The effective management of erosive tooth wear

The effective management of erosive tooth wear


Dental erosion is a widespread condition with prevalence rates that appear to have increased in recent decades, particularly in young adults.[1] Currently, it is the third most commonly observed oral condition after caries and periodontal disease and is drawing increased attention as a risk factor for tooth damage. This structural destruction is not triggered by lack of oral hygiene or high levels of dental plaque[2] but instead by the long-term exposure of non-bacterial acids that cause the dissolution of minerals to the surfaces of the teeth. [3] The action of these acids can develop lesions that are susceptible to abrasive wear and, if allowed to progress can lead to loss of enamel and sometimes exposure of dentine. Indeed, if it is not diagnosed and treated early, dental erosion can cause irreversible loss of hard dental tissue with a drastic reduction in oral health and a negative impact on the appearance of the teeth. However, at present patients are not routinely screened for dental erosion as part of a standard dental examination.

 

In order to minimise the effects of acid exposure on the teeth, it is important to first investigate the acid source and help the patient to eliminate that cause. The extrinsic sources of acids may be environmental or pharmacological but are often dietary. Certainly, the frequent consumption of acidic food and drinks, such as those high in sugar and those containing phosphoric, citric, acetic, ascorbic, tartaric and malic acid are all potentially erosive. However, this type of acid exposure can be reduced with personalised oral health education and some simple dietary changes. Conversely, intrinsic acid sources may be more difficult to identify as they are usually caused by stomach acid entering the mouth and eroding the teeth. It is often detected in patients with persistent gastroesophageal reflux issues, who are regurgitating stomach acid or in those with conditions that cause chronic vomiting such as eating disorders, alcoholism or severe stress.[4]

 

The problem is that erosive tooth wear can affect anyone, including patients that perform a scrupulous oral hygiene routine. Furthermore, little is known about its progression; for some patients it can be slow and gradual but for others it can cause rapid changes that can compromise the structure of the teeth significantly.2 Indeed, eroded teeth can chip or crack easily and demineralised areas are also a target for bacteria which can colonise and penetrate into the dentine to cause caries.[5] Weaknesses such as these can also make restoration difficult and more invasive treatments may be required. However, if the effects of tooth wear are detected in the initial stages, preventive measures can be introduced to halt its progression.

 

Unfortunately, dental erosion does not cause any discoloration or softening of the tooth surface in the initial stages, which makes it very difficult to detect with either visual and/or by tactile examination.[6] Furthermore, any patient symptoms may be very limited or even absent in these early stages. However, CALCIVIS has developed a revolutionary imaging system that can help dental professionals to identify dental erosion when the tooth enamel first begins to lose minerals and to effectively monitor the progression of the condition thereafter. The CALCIVIS imaging system uses a bioluminescent photoprotein, which produces a very short, low-level flash of light in the presence of free calcium ions released from actively demineralising tooth surfaces. An integrated intraoral sensor then captures this signal and immediately produces a map of active demineralisation at the chair side. With evidence-based information, dental professionals can then plan first response preventive treatment to manage dental erosion at the earliest, most treatable stages. Additionally, by producing engaging images that visualise active demineralisation on the surfaces of the teeth, the CALCIVIS imaging system allows dental professionals to explain the condition more effectively, support the management of risk factors and empower patients to take the necessary steps to prevent further damage to structure of their teeth.

 

By using innovation, dental professionals can add additional value and reliability to regular screening and examination processes to prevent disease progression and improve patient care.

 

[1] Jaeggi T. et al. Prevalence, incidence and distribution of erosion. Monogr Oral Sci. 2014; 25:55-73. https://www.ncbi.nlm.nih.gov/pubmed/24993258 [Accessed 8th July 2019]

[2] Bartlett D. et al. Monitoring erosive tooth wear: BEWE, a simple tool to protect patients and the profession. British Dental Journal 2019; 226 930–932. https://www.nature.com/articles/s41415-019-0411-7 [Accessed 8th July 2019]

[3] Shaw L et al. Dental erosion – the problem and some practical solutions. British Dental Journal. 1998 186(3) 115-118. http://www.oocities.org/scientistconrad/Colgate_Erosion/Manuscripts/Dental_erosion__the_problem_and_some_practical_solutions.pdf [Accessed 8th July 2019]

[4] Scheutzel P. Etiology of dental erosion – intrinsic factors. Eur J Oral Sci. 1996 Apr;104(2 (Pt 2)):178-90. https://www.ncbi.nlm.nih.gov/pubmed/8804885 [Accessed 4th April 2018]

[5] Abou Neel E.A. et al. Demineralization–remineralization dynamics in teeth and bone. Int J Nanomedicine. 2016; 11: 4743–4763. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034904/ [Accessed 8th July 2019]

[6] Johansson AK, et al. Dental Erosion and Its Growing Importance in Clinical Practice: From Past to Present. Int J Dent. 2012; 2012: 632907.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312266/ [Accessed 8th July 2019]

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