Assessing the risks of tooth erosion
Dental erosion is caused by the long-term exposure of non-bacterial acids that cause the dissolution of minerals to the surfaces of the teeth.[i] If not diagnosed and treated early, dental erosion can cause irreversible loss of hard dental tissue with a negative impact on oral health, function and aesthetics. Therefore, dental professionals should take a careful patient history to discover any possible causes of erosive tooth wear and
identify factors that may put patients at risk. In doing so, the condition may be detected early so that education and measures can be delivered as part of the minimally invasive, preventive approach.
Little is known about the progression of dental erosion, for some patients it may be slow and gradual, while for others it can cause rapid change. However, what we do know is that it is a multifactorial condition, which is dependent upon both biological and behavioural factors interacting on the tooth surface.1 For instance, one of the most important defence mechanisms is the clearance and buffering effects of saliva and research shows that a patient with a dry mouth runs a higher risk of erosion than one with a normal salivary secretion rate.[ii] Consequently, dental professionals should investigate any health conditions, medications or behaviours that could result in a reduction of salivary flow.
The consumption of dietary acids poses a significant risk for tooth erosion. For obvious reasons, patients consider a healthy diet and exercise beneficial, yet many may not realise that diets high in acidic fruits and vegetables may also have an impact on the structure of the teeth. When taking exercise, whether its training at the gym or out running, people often drink plentifully under conditions of a reduced salivary flow. Therefore, it is important to encourage patients to drink water, and not sports drinks that contain citric and malic acids, with a high erosive potential. Indeed, it has been revealed that individuals consuming sports and energy drinks once per week have a four times higher risk of tooth erosion in comparison to individuals who do not consume these beverages.[iii] Of course, an unhealthy lifestyle also presents risk factors as the consumption of sugary foods and drinks as well as sweets and vinegary foods that contain high amounts of acids, all pose a risk for erosive damage to tooth surfaces. Snacking throughout the day is also a significant problem as this exposes the teeth to repeated acid challenges without time for the enamel to remineralise.
It is important to consider the intrinsic factors (inside the body) that may put patients at an increased risk of dental erosion. Gastric acid entering the oral cavity during vomiting episodes or persistent gastro-oesophageal reflux over a long period of time can cause erosive tooth wear. This can occur as a consequence of some upper alimentary tract or digestive conditions as well as medication side-effects, alcohol or drug abuse and certain psychosomatic disorders such as extreme stress or anorexia and bulimia nervosa.[iv]
Oral hygiene habits must also be considered when assessing the risks of dental erosion. Although patients may believe that brushing the teeth after eating keeps the teeth healthy, brushing immediately after demineralisation when the tooth enamel is soft, can increase the loss of dentin surfaces. To resist abrasion from tooth brushing it has been demonstrated that the tooth surfaces require around 30 minutes to remineralise following an acid challenge.[v] Therefore, dental professionals should advise patients to rinse with water or chew sugar free gum to increase saliva flow after eating.
A range of factors must be thoroughly discussed and taken into account when assessing the risk of dental erosion. For patients at risk, education and support to implement strategies to reduce the frequency and severity of acid challenges and enhance defence mechanisms should be employed to protect the teeth from further damage. To create a full picture and enable patients to fully understand what is happening on the surfaces of their teeth, the CALCIVIS® imaging system provides the perfect communication tool. This devise device uses biotechnology to capture images of active demineralisation on the surfaces of the teeth early, so that preventive measures can be taken to stop further erosive loss of dental hard tissue. The CALCIVIS images engage patients and provide evidence to empower them into making the necessary dietary and behaviour changes needed to prevent further erosive damage. For clinicians, the CALCIVIS imaging system provides an early detection system which helps them make confident decisions for early treatment planning, along with the means to monitor the efficacy of preventive strategies.