Acid erosion, also known as
dental erosion, is the irreversible loss of tooth structure due to chemical dissolution by acids not of
bacteriaThe bacteria are a large group of unicellular microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
l origin. Dental erosion is the most common chronic disease of children ages 5–17, although it is only relatively recently that it has been recognised as a dental health problem. There is generally widespread ignorance of the damaging effects of acid erosion; this is particularly the case with erosion due to fruit juices, because they tend to be seen as healthy.
Acid erosion, also known as
dental erosion, is the irreversible loss of tooth structure due to chemical dissolution by acids not of
bacteriaThe bacteria are a large group of unicellular microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
l origin. Dental erosion is the most common chronic disease of children ages 5–17, although it is only relatively recently that it has been recognised as a dental health problem. There is generally widespread ignorance of the damaging effects of acid erosion; this is particularly the case with erosion due to fruit juices, because they tend to be seen as healthy. Erosion is found initially in the
enamelTooth enamel is the hardest and most highly mineralized substance of the body, and with dentin, cementum, and dental pulp is one of the four major tissues which make up the tooth in vertebrates. Tooth enamel is also found in the dermal denticles of sharks. It is the normally visible dental tissue...
and, if unchecked, may proceed to the underlying
dentinDentin is a calcified tissue of the body, and along with enamel, cementum, and pulp is one of the four major components of teeth. Usually, it is covered by enamel on the crown and cementum on the root and surrounds the entire pulp...
.
The most common cause of erosion is by acidic foods and drinks. In general, foods and drinks with a
pHpH is a measure of the acidity or basicity of a solution. It is defined as the cologarithm of the activity of dissolved hydrogen ions . Hydrogen ion activity coefficients cannot be measured experimentally, so they are based on theoretical calculations...
below 5.0–5.7 have been known to trigger dental erosion effects. Numerous clinical and laboratory reports link erosion to excessive consumption of drinks. Those thought to pose a risk are soft drinks and fruit drinks, fruit juices such as
orange juiceOrange juice is a popular breakfast beverage made from the extraction of liquid from fresh oranges. The term "orange juice" is also used, both colloquially and commercially, to refer to "concentrated orange juice"....
(which contain
citric acidCitric acid is a weak organic acid, and it is a natural preservative and is also used to add an acidic, or sour, taste to foods and soft drinks. In biochemistry, it is important as an intermediate in the citric acid cycle and therefore occurs in the metabolism of virtually all living things...
) and
carbonated drinksA soft drink is a drink that does not contain alcohol . Soft drinks are often carbonated and commonly consumed while cold. The most common soft drinks are colas, flavored water, sparkling water, iced tea, sweet tea, lemonade, squash and fruit punch....
such as
colaCola is a beverage usually containing caramel coloring, caffeine, and a sweetener such as sugar or high fructose corn syrup.Originally invented by the druggist John Pemberton, it has become popular worldwide. Coca-Cola has become the major international brand, leading to the drink often being seen...
s (in which the
carbonic acidCarbonic acid has the formula H2CO3. It is also a name sometimes given to solutions of carbon dioxide in water, which contain small amounts of H2CO3. The salts of carbonic acids are called bicarbonates and carbonates. It is a weak acid...
is not the cause of erosion, but citric and
phosphoric acidPhosphoric acid, also known as orthophosphoric acid or phosphoric acid, is a mineral acid having the chemical formula H3PO4. Orthophosphoric acid molecules can combine with themselves to form a variety of compounds which are also referred to as phosphoric acids, but in a more...
