While dental health issues such as gum disease and caries have had much public exposure, dental erosion is fast becoming a concern as more and more people, especially younger adults, suffer from dental erosion.
Health on Female First
Defined as a chemical process, dental erosion involves the dissolution of enamel and dentine by acids not derived from bacteria when the surrounding aqueous phase is unsaturated with respect to tooth minerals. It can be further classified as either intrinsic due to acid attack from the stomach or extrinsic derived from dietary factors.
Enamel erosion is a significant yet preventable problem in the UK. Enamel erosion is on the increase, and this is partly due to modern day eating and drinking habits. Research has shown that carbonated drinks can double or triple the incidence of tooth decay. Fluoride has an important role to play to help prevent enamel erosion as it hardens the outer layer of teeth, making it more difficult for bacteria to penetrate the enamel.
The consequence of erosion is a softening of enamel and dentine which renders the tooth more susceptible to other mechanical factors such as abrasion or attrition. The end result is a loss of tooth substance.
DENTAL EROSION: FACTS & STATS at a glance
In the National Diet and Nutrition Survey: Responses from young people aged four to 18 years suggest:
- Over half of the young people (aged four to 18) showed signs of tooth erosion.
- 46% of four to six-year-olds had erosion in their milk teeth. For 12% of these, the erosion had spread to the dentine and pulp of the tooth.
- 34% of 15 to 18 year olds examined were suffering from tooth erosion, with 5% showing signs of extensive damage.
- Young people in the Northern region aged seven to 18 years were significantly more likely to have an experience of erosion than those in London and the South East.
In another study of British 14-year-old school children, 51% of 14 year-olds examined showed evidence of tooth erosion.
Epidemiology
The prevalence of dental erosion varies widely and depends upon age. Results from a recent review noted that tooth erosion occurs in:
- Pre-school children: 6-50%.
- Adolescents: 11-100%.
- Adults: 4-82%.
Whilst these figures illustrate the variability of dental erosion, there is a growing consensus view in the dental community that dental erosion is increasing as a problem and one that needs to be addressed.Â
Risk Factors
The aetiology of dental erosion is described as multi-factorial, but the important factors include systemic disease with gastro-intestinal reflux disorders (GORD) and dietary issues.
Diet Woes:
Dietary factors have also been extensively investigated as causes behind dental erosion. High consumption of fruit juices, citrus fruits, and carbonated drinks have all been shown to increase the risk of erosion. More recently, attention has focused upon the so-called energy drinks. Most of these beverages contain sugar in amounts that exceed our maximum recommended daily intakes. This factor, linked with their low pH, makes them a high risk for causing dental erosion. As a result, people should be warned of the risk of such drinks to their teeth.
Sugar substitutes (polyols) have also been identified as a cause of dental erosion. While drinks containing polyols may decrease the risk of dental caries, they increase the risk of erosion enormously and should therefore be avoided.
Gastro-intestinal Reflux Disorders – the facts…
Stomach contents are acidic and those suffering from GORD are at a greater risk from dental erosion. In such cases, the palatal surfaces of the upper anterior teeth are more susceptible to erosive attacks then surfaces elsewhere. A further group of patients at risk from GORD are those who have undergone bariatric surgery to assist weight loss. Such patients do have an increased risk of gastric reflux and may also change their eating habits. The bad news is an increased risk of dental erosion.
Preventing Dental Erosion
In the first instance, the underlying cause of the erosion needs thorough investigation. This should involve dietary counselling and a medical investigation if intrinsic factors are considered to be the cause. Patients’ oral hygiene practices need to be identified, especially the timing of tooth brushing in relation to an acid challenge from a drink or the like. For example, brushing teeth immediately after taking an energy drink or a fruit juice will increase the rate of loss of tooth substance. Tooth brushing should not be discouraged but patients should be told that time should be allowed after taking such drinks for saliva to buffer the effects of the acid from the drinks.
Fluoride in the Prevention and Management of Dental Erosion
Conventional sodium fluoride toothpastes reduce erosive tissue loss, but have limited efficacy regarding the prevention of toothbrush abrasion. By contrast alcohol free mouthwashes, such as Dentyl Active which have fluoride levels greater than >225 ppm has been shown to have a significant remineralisation benefit.
It is clear that dental erosion is now a significant oral healthcare problem, especially in adolescents and young adults. The cause of the erosion needs thorough investigation in terms of dietary factors or disorders that can give rise to GORD. The latter may well require consultation with the patients’ medical practitioner. A dietary analysis should be completed on all patients who present with signs of erosion, and advice given on what foods and drinks to avoid or cut down on.
Oral hygiene advice is also imperative especially in relation to consuming erosive food and drinks.
Fluoride applications are the most useful treatments to encourage remineralisation and reduce further episodes of erosive attacks.
Tagged in Teeth Dental Health Oral health