dental-erosion
Prevalence: Significant and increasing problem worldwide; affects up to 30-50% of children and adolescents, with increasing prevalence linked to dietary habits and gastroesophageal reflux disease
Overview
Etiology and Risk Factors
Extrinsic acids — dietary: carbonated soft drinks (pH 2.4-3.5), sports/energy drinks (pH 2.4-4.0), fruit juices and citrus fruits (pH 2-4), white wine and alcohol (pH 2.8-3.8), pickled foods and vinegar.
Intrinsic acids — gastric: gastroesophageal reflux disease (GERD) — acid reflux exposes teeth to gastric acid (pH 1-2); eating disorders (anorexia nervosa with purging, bulimia nervosa) — self-induced vomiting brings gastric acid into the mouth; rumination disorder — habitual regurgitation of food.
Environmental/occupational: industrial exposure to acid fumes (battery manufacturing, wine industry, chemical plants); acid pools in competitive swimmers (improperly maintained pool water).
Behavioral and lifestyle factors: holding acidic beverages in the mouth before swallowing, 'swishing' technique, drinking without straw, mouth breathing (reducing saliva buffering).
Professional Content
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Pathogenesis
Acids with pH below the critical threshold (5.5 for enamel, 6.0-6.7 for dentin) dissolve calcium and phosphate ions from the tooth surface through a direct chemical process — no bacteria required.
Classification
BEWE Score 0 — No erosion
Normal tooth surfaces.
BEWE Score 1 — Initial
Early surface changes.
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.
Diagnosis
Clinical examination using the BEWE (Basic Erosive Wear Examination) index to score all sextants (0-3 per sextant) and guide treatment. Cumulative score guides recall interval and treatment planning.
Treatment Protocol
Prevention — Eliminate the Causative Agent
Dietary modification and medical management
Prognosis
Prognosis is excellent if the causative factor is eliminated early. Once the acid source is removed, erosion stops.
Prevention
- Limit acidic beverage consumption to mealtimes only (not between meals)
- Use a straw when consuming acidic drinks
Interactive Quiz
Test your understanding of dental-erosion.
Q1.
3D Pathology Description
Show progressive surface dissolution of enamel from the palatal surface of an upper central incisor (intrinsic pattern) and the occlusal surface of a lower molar (extrinsic pattern), demonstrating cupping, smooth surface loss, and dentin exposure compared to normal tooth anatomy.