What is dental erosion?

Dental erosion is when tooth structure is dissolved away by strong acid from some foods, beverages and medicines, or from refluxed stomach acids. These enter the mouth frequently enough to simply dissolve the surface layers of tooth enamel and, in extreme cases, the underlying dentine. Erosion is totally unrelated to plaque and tooth decay. Which tooth surfaces are affected depend on where the acid comes from and whether there is enough saliva around to neutralize it. Parts of the teeth that are close to the major salivary glands are most invariably protected. The sites far away from the salivary ducts are vulnerable, especially if saliva production is low or if the acid attack is frequent.

Some of the more common causes of erosion are:

  • Drinking carbonated soft drinks or wines or champagnes too frequently. These contain orthophosphoric acid (food acid 338). These can thin enamel on different parts of the upper teeth, depending on how the items are consumed. They often affect the tongue side of the upper teeth.
  • Swishing acid drinks around in the mouth before swallowing subjects the teeth to increased acid attack.
  • Rinsing the mouth with Vitamin C (ascorbic acid, food acid 331) preparations or chewing Vitamin C tablets for prolonged periods too frequently can cause loss of enamel from most surfaces of the teeth. Vitamin C is contained in all sorts of drinks, sports drinks and candies.
  • Eating (especially sucking) citrus fruit too frequently, especially lemons and grapefruit or their concentrated juice (citric acid, food acid 330). Excessive consumption of apple or pineapple juice can also result in erosion. This will usually cause thinning of enamel on the upper front teeth, and sometimes the biting surfaces on the back teeth. Chewing the skins of citrus fruit can increase the risk of dental erosion.
  • Having too much vinegar in contact with the teeth – either in salads, directly, or brushing teeth with it – will often affect the teeth on the biting surface.
  • Any problem which results in stomach acid refluxed into the mouth, such as: 
gastro oesophageal reflux, heartburn, gastric ulcers or dysfunction, duodenal or peptic ulcers, hiatus hernia, any cause of recurrent vomiting, regurgitation or reflux e.g. asthma, bulimia, anorexia nervosa, during pregnancy, alcoholism, or chronic constipation.

Be aware also of some unusual causes or contributing factors:

  • Occupational risks e.g. welders working with acid fluxes, concrete workers using hydrochloric acid.
  • Vegetarian diets can sometimes cause erosion, eg. excessive consumption of sour berries or fruits, pickles containing acetic acid.
  • Frequent use of spas, or swimming in large improperly chlorinated pools can cause erosion (from excessive hydrochloric acid present). Industrial acids can result in airborne acidic contaminates of the working environment.
  • Medicaments such as iron tonics, acid replacements for people suffering from achlorhydria, or acid to dissolve small renal calculi, can cause severe erosion.

All the above can cause erosion to occur much more quickly if accompanied by other factors:

  • If you have a dry mouth from dehydration e.g. from thirst during work or play, stress, hard physical work, exercise, or from alcohol consumption your saliva is shut down and cannot confer protection. Dehydration is the most common contributing factor for dental erosion in healthy patients.
  • If you have a dry mouth resultant from prescribed drugs, e.g. antidepressants, asthma medications, most illegal drugs and a number of medical conditions, e.g. diabetes. Over 400 prescribed drugs cause mouth dryness.
  • Bushing teeth immediately after an acid challenge.
  • Abrasion from chewing especially for people on lactovegetarian diets, stone ground flour.
  • Attrition from bruxing (tooth grinding)

How can I tell if I have dental erosion?

Early signs of erosion can only be detected in a thorough history and dental examination. If you can see enamel thinning on the front top teeth and can see some yellow patches showing through, or the length of teeth getting shorter, then the erosion is quite advanced. It is important that it be detected before the damage becomes so severe. There are other ways by which enamel can be worn from teeth. We can help you find out what is causing the problem, and help you to control the causes or protect the teeth from damage. Sometimes your teeth become quickly sensitive to sweet and sour tastes, or cold air. Other factors as well as erosion can cause this to occur, such as dental decay. Again, we can help determine the cause and help control this pain. Brushing with toothpastes like Sensodyne only serves to mask the problem. You might be aware of a sour or bitter taste in your mouth quite often. This may be from regurgitated stomach acids. If you have some medical condition or are taking strong drugs, which result in frequent vomiting, frequent checks are required. Early detection of damage can save you a lot of discomfort and costly repair later on.

