Enamel erosion is a condition where teeth are gradually worn away by acids. Unlike tooth decay, this process does not involve bacteria.
First of all the good news: your teeth are designed to handle normal eating and drinking habits! Your saliva is there to remineralise them after eating or drinking. It’s only when there are too many acid attacks throughout each day that there’s a problem.
How do acid attacks happen?
The acid can come from either of two sources:
- Outside the person – food or drink, such as fruit juices, smoothies or fizzy drinks
- Inside the person – stomach.
What effect does acid have on teeth?
Teeth are covered by a hard outer layer called enamel. Each time you eat or drink anything acidic, the enamel becomes soft for a while and leeches minerals (mainly calcium). This process is called demineralisation.
Saliva to the rescue!
When this happens, your saliva starts a natural repair process called remineralisation. Saliva dilutes and clears away acids that come into contact with teeth and acts as a buffer. What’s more, saliva contains calcium and phosphate, which can replace the minerals that have been lost.
But if acid attacks happen too frequently, your teeth won’t get a chance to repair themselves. Over time, you may then lose enamel.
Some people are much more susceptible to acid erosion than others. We don’t yet know why this is. There may be genetic factors involved. And as mentioned above, your saliva also matters: both the amount (flow rate) and the composition of saliva play a role.
How do I know if I have acid erosion?
- You may notice changes in the colour of your teeth. They may appear more yellow because the dentine (the layer of the tooth underneath the enamel) becomes more visible or exposed. Dentine is darker and yellower than enamel.
- The shape of the teeth may also change. For example, they may appear hollow, flattened or shortened.
- Teeth may also become sensitive to hot and cold.
When acid erosion occurs together with clenching or grinding, the wear on the teeth can be much more severe.
Erosive tooth wear is most common on front teeth and the biting surfaces of the back teeth.
What can I do about acid erosion?
This depends on where the acid comes from.
1. Food and drink
The most common cause of acid erosion is acidic drinks and foods outside meal times.
By acidic foods, we mean foods that have a low pH. pH is a scale from 1 to 14 that measures how acidic or alkaline a liquid is – as shown below:
We’re not talking about foods that are classified as “acidic” by alternative health proponents of the so-called alkaline diet. Unfortunately, you’ll come across lists of these when you google “acidic foods”!
Acidic drinks and foods include:
- fizzy drinks, including diet versions
- fruit-based drinks like smoothies, lemonade, or Ribena (including Light versions)
- alcoholic drinks, such as cider, wine, alcopops, cocktails
- acidic sweets
- chewable vitamin C tablets, aspirin (when left to dissolve in the mouth)
- effervescent vitamin or mineral supplements (such as Berocca)
- fruit teas
Some common drinks on the market can be very corrosive. Apparently, you can clean old coins in a well-known fizzy drink. If it has this effect on metal, you can easily imagine the effects on the tooth structure.
What action can I take?
- Decide to drink or eat acidic things less often. When you do, drink or eat them quickly.
- Drink or eat them as part of a meal. This reduces the number of acid attacks.
- Drink plain still water whenever possible.
After an acid attack:
- Rinse with water or with a fluoride mouthwash. Or finish your meal with cheese or milk. This will help cancel out the acid.
- Chew sugar-free gum – this helps produce more saliva.
- If you want to brush your teeth, wait for at least 20 minutes. If the enamel is still soft from the acid attack, you can damage it when brushing. Let the enamel harden first!
- Use a toothpaste containing 1450ppm fluoride. One which contains stannous fluoride may be best.1 After brushing, spit and don’t rinse. That way, the fluoride stays on your teeth for longer and hardens the enamel.
The key is to make sure your teeth are not exposed to a highly acidic environment too often or too long!
2. Inside the stomach
Acid can reach the teeth not only from above, but also from below:
If you experience acid reflux, seek medical help from your GP. When left untreated for a long time, severe acid reflux increases the risk of oesophageal cancer (cancer of the food pipe). There’s no need to panic – but it’s important to get it seen to.
Controlling acid reflux, for example, by using antacids, will also help minimise any damage to your teeth.
Vomiting may be the result of pregnancy, certain medical conditions, and medications.
Another very common cause of acid erosion is bulimia. Unfortunately, many people feel it’s an embarrassing problem and try to hide it from their dentist. Please don’t be embarrassed! Dentists are trained health professionals. Anything that impacts your dental health will be of interest to them. By knowing about it, they can help you minimise any damage to your teeth.
Eating difficulties often have an emotional basis. Exploring this area with an appropriate professional can yield tremendous results. Don’t be shy about contacting a psychologist or counsellor for help. The advice of an empathetic dietician can also be helpful.
Some medications have an unwanted side effect: they reduce saliva flow. Saliva is important not only for reducing acid erosion, but also for preventing tooth decay.
Dry mouth can also be caused by medical conditions such as Sjogren’s syndrome and diabetes, and cancer treatment (radiotherapy or chemotherapy) such as radiation therapy for throat or mouth cancers.
If you experience dry mouth, talk to your dentist and your GP. In the meantime, here are some tips:
Can I repair the damage of acid erosion?
Enamel can’t be replaced once it’s been lost. But early on, fluoride toothpastes can re-harden softened enamel. Ask your dentist which toothpaste they recommend for your unique situation.
If you experience sensitivity to cold or hot as a result of acid erosion, use a toothpaste for sensitive teeth.
How can a dentist help?
The key is to address the cause of acid erosion. Otherwise, things won’t stay stable for very long!
Your dentist may also:
- prescribe a high-fluoride toothpaste
- provide fluoride varnish or a dentine bonding agent or sealant to help with sensitivity
- make you a mouth guard if you grind your teeth at night.
If the damage is severe, you may choose to have your teeth restored. This isn’t always necessary. But it may be an idea if
- the tooth structure is damaged enough to make eating difficult
- you’re in a lot of pain due to erosive tooth wear, or
- you’re embarrassed by the appearance of your teeth.
Usually, the repair involves using direct composite. This is a tooth-coloured filling material that bonds to the tooth. In more severe cases, you may need a veneer or a crown.
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Sources of Information
Kay, E. (editor) (2016). Chapter 33: Tooth Wear. Dentistry at a Glance. First Edition. John Wiley & Sons, Ltd.
Milosevic, A. (2017). Acid Erosion: An Increasingly Relevant Dental Problem. Risk Factors, Management and Restoration. Primary Dental Journal, Vol 6, Issue 1. https://doi.org/10.1177/205016841700600105
- Huysmans MC, Jager DH, Ruben JL, Unk DE, Klijn CP, Vieira AM. Reduction of erosive wear in situ by stannous fluoride-containing toothpaste. Caries Res. 2011;45(6):518-23. doi: 10.1159/000331391. Epub 2011 Oct 5. PMID: 21985895.