What is Dental Erosion?
We see it in the chair every day. A patient comes in, and the wear patterns just don’t look like typical attrition or abrasion. The surfaces are glassy, cupped, almost melted looking. This is dental erosion.
And let’s be clear, this isn’t tooth decay. We were all trained to hunt for caries, the work of bacteria. But tooth erosion, or erosive tooth wear, is a different beast entirely. It’s a pure chemical process. A straight-up acid attack that leads to tooth surface loss. The real problem is the loss of tooth enamel, that hard, protective coating. Because once it’s gone, it’s gone forever. It doesn’t regenerate.
What we’re seeing is a progressive volume loss. The acid first creates a softened mineralized tooth surface, making it incredibly vulnerable. Underneath that enamel is the sensitive dentine, and when that gets exposed, the problems really start. This is how we end up with severe erosion. It’s a fundamental challenge to the tooth structure itself. So while it’s not decay, the end result can be just as damaging to a patient’s long-term oral health. The source of the acid can be anything from acidic foods and acidic drinks to internal sources like stomach acids. This is where the patient history becomes so critical.
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Causes of Erosion
The usual suspects are everywhere. The big one is diet. We’re practically swimming in acidic foods and drinks. It’s the soft drinks, the fruit juices, the sports drinks, even some wines. The citric acid and phosphoric acid in these products create the perfect conditions for the acid dissolution of tooth enamel.
But it’s not just about what patients put in their mouths. Sometimes the acid comes from within. This is where we need to think like physicians. Gastroesophageal reflux disease (GERD) is a major contributor, bringing powerful stomach acids into the oral cavity, often while the patient is sleeping. This can cause absolutely devastating tooth wear, especially on the palatal surfaces of the anterior maxillary teeth. We see it all the time.
Then there are the more sensitive topics. We have to be prepared to ask about eating disorders. Bulimia, with its cycle of frequent vomiting, directly exposes teeth to gastric acid, leading to rapid loss of tooth enamel and exposed dentin. It’s a difficult conversation, but a necessary one if we want to get to the root cause.
And of course, other factors can compound the problem. Co-existing conditions like teeth grinding (bruxism) can accelerate the tooth wear started by erosion, creating a destructive feedback loop where softened enamel is easily ground away, especially on the occlusal surfaces.
What Can Cause Dental Erosion? More Than You’d Think.
You might think this is all about teenagers and their love for carbonated drinks. And sure, that’s a big part of it. But the increased risk for enamel erosion comes from some surprising places and affects all age groups.
We see it all the time with medical conditions. Chronic acid reflux (or gastro oesophageal reflux as it’s formally known) is a major culprit, bathing the teeth in powerful acids while a person sleeps. We also have to be mindful of patients with other eating disorders or a history of excessive vomiting. The damage can be rapid and severe. And sometimes it’s linked to other health challenges, like chronic alcoholism.
But it gets even more specific. Think about the “healthy” patient who takes chewable vitamin C tablets every day. They think they’re doing something good, but that constant direct acid contact is a disaster for their enamel. Or the competitive swimmer who spends hours a week in improperly maintained chlorinated swimming pools. That chemical environment can be incredibly erosive.
Even our youngest patients are at risk. In paediatric dentistry, we’re seeing more erosion on both deciduous teeth (the primary dentition) and new permanent teeth. This isn’t just about sweet foods; it’s the constant exposure to acidic juices and sports drinks that’s the real problem.
Effects of Erosion
The bottom line is that the effects are profound. We’re talking about significant tooth surface loss and tooth wear. This isn’t just a clinical finding; it has real consequences for the patient. The most immediate complaint is often tooth sensitivity. That sharp pain from hot or cold foods and drinks is a classic sign that the protective enamel is gone. It directly impacts their quality of life.
These erosive lesions can dramatically alter the cosmetic appearance of teeth, making them look thin, translucent, or yellow as the darker dentin shows through. This can be a huge source of anxiety for patients.
And it gets more complicated. A highly acidic environment can sometimes feel like it’s causing dry mouth. The salivary glands can’t keep up with the acid challenge, and saliva is our primary natural defense. Without enough of it to neutralize the acid, the risk for not only erosion but also tooth decay goes way up.
Failure.
That’s what it feels like when it progresses to the point of severe loss of tooth structure. This is when we have to start discussing major restorative treatment. It’s not a simple filling anymore. We’re talking about costly, complex, and time-consuming work that often requires multiple dental visits. All because of a chemical process that went unchecked for too long.
Spotting the Sneaky Signs of Enamel Erosion
So, what are we actually looking for in the chair? As a dental practitioner, spotting early erosive wear is one of the most important things we can do for a patient’s long-term dental health. It’s subtle at first.
