What is Enamel Erosion?

What is Enamel Erosion?

Enamel is a highly mineralized acellular tissue, composed predominantly of a crystalline form of calcium phosphate known as hydroxyapatite. While providing the mechanical strength required for chewing, the high mineral content makes enamel susceptible to an erosive process of demineralization by acid. Unlike the situation with caries, eroded tooth surfaces are normally clean and free of dental plaque. The common sources of acid are dietary fruits, fruit juices and carbonated drinks. Acids can soften the enamel which if not re-hardened, can then be worn away. Once the enamel is lost, the body cannot replace it.

The erosive process is invisible in early stages. If there is progression to tooth wear, anatomical features such as cingulums and mamellons start to become less distinct. In later stages on anterior teeth the enamel can thin at incisal edges and become more translucent, eventually chipping away. Once dentine is exposed the teeth appear yellower and tooth sensitivity can develop. In severe cases, loss of tooth tissue compromises function, as well as patient comfort and aesthetics.

Erosive tooth wear is a common and increasing problem, with effects that accumulate with age. A recent study showed around 30% of young adults in European countries were affected*.

*Bartlett DB et al. Prevalence of toothwear on buccal and lingual tooth surfaces and possible risk factors in young European adults. J Dent. 2013; 41:1007–1013

What increases risk of enamel erosion?

What increases risk of enamel erosion?

Consumption of dietary acids is probably the most common modifiable factor affecting the broadest segment of the population. Contrary to patient expectations, a healthy diet involving frequent consumption of acidic fruit and juices can increase the risk of erosive tooth wear, due to repeated acid attacks throughout the day. Probably the most common risk factor is snacking on acidic fruits, but habits like swilling around the mouth, that increase contact time between acid and teeth, will also increase risk of erosion.

Individuals will have different susceptibility to enamel erosion depending on charateristics of their saliva and acquired pellicle, that coat and protect the teeth. However these natural defences can be readily overcome by many dietary acids. Conditions where teeth are exposed to gastric acid are also well recognised as significant risk factors, for example eating disorders involving vomiting and problems such as gastroesophageal reflux.

Underlying trends of increase in lifespan and retention of teeth suggest that the risk of erosion at population level will continue to increase in future.

The importance of early stage management

The importance of early stage management

The effects of tooth wear are cumulative, so a degree of erosive tooth wear can be expected over a lifetime, partly due to ageing. However in high risk individuals, the rate of progressive tooth wear is increased. In the early stages patients commonly do not experience symptoms, but at relatively advanced stages when the loss of tooth substance leads to shortened teeth, restorative treatments may be necessary.

It is therefore important that clinicians diagnose early stages in enamel erosion and perform risk assessment to identify those patients who would benefit from preventive strategies, in order to reduce enamel loss. A detailed history and examination can help to determine if there is risk of acid originating from the diet or other source. General preventive advice may include reducing the frequency of acid intake, modifying habits such as sipping and swilling to minimise acid exposure and avoiding brushing teeth immediately after acid consumption, while enamel surface is softened and vulnerable to wear.

As part of the preventive regimen, twice daily brushing with fluoride toothpaste remains essential. REGENERATE Enamel Science™ Advanced Toothpaste contains fluoride as well as NR5™ technology and is suitable for use in place of regular toothpaste.