How can I control dental erosion?

If it is caused by acidic foods or beverages, then it is mainly a matter of trying to stop consuming these, and changing to alternative foods or beverages which are not so acidic, or changing the way these are consumed. Since saliva is such a big issue, it is also about keeping well hydrated and keeping the saliva flowing.

  • Start the day with a glass of water and fresh fruit to stimulate your taste buds and get the saliva working.
  • Think of different ways to ensure you drink at least 1.5 litres of pure water a day. Carry a small plastic bottle of water with you on outings and when doing physical activities.
  • Watch for periods of dehydration. Never drink acids when dehydrated.
  • If you are thirsty or dehydrated, drink water, iced tea or coffee, or hot chocolate instead.
  • Avoid acidic liquids in the diet (wine, beer, soft drinks, fruit juices, cordials, sports drinks).
  • Look at the labels on foods and beverages. Acidic substances are citric acid (330), ascorbic acid (331), orthophosphoric acid (338), and acetic acid.
  • Restrict acid drinks to meal times rather than in between.
  • Drink acid beverages quickly or with a straw, do not sip or swish around.
  • Limit your caffeine intake (chocolate, cola soft drinks, coffee, tea – use caffeine free or herbal instead).
  • Eat a variety of fresh fruit and vegetables for their water and food content and also to increase the amount of saliva in your mouth.
  • Chew lots of sugarless gum to also increase saliva in your mouth. At least two times per day preferably for up to 30 minutes, rinse your mouth first if its too dry to chew.
  • Finish meals with neutral food, eg cheese, rather than acid drinks, eg wine or Coke.
  • Don’t go to bed on a full stomach. Wait at least 2-3 hours after a heavy meal to give your saliva time to neutralise acid.
  • If drinking a lot of alcohol at night, have a big glass of water or milk and clean your teeth before you go to bed.
  • Neutralise stomach acids with saliva, which contains bicarbonate.
  • Rinse with water after acid consumption. A simple bicarbonate mouth rinse will neutralise and freshen as well (do not swallow bicarbonate mouth rinses).
  • Watch your lifestyle for health hazards. Watch for dehydration and acid drinks in recreation. Adopt a lifestyle and diet that copes with any health problems and doesn’t damage your teeth.

If prescribed medicines are causing a dry mouth, ask you medical doctor whether an alternative medical preparation can be found. If you are a wine taster, and this have to keep wine in contact with the teeth for long periods of time, or if you have an acid reflux or frequent vomiting problem, or if you have a persistent dry mouth then erosion is much more difficult to control. The following is a list of other helpful strategies:

  • Fluoride helps strengthen enamel against dissolution. We can supply very strong neutral pH fluoride toothpaste for use at night if saliva flow is low.
  • Don’t brush immediately after a meal or other acid challenge as you can brush off dissolved tooth matrix. Its best to brush before breakfast and last thing at night.
  • Always use a soft tooth brush and a vertical brushing technique
  • If you have an acid reflux or vomiting problem, rinse your mouth out with water or milk immediately after you feel the acid in your mouth. DO NOT BRUSH YOUR TEETH straight after, even though you would like to. This may brush away dissolved mineral held in the plaque covering your teeth. If you wish to freshen up your mouth, use a fluoride mouth rinse, or a liquid antacid preparation.
  • If vomiting or acid reflux occurs at regular times each day, place antacid preparations in your mouth prior to the expected episode. If vomiting is induced voluntarily, we can make a protective mouth guard.

Remember, if you suspect that the erosion is continuing, keep visiting regularly. Special protective coatings may be placed on the surface being damaged if other methods of control are not totally effective. Adapted from material compiled by Prof John McIntyre (University of Adelaide), Dr. William Young (University of Queensland) and Prof Laurence J Walsh (University of Queensland)