Clinical Manifestations
Early erosion: loss of surface luster (silky, 'frosted' appearance of enamel), subtle rounding of sharp incisal edges, loss of surface detail of developmental grooves and cusps.
Cupping: on posterior tooth occlusal surfaces, round-bottomed concavities form in the dentin, often surrounded by a raised rim of enamel. Amalgam restorations may appear raised above the surrounding tooth surface ('proud amalgam') as the tooth dissolves around them.
Palatal erosion (intrinsic acid pattern): erosion of the palatal surfaces of upper front teeth — pathognomonic of chronic vomiting or GERD. Creates a smooth, dish-shaped concavity across the palatal surfaces.
Dentinal sensitivity: as enamel is lost and dentin exposed, patients experience hypersensitivity to cold, air, sweet, and osmotic stimuli — open dentinal tubules allow direct stimulus-to-pulp transmission.
Anterior tooth: erosion creates short clinical crowns, incisal edge rounding, and loss of vertical dimension in severe cases.