). Additionally,
wineWine is an alcoholic beverage typically made of fermented grape juice. The natural chemical balance of grapes is such that they can ferment without the addition of sugars, acids, enzymes or other nutrients. Wine is produced by fermenting crushed grapes using various types of yeast. Yeast consumes...
has been shown to erode teeth, with the pH of wine as low as 3.0–3.8. Other possible sources of erosive acids are from exposure to
chlorinatedChlorine Chlorine Chlorine ( , from the Greek word 'χλωρóς' (khlôros, meaning 'pale green'), is the chemical element with atomic number 17 and symbol Cl. It is a halogen, found in the periodic table in group 17 (formerly VII, VIIa, or VIIb). As the chloride ion, which is part of common salt and...
swimming poolA swimming pool, swimming bath, wading pool, or simply a pool, is an artificially enclosed body of water intended for swimming or water-based recreation. There are many standard sizes; the largest and deepest is the Olympic size...
water, and regurgitation of
gastric acidGastric acid is a secretion produced in the stomach. It is one of the main ditotonic solutions secreted, together with several enzymes and intrinsic factors...
s.
Extrinsic acidic sources
Acidic drinks and foods lower the pH level of the mouth so consuming them causes the teeth to demineralise. Furthermore, sugars contained in food and drink also turn to acid, which further erodes the teeth. Drinks low in pH levels that cause dental erosion include fruit juices, sports drinks, and carbonated drinks. Orange and apple juices are common culprits among fruit juices. Carbonated drinks such as
Coca-ColaCoca-Cola is a carbonated soft drink sold in stores, restaurants and vending machines internationally. The Coca-Cola Company claims that the beverage is sold in more than 200 countries...
are also very acidic. Frequency rather than total intake of acidic juices is seen as the greater factor in dental erosion; infants using feeding bottles containing fruit juices (especially when used as a comforter) are therefore at greater risk of acid erosion.
SalivaSaliva is the watery and usually frothy substance produced in the mouths of humans and most other animals. Saliva is produced in and secreted from the salivary glands...
acts as a buffer, lowering the pH when acidic drinks are ingested. Drinks vary in their resistance to the buffering effect of saliva. Studies show that fruit juices are the most resistant to saliva's buffering effect, followed by, in order: fruit-based carbonated drinks and flavoured mineral waters, non-fruit-based carbonated drinks, sparkling mineral waters;
Mineral waterMineral water is water containing minerals or other dissolved substances that alter its taste or give it therapeutic value. Salts, sulfur compounds, and gases are among the substances that can be dissolved in the water. Mineral water can often be effervescent. Mineral water can be prepared or can...
being the least resistant. Because of this, fruit juices in particular, may prolong the drop in pH levels.
A number of medications such as vitamin C, aspirin and some iron preparations are acidic and may contribute towards acid erosion.
Intrinsic acidic sources
Dental erosion can occur by non-extrinsic factors too. Intrinsic dental erosion is known as perimolysis, whereby
gastric acidGastric acid is a secretion produced in the stomach. It is one of the main ditotonic solutions secreted, together with several enzymes and intrinsic factors...
from the stomach comes into contact with the teeth. People with diseases such as
anorexia nervosaAnorexia nervosa is a psychiatric illness that describes an eating disorder characterized by extremely low body weight and body image distortion with an obsessive fear of gaining weight...
, bulimia, and
gastroesophageal reflux diseaseGastroesophageal reflux disease ', gastro-oesophageal reflux disease ', gastric reflux disease, or acid reflux disease is defined as chronic symptoms or mucosal damage produced by the abnormal reflux inthe esophagus....
often suffer from this. GERD is quite common and an average of 7% of adults experience reflux daily. The main cause of GERD is increased acid production by the stomach.
Behaviour
Acid erosion often coexists with
abrasionAbrasion is the loss of tooth structure by mechanical forces from a foreign element. If this force begins at the cementoenamel junction, then progression of tooth loss can be rapid since enamel is very thin in this region of the tooth...
and
attritionAttrition is the loss of teeth structure by mechanical forces from opposing teeth. Attrition initially affects the enamel and, if unchecked, may proceed to the underlying dentin. Once past the enamel, attrition quickly destroys the softer dentin....
. Abrasion is most often caused by brushing teeth too hard.
