Special Issues
March 2009
Volume 5, Issue 3


Encouraging healthier lifestyles is a priority for all health professionals, prevention being better than cure. For dentists, the primary focus of preventative messaging has been around dental caries, but there is growing concern about the increase in tooth surface loss, and erosive tooth wear in children in particular.1-3

Tooth surface loss (TSL) is the pathological, non-carious loss of tooth tissue. It is a multi-factorial process that includes chemical and physical influences, rather than microbiological factors, distinguishing it from caries. Dental erosion is one aspect of TSL which also encompasses abrasion, attrition and abfraction.

Recently the World Health Organization has defined dental erosion as "the progressive irreversible loss of dental hard tissue that is chemically etched away from the tooth surface by extrinsic and/or intrinsic acids by a process that does not involve bacteria".4

Data on the prevalence of dental erosion has been building around the world, with studies looking at the extent of the problem in children. European studies suggest it is prevalent in up to half of all pre-school children, and between 24-60% of school-aged children.5-7 However, as scoring systems differ, some studies put prevalence much higher; with adults (18 to 88 years of age) prevalence has been reported as high as 82%.8 Possible factors contributing to the variation in levels of acid erosion awareness include differences between dentists in reporting rates, an under-diagnosis of the condition, differing scoring systems and sample population and the difficulty in differentiating between erosion, attrition and abrasion, particularly in the early stages.2,9

There appears to be less research specifically about dental erosion in the US. Indeed, in 2001 in a joint report, the American Dental Association Council on Access, Prevention and Interprofessional Relations and the Council on Scientific Affairs to the House of Delegates noted: "Few studies reported the prevalence of dental erosion among the US population, although the problem is common."10

In 2005, early data indicated a prevalence of erosion of 5.5 per cent in 12-14 year olds selected from two schools in San Antonio, Texas.11

A multi-centre study in March 2008 with the University of Indiana, University of California San Francisco and University of Texas, San Antonio, found tooth erosion had been found in 30 per cent of a cohort of 900 Texas children aged between 10 and 14 years.12

Prevalence in other countries would suggest dental erosion in the US is no different, especially given the similarity with Western diets. Indeed, one study found similar prevalence levels among adolescents in Maryland, US (41%), and Scotland, UK (37%).13

As the expectation grows that teeth will last longer because of advances in dentistry and healthcare, it is important to consider the implications of tooth erosion. Identifying early signs and symptoms and providing appropriate counseling should help minimize the impact of tooth erosion in the longer term.

The public is increasingly familiar with problems associated with carbonated sodas. Carbonated drinks sales, particularly those containing sugar are declining,14 in part due to publicity about excessive calories leading to diabetes and other metabolic syndrome disorders, as well as obesity.

However, as dental erosion is non-carious, simply swapping to diet sodas will not remove the danger of erosion, as many sugar-free versions have the same sort of erosive potential as their sugar containing counterparts.15

Trickier to communicate will be the hidden problems associated with healthier diets. Fruits and juices contain extrinsic acids, such as citric and ascorbic acids,4 so encouraging increased consumption of healthy foods may actually increase the risk of exposure to acid dental erosion. As acid can soften enamel, tooth-brushing habits also need consideration.

Dentists and dental hygienists are ideally placed to raise awareness of this condition, which leads to irreversible tooth surface loss. The aim, then, is to encourage good oral hygiene and dietary habits from early on in life. Taking action early can reduce the likelihood of discoloration, sensitivity, tooth weakening, and even total tooth destruction,4 and avoid extensive and costly repair work later on.

This report is designed to provide an overview of the multi-factorial process relating to erosive tooth wear and what advice can be given to patients. It will enable dental professionals to discuss with their patients not only dental hygiene concerns but also diet and eating habits, as well as other contributory factors. It's an exciting challenge.

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