wait a half an hour until you bush your teeth.
Use a re-mineralizing agent such as sodium fluoride in the form of mouth rinse or a tablet before brushing. One can also use fluoride or gels which can be supplied by your dentist.
Increase your consumption of milk or dairy products as these tend to coat the teeth and have an anti-acidic effect. Milk (low or non-fat) is recommended as it contains calcium and phosphorus which help in the remineralisation process. Cow milk also contains the sugar lactose which is the least decay-causing sugar, so it may be a wise choice of beverage.
If sensitivity is a problem because of excessive wear, then we can try dental desensitizers, i.e., bonding agents, to reduce the sensitivity.
Stay tuned! In the next blog, we will discuss Attrition…until then.
Yours in excellent dental health,
Dr. Robert Axelrad. Brampton’s Gentle Dentist