Wednesday 12th December 2018

Tooth Erosion

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What is dental erosion

Acids are the worst enemies of teeth, whose surface is made of minerals which are subject to acid erosion. Acids can be produced in the mouth mainly in two ways: by bacteria using the food we eat, especially carbohydrates, to live, grow, multiply and turning the food we eat into acids (this process is tooth decay); and by acids already present in foods and drinks we consume (tooth erosion).

Dental erosion, or tooth erosion, is one of the many conditions that can damage teeth and one of the most common.

Tooth erosion is the irreversible loss of tooth tissue caused by chemical dissolution by acids without the intervention of plaque bacteria involved in tooth decay.

The acid attacks the enamel, the dental hard tissue on the tooth surface that acts as a protective coating of the the sensitive dentine underneath. First the tooth enamel and then, if left unchecked, the dentine are destroyed. Our diet contains many acidic foods and drinks which in a susceptible individual and in certain circumstances, like an increased frequency of exposure to them, may lead to erosion. This higher frequency of exposure may override the mouth's natural buffering capacity, which is different among individuals.

Unlike tooth decay, erosion dissolves all the surface of the tooth. Acids in the mouth can destroy tooth structure. Teeth can and usually will repair themselves using minerals from the saliva but, if the acid is in the mouth too often and for a long period of time, teeth are not given time to remineralize and the enamel on the hard tooth surface gets progressively thinner, the tooth shrinks and crumbles, and ultimately the underlying dentine is exposed, causing pain and sometimes death of the tooth. This process is irreversible, and restoring function and looks needs pricey cosmetic dentistry.

A certain amount of erosion is a normal part of tooth wear, especially over time. But tooth erosion is now a common chronic disease of kids aged 517, although it has been known as a dental health problem only recently. For this reason, whereas awareness of the importance of regular cleaning to prevent tooth decay is widespread, the problem of dental erosion, though serious and growing, is not so well recognized by many people and there is general ignorance of its damaging effects: this is especially true about acid erosion caused by fruit juices, since they are seen as healthy. Yet the contribution of erosion to dental wear is on the increase, partly because of greater consumption of fizzy drinks, with or without sugar and including 'diet' brands, and children and teenagers are among their biggest consumers.

 

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What causes tooth erosion

The pH is the unit of measure of the acidity or its opposite, alkalinity, of a solution. Solutions above 7.0 pH are alkaline and solutions below 7.0 are considered acidic. In a healthy person, the mouth has a neutral pH of 7.0. But when acidic drinks enter the mouth, the pH drops under neutral to damaging levels.

The most frequent cause of dental erosion are acidic foods and drinks. Usually foods and drinks with a pH below 5.05.7 are thought to be responsible for erosion. Many clinical studies associate tooth erosion to excessive consumption of drinks, especially pure fruit juices, soft drinks, fruit drinks, squashes, sports drinks, energy drinks, diet drinks and carbonated drinks, although in the latter not carbonic acid alone but the strong acid cocktail created by its combination with citric, malic and phosphoric acid is considered as the cause of erosion.

Even wine can erode teeth, having the very low pH of 3.03.8. So can champagne, vinegar, pickles, berries, even flavoured carbonated water according to a University of Birmingham, UK, research. Other origins of erosive acids can be medicines with an acid content, gastric acids in vomit and water in chlorinated swimming pools.

Frequency of exposure to acidic foods and drinks is another important factor, besides pH and length of exposure.

Orange, citrus fruits and many other fruits and vegetables, healthy and indeed essential to a good diet, contain vitamin C, which is an acid known to cause tooth erosion, ascorbic acid. Citrus fruits and juices (orange, grapefruit, lemon, lime, tangerine and others) also contain another acid harmful to teeth, citric acid.

So, should we stop consuming these foods and drinks which promote our health and help to prevent serious diseases? Of course not, but we can take precautions.

 

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What to do to prevent tooth erosion

We don't need to stop altogether all consumption of acidic foods and drinks. As a general principle, we should keep their contact to the teeth and the frequency of their consumption short and limited.

In practical terms that means, for instance, consume them on the same occasions, like at mealtimes, rather than nibbling, snacking and sipping them throughout the day. It also means that you should drink acidic drinks quickly without slowly sipping them and without swishing them around your mouth. Drink fruit juices and sugar-free soft (soda) drinks with straws: that reduces the contact of the acids in the drinks with your teeth.

Sugar-free drinks don't have a role in preventing dental erosion but should still be preferred because they help to prevent tooth decay. Tea and coffee without sugar (you may use artificial sweeteners instead), sugar-free soya milk, milk and water don't contribute to tooth erosion. Regarding soya milk, while both human breast milk and cow's milk have little fluoride (0.04 mg/l), soya milk contains much more fluoride (0.5 mg/l): since fluoride is beneficial to teeth, sugar-free soya milk is the best drinking option for teeth health. This is also true of soy-based infant formulas as opposed to dairy milk-based infant formulas.

Examples of artificial sweeteners are xylitol, saccharin, sorbitol, aspartame and mannitol. Xylitol, found in sugar-free chewing gum and other products, is thought to be beneficial to teeth. Use of sugar-free chewing gums after consumption of acidic foods and drinks helps because they stimulate salivary secretion. Saliva prevents tooth erosion by neutralizing acids, washing them away from the tooth surface, and re-mineralizing teeth.

This is why mouth dryness, which in turn is caused by dehydration, is to be avoided: because saliva production ceases and cannot provide protection. Dehydration is the most widespread contributing factor in tooth erosion in healthy individuals. You can have a dry mouth from many causes: thirst while working or playing, exercise, hard physical work, anxiety, stress, medical conditions, alcohol consumption, prescribed medications. Drink plenty of water and don't wait until you feel thirsty, because that's when dehydration has already developed.

Try to avoid drinking anything but water after cleaning your teeth at bedtime because salivation is reduced while sleeping, so acids are left undisturbed. Water is the best drink to have between meals as well.

While it is recommended to brush teeth twice a day with fluoride toothpaste, wait one hour before cleaning your teeth after consumption of acidic food or drink, e.g. fruit or fruit juices, or after vomiting. Acids temporarily soften the tooth surface's enamel, which will be further damaged by the brushing thus accelerating the erosion. If time is allowed to pass, saliva will remineralise the softened enamel.

Visit your dentist every 6 months for regular check-ups. Erosion takes some time to develop, so the dentist can spot signs of incipient erosion and advise you accordingly.

 

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DENTAL HEALTH