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Protecting against tooth erosion
In addition to being vigilant for dental erosion, the dental professional should raise awareness about the problem among patients.
Further research about the prevalence in the US of dental erosion will give some indication as to incidence, and whether the problem is growing. Should this be the case, it will be important to consider what the appropriate advice will be to give to parents. Dental professionals will also want to be able to advise on the optimal products to help protect children's teeth.
Click here to view 'A check list for identifying and managing the high risk patient.' Adapted from Bartlett 2005.49
Tooth surface loss is multi factorial and it is not just about looking out for the physical signs once erosion has occurred. As discussed earlier, societal factors, diet and fluid consumption, as well as oral hygiene habits all have a part to play.
Building a rapport with patients - children and their parents - allows the potential to discuss the nature of foods and drinks, and eating and drinking habits.
- Erosion is likely to occur to a greater extent in boys than girls, and social grouping may also impact on likelihood, so advice will need to be tailored accordingly.
- For advice to get through, radical changes in dietary habits should be avoided. Instead, encourage sensible eating and explain what the risks are in behaviour such as frequent exposure to soft drinks, or even sipping, grazing or swishing.
- For infants, check with the parents as to what drinks are given via a bottle or feeding cup, especially if the child uses the bottle as a soother or pacifier. Water and milk are non-erosive,39 but juices and other soft drinks unless specially formulated to minimize titratable acidity, are better drunk quickly, or via a straw.
- For older children, encourage them to drink more water and milk, while cutting down on soft drink consumption, or even having a drink of water after a soda. Be aware, though, of a growing interest in 'functional' drinks that, although marketed as healthy, may still present similar levels of acid challenge.
- Stimulating saliva is beneficial to promote more secretion of neutralizing bicarbonate and restorative salivary protein, as well as apatite. Chewing sugar-free gum may help, and it also has the added benefit of reducing post-prandial reflux.50 Chewing some cheese will release calcium and proteins into the saliva, and is also likely to stimulate salivary flow. However, as cheese is a source of saturated fats, the amounts consumed should be in line with healthy eating guidelines.
- If dry mouth or reflux is occurring, the cause - whether it is as a result of diet, illness or medication - needs to be determined.
- Fluoride is important, but brushing teeth soon after acidic food could do more damage than good. With that in mind, using a low abrasivity toothpaste and a softer brush should reduce impact. Palatability will encourage use. And the research looking at calcium, phosphate and calcium phosphopeptides indicates these ingredients may be worth seeking out.
- Check whether mouthwashes are used, if so which ones and how frequently. Using an acidic mouthwash as a pre-brushing rinse should be avoided.
The first step in reducing the burden of erosive tooth wear is education. This can only be achieved if the dental profession takes the lead by talking to patients about this problem and providing them with advice on how best to prevent and manage it.
Above all, the aim is to build awareness and encourage the adoption of lifelong healthy habits. Slowing down and limiting the erosive challenge to teeth will help them last a lifetime, without sensitivity, discoloration or weakening.