Dear editor

I have a male patient, aged 71 on no medication, a bruxer, suffering from unexplained, continued enamel erosion/wear. He has had considerable incisal edge wear and more loss of buccal enamel on the lower canines and premolars. Four years ago I opened the vertical dimension, with composite additions, to make up for wear and to leave sufficient room for restorative material.

We have explored acid food and drink issues, with the patient keeping a diary. He has sought medical advice and treatment for potential GORD, OH methods have been explained over a number of years and the use of fluoride toothpastes, enamel repair pastes and high fluoride treatments have been discussed in detail.

Unfortunately, there has been a recent deterioration in the buccal surfaces of the upper anteriors and, to a lesser extent, the lower anterior buccal surfaces.

I am at a loss to determine the possible causes and can only think that there is still some form of acid attack in conjunction with bruxism and traumatic toothbrushing.