Dental Erosions

When teeth come into contact with acids and there is subsequent superficial loss of tooth structure, the condition is referred to as dental erosions (ICD-10: K03.9 – Disease of hard tissue, unspecified). The acids are either endogenous (endogenous) acids or exogenous (exogenous) acids. This process occurs without the involvement of bacteria, thus unlike caries or periodontitis. Normally, there is a balance between demineralization and remineralization of the enamel in the oral cavity. If this balance is disturbed in favor of demineralization, erosive tooth structure changes occur. Erosion index (according to Lussi et.al. ):

  • Grade 0 – No erosion
  • Grade 1 – superficial loss of enamel
  • Grade 2 – dentin exposed on less than half of the tooth surface.
  • Grade 3 – on more than half of the tooth surface exposed dentin.

Symptoms – complaints

Dental erosions do not initially cause any discomfort. Only when so much enamel has been lost that the dentin (tooth bone) is exposed, pain and sensitivity to temperature occur. Dental erosions can affect all teeth. Patients suffering from bulimia or reflux often have erosions on the backs of their maxillary incisors. In contrast, erosions are more likely to occur on the front surfaces of teeth when exposed to external acid.

Pathogenesis (disease development) – etiology (causes)

The body’s own stomach acid can cause erosions when gastrointestinal disorders with acid regurgitation or reflux of stomach acid (reflux disease) are present. However, patients suffering from eating disorders such as anorexia nervosa (anorexia) or bulimia (binge eating disorder) also often have significant erosions around the teeth. The most common acids supplied to the body from outside are acids in foods and beverages. These include, in particular, fruit juices or carbonated beverages as well as an unbalanced diet that is high in fruit. Another risk factor is occupational exposure to acids. Foods containing calcium and phosphate have a less erosive effect than those without these additives. These include milk and dairy products. Saliva can also promote the development of erosions if its functions – including neutralizing acids – or its composition – calcium and phosphate buffer acids – are disturbed. Certain medications can decrease the amount of saliva and thus also promote the occurrence of erosive changes. These include:

Consequence diseases

Consequences of dental erosions are pain-sensitive teeth. Furthermore, the erosive changes represent an aesthetic impairment.

Diagnostics

Erosions can be detected by visual diagnosis. A general medical history as well as a dietary history provide important clues to the possible cause of the erosions. If necessary, a psychologist should be consulted to the extent that anorexia nervosa or bulimia are suspected or self-reported by the patient. A detailed medication history should also be taken, since many medications can inhibit salivary secretion. Salivary analysis will indicate whether saliva is impaired in quantity, buffering capacity (the ability to neutralize acids), or viscosity in a way that promotes the development of erosions.

Therapy

To prevent the progression of erosions and thus the loss of tooth structure, the cause must first be identified and treated. Often, affected patients do not know what is causing the erosions. In such cases, it is advisable to have a food diary kept for a few days to reveal any frequent consumption of acidic foods and/or beverages. The use of fluoride products is recommended as a local therapeutic measure. This results in remineralization in the area of the tooth enamel. At the same time, the fluoride forms a protective layer on the tooth surface, which protects the tooth from acid attacks and can thus sometimes reduce the extent of erosion.The method is particularly useful in patients with nocturnal reflux or belching. Nutritional counseling is useful in patients whose erosions are caused by food and beverages.