Acid erosion

Acid erosion is a form of tooth wear caused by acid softening the surface of tooth enamel.

Acidic foods and drinks like fruit, soda, orange juice and wine feature prominently in diets today. These demineralize and soften the tooth surface, making it more susceptible to physical damage, even by brushing1.

Acid erosion is a growing concern in clinical practice today, with 50% of US dental professionals reporting seeing an increase in acid erosion compared to 5 years ago2.

Impact of acid erosion

The wear caused by acid erosion can lead to reduced thickness of tooth enamel and a change in texture, shape and appearance of the teeth, which may also cause teeth to become sensitive.

People do not typically become aware of acid erosion until it has reached an advanced stage.

In the long-term, the effects of acid erosion may require dental treatment in order to protect the tooth and the dentin underneath.

Causes of acid erosion

When tooth enamel is exposed to acids (from food, beverages or the stomach), it temporarily softens and loses some of its mineral content. Saliva will help neutralize acidity, restore the mouth's natural balance and slowly harden the tooth enamel. However, because the tooth's recovery process is slow, if the acid attack happens frequently, the tooth enamel does not have the chance to repair.

Some fruit juices, wine and various fruits can be acidic and therefore potentially damaging to teeth. Acidic foods should not and cannot easily be avoided, but care needs to be taken as to how they are consumed.

It is not just what is consumed that causes acid erosion, but also the way that acidic foods and drinks are held within the mouth. Holding or retaining acidic beverages in the mouth prolongs the acid exposure on the teeth, therefore increasing the risk of tooth enamel erosion. Swishing an acidic beverage, for example, can increase the beverage's contact with the tooth or teeth, increasing the risk of tooth erosion.

Tooth erosion can also result from intrinsic acids e.g. as a consequence of bulimia (vomiting) or indigestion (regurgitation/gastric reflux).

Diagnosing acid erosion

Patients at risk of developing acid erosion can be proactively identified using risk factors and lifestyle.

Patients at risk of acid erosion include:

Soda swishers
People who snack frequently throughout the day
Patients consuming diets with high levels of fruit and fruit juices
Patients with eating disorders
Patients with gastric reflux

Management of acid erosion

Dental professionals can support their patients to manage and to help prevent the effects of future acid erosion.

Reduce the frequency of consumption of acidic foods and drinks
When consuming acidic drinks use a straw placed towards the back of the mouth
Avoid swishing acidic drinks
Wait as long as possible after consuming acidic foods and drinks before brushing teeth
For patients particularly at risk of acid erosion experts recommend a regime of BRUSH-EAT-RINSE

References:

Lussi A. Erosive "Tooth Wear- A Multifactorial Condition of Growing Concern and Increasing Knowledge." Monogr Oral Sci. Basel, Karger, 2006, vol 20, pp 1-8.
Zero DT et al. J Clin Dent 2006; XVII (4): 112-116.

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