Throthing or swishing acidic drinks around the mouth increases the risk of acid erosion.
Signs
There are many signs of dental erosion, including changes in appearance and sensitivity. One of the physical changes can be the color of teeth. There are two different colors teeth may turn if dental erosion is occurring, the first being a change of color that usually happens on the cutting edge of the central incisors. This causes the cutting edge of the tooth to become transparent. A second sign is if the tooth has a yellowish tint. This occurs because the white enamel has eroded away to reveal the yellowish middle layer of the tooth called dentin. A change in shape of the teeth is also a sign of dental erosion. Teeth will begin to appear with a broad rounded concavity, and the gaps between teeth will become larger. There can be evidence of wear on surfaces of teeth not expected to be in contact with one another. If dental erosion occurs in children, a loss of enamel surface characteristics can occur.
AmalgamAmalgam may refer to:* Amalgam , mercury alloy* Amalgam , material of "silver" tooth fillings* Amalgam Comics, publisher* Amalgam, Gauteng, South Africa* Amalgam , fictional character in the Marvel Universe...
restorations in the mouth may be clean and non-tarnished. Fillings may also appear to be rising out of the tooth, the appearance being caused when the tooth is eroded away leaving only the filling. The teeth may form divots on the chewing surfaces when dental erosion is occurring. This mainly happens on the first, second, and third molars. One of the most severe signs of dental erosion is cracking, where teeth begin to crack off and become coarse. Other signs include pain when eating hot, cold, or sweet foods. This pain is due to the enamel having been eroded away, exposing the sensitive dentin.
Prevention and Management
Preventive and management strategies include the following:
- Treating the underyling medical disorder or disease.
- Modifying the pH of the food or beverage contributing to the problem, or changing lifestyle to avoid the food or beverage.
- Decrease abrasive forces. Use a soft bristled toothbrush and brush gently. No brushing immediately after consuming acidic food and drink as teeth will be softened. Leave at least half an hour. Rinsing with water is better than brushing after consuming acidic foods and drinks.
- Drinking through a straw
- Using a remineralizing
Remineralisation of teeth is a process in which minerals are returned to the molecular structure of the tooth itself. Teeth are porous allowing fluids and demineralisation beneath the surface of the tooth. When demineralised, these pores become larger...
agent, such as sodium fluorideSodium fluoride is the inorganic compound with the formula NaF. This colorless solid is a source of the fluoride ion in diverse applications. Sodium fluoride is less expensive and less hygroscopic than the related salt potassium fluoride....
solution in the form of a fluoride mouthrinse, tablet, or lozenge, immediately before brushing teeth.
- Applying fluoride gels or varnishes to the teeth.
- Drinking milk or using other dairy products.
- Using a neutralizing agent such as antacid tablets.
- Dentine bonding agents applied to areas of exposed dentin
See also
- Abrasion
Abrasion is the loss of tooth structure by mechanical forces from a foreign element. If this force begins at the cementoenamel junction, then progression of tooth loss can be rapid since enamel is very thin in this region of the tooth...
- Abfraction
Abfraction is the loss of tooth structure from flexural forces. This has not been supported yet by dental research but it is hypothesized that enamel, especially at the cementoenamel junction , undergo this pattern of destruction by separating the enamel rods.As teeth flex under pressure, the...
- Attrition
Attrition is the loss of teeth structure by mechanical forces from opposing teeth. Attrition initially affects the enamel and, if unchecked, may proceed to the underlying dentin. Once past the enamel, attrition quickly destroys the softer dentin....
- Bruxism
Bruxism is characterized by the grinding of the teeth and is typically accompanied by the clenching of the jaw. It is an oral parafunctional activity that occurs in most humans at some time in their lives. In most people, bruxism is mild enough not to be a health problem...
External links
Further reading
- Adrian Lussi. Dental Erosion: From Diagnosis to Therapy. Karger Publishers, 2006. (ISBN 9783805580977)