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Dental erosion, a new pandemic?

Dental erosion, a new pandemic?

I hope I got your attention with the title. Tooth erosion is a major problem in the 21 century for a number of reasons. Diet, people living longer and having teeth longer, medications, obesity and sleep problems are all relevant factors.

Erosion-1

Intrinsic erosion from reflux affects the inside surfaces of teeth

So what is tooth erosion? Teeth dissolve in an acidic environment (the correct scientific term is ‘corrosion’, but dentists grew up being told it is erosion). Images of eroded teeth can be seen here.

There are two main sources of acid in the mouth:
Extrinsic: This means it comes from outside, so it is acid we put in our mouths
Intrinsic: This is acid we generate, primarily regurgitated from our stomach. There is also acid from bacteria in the mouth and in rarely acidic saliva.

Like most things in life it is all about balance. Every day we generate a acid in our mouths from bacteria and eat a little acidic food in our diet which hopefully is neutralised by saliva (which should be alkaline, the opposite of acidic) as well as alkaline foodstuff like milk. The acid balance swings back and forth resulting in calcium and phosphate being removed and replaced in teeth. The building blocks of teeth, crystals of hydroxyappatite, can be dissolved and remade depending on the acid level (also call the pH). A neutral pH is 7, below this is acidic, above is alkaline (also called basic).

Erosion-2

erosion accelerates toothbrush abrasion

So what? Loss of balance, that is being acidic more than basic, will slowly dissolve our teeth. The outer layer of teeth is enamel which is very acid resistant. Under the enamel is dentine which is about 10 times easier to dissolve. Many people who come to see me describe how they have noticed their teeth slowly “wearing” away for years but for the last few years that wear has dramatically increased. This describes what happens when the outer enamel layer is finally lost and large amounts of dentine exposed, when dramatically faster tooth structure loss is experienced.

Erosion is linked to other challenges. Many people who show erosion may also grind their teeth in their sleep, may snore or have sleep apnoea. They are part of a group of behaviours called ‘sleep disorders’ and the oral manifestation can be a facilitation of gastric reflux (which erodes the teeth). It is not surprising therefore that correct diagnosis of the underlying problems is difficult.

Unfortunately these conditions can be undiagnosed for years. By the time I get to see most people their problems are advanced and are more complex to manage. The take home message for you is erosion needs to be identified early and managed to prevent severe dental (and potentially medical) complications.

There is a lot more to this topic which we will talk about when we see you.

Please note that this is not a strict scientific document rather it is intended to present the topic in every day English.