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Human enamel is one of the strongest and hardest substances in the body. However, in the presence of repeated and regular exposure to acids, damage occurs at an increased rate of progression, potentially affecting aesthetics and reducing the restorability of the teeth. This article provides an update on the extrinsic and intrinsic chemical factors that can cause tooth wear. Updated information on gastro-oesophageal reflux, obstructive sleep apnoea, asthma and eating disorders are discussed. Bearing in mind the number of medical conditions that can impact on progression, our job as dentists is to inform the patient of the importance of prevention in other areas of their lives, such as diet and oral hygiene, to mitigate progression.
CPD/Clinical Relevance: Updated information on the chemical risk factors for erosive tooth wear progression is relevant for GDPs.
Article
Human enamel is resilient. It is capable of withstanding a compression strength of 363 Mega Pascals, the equivalent of 3630 kg of weight pressing on an area of 1 cm2, and so is one of the strongest substances in the body until exposed to acids.1 When exposed to acids, the ionic crystalline bonds, which make up 98% of the enamel structure, can dissociate and breakdown. Once softened, any mechanical action can promote tissue loss.2 Until recently, enamel softening was recognized predominantly as a surface phenomenon with limited subsurface effect. However, recent investigations have shown that acid challenge can result in 3–4 microns of wear, with subsurface softening observed up to 50 microns below the surface.3
Clinically and academically, we are increasingly using the term ‘erosive tooth wear’ to recognize that severe tooth wear rarely happens without some degree of exposure to acids.4 This article discusses the intrinsic and extrinsic chemical factors relating to tooth wear, and how we are increasingly recognizing the impact of medical comorbidities on tooth wear. It is impossible to distinguish from the appearance of worn teeth the origin of the acid, particularly as it may be coming from more than one source. Therefore a thorough history and understanding is important. The source of the patient's wear in Figure 1 was predominantly dietary, but the patient was referred for gastro-oesophageal reflux disease (GORD) because the dentist had not diagnosed the source of dietary acid.
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