Dental erosion: brushing straight after an acid accelerates enamel loss

Dental erosion is the loss of hard tissue by chemical dissolution without bacterial involvement, and it is increasing for reasons tied to dietary habits.

It must be distinguished from other forms of wear because the management differs. Abrasion is mechanical, typically from faulty brushing; attrition arises from tooth-to-tooth contact, as in bruxism.

Erosion has a characteristic appearance: smooth, glossy surfaces with loss of occlusal anatomy, and restorations that appear to stand proud because the enamel around them has dissolved.

That detail of raised restorations is one of the most reliable signs, because composite and amalgam do not dissolve in acid whereas enamel does.

Acid sources divide into extrinsic and intrinsic. Extrinsic ones are dietary: carbonated drinks, citrus juices, sports drinks, wine, vinegar, some fruit infusions.

Intrinsic sources are gastric, and more aggressive because of their very low pH. Gastro-oesophageal reflux, recurrent vomiting, eating disorders.

Location guides the diagnosis. Erosion from intrinsic sources typically affects the palatal surfaces of the upper anteriors, while dietary erosion involves the buccal and occlusal surfaces more.

A patient with marked palatal erosion and no acidic dietary habits should be investigated for reflux, and in some cases the dental observation is the first that leads to diagnosis.

The advice that most changes the course concerns the timing of brushing. After an acid episode the enamel is temporarily softened, and brushing at that moment removes the surface layer.

The correct instruction is to wait at least half an hour, rinsing meanwhile with water or a neutralising solution. It is a free habit that appreciably reduces tissue loss.

How something is consumed matters as much as how much. An acidic drink sipped slowly over an hour produces far longer exposure than the same amount drunk in two minutes.

A straw positioned past the incisors reduces contact with the anterior buccal surfaces, a simple measure for those unwilling to give up certain drinks.

In summary: erosion is recognised by smooth surfaces and raised restorations, palatal location points to a gastric cause, no brushing within half an hour of an acid, and consumption patterns weigh as much as quantities.