You start to see a loss of the natural texture on the enamel surface. It gets this weirdly smooth, glassy look. Then you might notice the cusps of the molars looking shallow, almost melted. That’s “cupping,” a classic sign that the dental hard tissue is dissolving. Before you know it, the darker, yellow underlying dentine starts to show through, which patients really notice.
And the patient’s chief complaint? Often, it’s a sudden onset of teeth sensitivity. They’ll say that ice cream or a hot coffee is suddenly causing a sharp pain. That’s the alarm bell. It means the protective enamel is thin enough that external triggers are reaching the nerve. This isn’t just a clinical finding; it’s a quality-of-life problem.
Preventing Dental Problems
So, how do we get ahead of this? It’s all about defense. We have to shift the conversation from treatment to prevention.
Fluoride is still our best friend. Recommending a fluoride toothpaste and a fluoride mouth rinse is baseline. We know fluoride helps strengthen tooth enamel, making it more resistant to an acid challenge. It’s not a silver bullet, of course, but it’s a critical part of the strategy.
We also need to talk about saliva. It’s the unsung hero. We should be encouraging patients to chew sugar-free gum after meals or acidic drinks. It does two things: stimulates saliva production and helps neutralize the acid sitting on the teeth. Simple. Effective.
But the hardest part is the behavioral change. It means advising patients to avoid or limit acidic foods and drinks. Reducing consumption of soft drinks and fruit juices is a tough sell, but it’s a conversation we have to have. It’s about explaining the ‘why’ behind the advice. It’s about reducing that constant acid challenge.
And, of course, regular dental check-ups are non-negotiable. That’s our chance to perform clinical oral investigations and catch the early signs of erosion. The earlier we spot it, the more options we have to prevent it from getting worse.
Practical Ways to Prevent Dental Erosion
Telling patients to just “stop consuming acidic drinks” is a good start, but it’s not always realistic. So, we need to give them practical strategies. The Australian Dental Association and other groups offer great advice that we can pass on.
First, how they drink matters. Instead of sipping that acidic beverage over an hour, drink it with a meal and be done with it. Using a straw can help bypass the front teeth. And afterward? Rinse immediately with plain water to dilute the acid.
Here’s the counterintuitive one: Wait before you brush. After an acid exposure, the enamel surface is softened. If you brush right away, you’re literally scrubbing away your enamel. Wait at least 30 to 60 minutes. When you do brush, use a soft toothbrush and brush your teeth gently.
And let’s talk about saliva again. Chewing sugar-free chewing gum after a meal or acidic snack is a fantastic way to stimulate saliva and help neutralize the acid. It’s a simple habit that makes a real difference. We have to empower our patients with these little life hacks if we want to truly prevent dental erosion.
Restorative Options
But what happens when prevention isn’t enough? Sometimes we see patients when the damage is already done. Then we have to pivot to restorative treatment.
The goal is twofold: repair the lost tooth structure and protect what’s left. For more minor cases, a simple topical application of fluoride varnish can help re-harden the enamel and reduce sensitivity. It’s especially useful for our younger patients.
For more noticeable damage, dental bonding can be a great option. It’s minimally invasive, cost-effective, and can do wonders for both the cosmetic appearance of teeth and for covering exposed dentin to reduce tooth sensitivity.
But in severe cases… Well, that’s when things get serious. When there’s been substantial loss of tooth structure, we have to look at more extensive options. This could mean veneers to restore the front teeth or full crowns to rebuild function and protect the remaining tooth. Sometimes it even involves implants if a tooth can’t be saved. This is the last resort. It’s where nobody wants to end up, but it’s our job to manage it when we get there.
The real kicker is that even the most beautiful restorative work will fail if the underlying cause of the erosion isn’t addressed. And that brings us right back to the beginning. The problem isn’t the tooth. It’s the environment. And changing that is the real challenge, isn’t it?
Closing Thoughts
At the end of the day, dental erosion is a silent problem. It doesn’t hurt until it’s already done significant damage. Unlike tooth decay, it’s not caused by something we can just drill out and fill. It’s a lifestyle and health issue playing out on the surface of the teeth.
But the real story isn’t about drills and fillings, or even crowns and veneers. It’s about being a detective. It’s about sitting down with a patient and connecting the dots between their diet, their health, and what we’re seeing in their mouth. Our job is shifting from just being a repair person to being a coach for their overall oral health.
We have the tools for restorative treatment, of course. But preventing it from happening in the first place? Or stopping it in its tracks? That’s the real win. It’s about helping our patients understand the ‘why’ behind the problem so they can finally take control. And that’s a far more powerful solution than any restoration we could ever place.
