What is Tooth Erosion?

Tooth erosion, also called dental erosion, is the wearing down of the protective outer layer of teeth, called enamel, over time. Enamel is made up of crystalline calcium phosphate and is the hardest material in the human body. Still, some substances can eat away at the enamel over time and processes that can physically wear the enamel down. Once enamel is worn away, the dentin of the tooth is exposed, which can lead to sensitivity, pain, and tooth decay.

Causes of Tooth Erosion

There are many causes of tooth erosion and everyone will experience some degree of this over their lifetime from the natural, everyday use of their teeth. However, excessive erosion can be attributed to some specific external sources and internal conditions.

External Sources 

A common cause of enamel erosion is the overconsumption of acidic or sugary beverages, such as soft drinks, coffee, sports drinks, or fruit juices. The acids in these beverages, or acidic foods like pickles and certain fruits, can dissolve enamel over time. Sugars and starches can also lead to acidic conditions in the mouth from the production of acids by oral bacteria. According to research , this is especially true of highly processed starches, like potato chips, sandwich bread, or cakes.

Research has shown that a wide array of medications can lead to tooth erosion , either due to direct contact with teeth or by reducing saliva production. Saliva works to dilute acids in the mouth and also to wash away particles of food, helping to reduce enamel erosion and tooth decay. So, medications that cause dehydration can prevent this protective process. This is also true for alcohol, which can cause dehydration.

Although it may seem counterintuitive, some oral health practices can cause enamel erosion. Overbrushing or using abrasive pastes on teeth will physically erode enamel and should be avoided. 

Internal Causes and Medical Risk Factors

Stomach acid is naturally present in the body for digesting food, but it can be a cause of severe tooth erosion for those with conditions like gastroesophageal reflux disease or bulimia, where stomach acid comes into contact with the teeth.

Additionally, any condition that causes frequent dehydration or decreased saliva production can lead to the erosion of tooth enamel. This effect is seen in diabetes, thyroid disease, certain autoimmune diseases, and some infections. Even excessive physical activity can lead to dehydration when someone is not drinking enough water.

Tooth enamel can also be physically worn down by tooth grinding or clenching of the jaw. Often, the person does not realize that they are doing this, since it might occur during sleep . However, a dentist can usually determine if someone is grinding their teeth by the wear and tear on the bite surfaces.

Signs of Damaged Tooth Enamel

Enamel erosion occurs gradually and will present differently in early and later stages.

Early Stages of Tooth Erosion

In the earlier stages of tooth erosion, the enamel has begun to thin and this can cause tooth sensitivity or pain and chipping or pitting of the teeth. The teeth will also become more and more yellow as the enamel thins and the underlying dentin begins to show.

Later Stages of Tooth Erosion

In the later stages of tooth erosion, the enamel has become extremely thin and dentin may be exposed. This may cause more pain, sensitivity, and an increased likelihood of cavities and dental abscesses .

Treatments for Tooth Erosion

Remineralization 

Treatment for tooth erosion depends on its severity. In cases where enamel has thinned, but dentin is not exposed or too close to the surface, a dentist might recommend remineralization therapy. This essentially consists of prevention methods. Remineralization aims to restore tooth enamel by adding back minerals like calcium. Remineralization therapy might include a highly concentrated form of fluoride that can be applied to teeth as a protective measure. However, these are generally used on children.

Studies have also shown benefits from pastes containing Casein Phosphopeptide Amorphous Calcium Phosphate (CPP-ACP) for tooth enamel repair. When compared with fluoride toothpaste, it was the only substance that promoted a significant increase in enamel microhardness and reduced tooth wear.

Dental Sealants

Sealants are semi-permanent coatings made of a type of resin. They are typically applied to molars and are effective at preventing tooth decay on teeth that are prone to cavities.

Tooth Enamel Repair for Advanced Tooth Erosion

For enamel that is severely damaged, remineralization may not be possible. In these cases, the teeth may need to be replaced to varying degrees. This can be accomplished in a few different ways and will also depend on whether tooth decay is present.

Bonding

Dental bonding can be used to repair teeth by applying a composite material to cracks, chips, or pits caused by damaged enamel. Bonding can also be used for discoloration caused by tooth erosion.

Crowns

Dental crowns , sometimes called caps, are often used to strengthen and cover a damaged tooth. Dental crowns are coverings that are made to look and feel like the original tooth. The damaged tooth is filed down and the crown is placed over it.

Veneers

Veneers may be an option in some cases, but they generally cannot be used if the teeth are severely decayed. Veneers are similar to crowns in that the original tooth is filed down and the veneer is placed over it, but they can be made of resin or porcelain and are usually considered cosmetic solutions. 

How to Prevent Enamel Erosion

As usual, preventing the problem is far better than dealing with it later. There are many ways to prevent excessive tooth erosion. Even those who are already experiencing problems with tooth erosion can prevent further damage by taking these preventative steps.

• Limit acidic or sugary beverages. Avoid slowly sipping on these beverages throughout the day. Contact with teeth can also be limited by using a straw.
• Avoid brushing your teeth directly after consuming acidic products. A common misconception is that it is always best to brush teeth directly after eating, but brushing while acid is still present can damage teeth. Waiting to brush will allow saliva to restore tooth enamel enough to resist damage. Rinsing or drinking water can hasten this process.
• Brush or drink water after eating sugary or starchy foods. It is best to brush shortly after eating these foods or to rinse teeth by drinking water when brushing is not possible.
• Keep acid reflux in check. Treating conditions that cause stomach acid to enter the mouth helps with the prevention of tooth erosion.
• Stay hydrated. Staying hydrated can maintain normal levels of saliva production, which will dilute acids and prevent enamel damage.
• Don’t overbrush. Brushing too often or too hard can physically wear down enamel.
• Use fluoride. Fluoride helps to protect against enamel erosion. Fluoride can be found in special toothpastes, mouthwashes, and fluoridated water. 
• Snack on yogurt. The calcium in plain yogurt and other dairy products can help to remineralize teeth and can be a better alternative to sugary snacks. 
• Chew sugar-free gum. Chewing gum can increase saliva production.

When to Visit a Dentist

While it is important to visit a dentist anytime tooth pain, sensitivity, or damage is present, it is also important to get regular cleanings and checkups at a dental office. A dentist can identify early signs of enamel erosion and a plan can be put into place before any real damage is done.

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