Dental erosion: the cause can be read from which surfaces are affected

Dental erosion is the loss of hard tissue through chemical action, without bacterial involvement, and it is distinguished from other forms of wear by the distribution of the lesions.

Abrasion is mechanical from an external agent, typically brushing, and produces wedge-shaped cervical lesions. Attrition is tooth against tooth, producing shiny facets on occlusal surfaces.

Erosion looks different: smooth, rounded surfaces with loss of anatomy and enamel appearing translucent at the incisal edges.

On occlusal surfaces it produces hollows in which existing restorations stand proud, because amalgam or composite do not erode while the enamel around them does.

That detail is among the most reliable signs, and it is visible before the patient reports anything.

The distribution reveals the origin, and that is the information allowing direction without lengthy questioning.

Dietary origin chiefly affects the buccal surfaces of the upper anteriors and the occlusal surfaces, that is where the acidic drink passes and lingers.

Gastric origin, from reflux or vomiting, affects instead the palatal surfaces of the upper teeth, because that is where the acidic contents arrive on their way up.

Marked palatal erosion on the upper anteriors is therefore a finding to raise with the patient and one deserving medical investigation, regardless of what they report.

On the dietary side the factor that counts is not how much acid is consumed but how long it remains in contact. A drink sipped slowly over an hour is more damaging than the same quantity drunk in two minutes.

This yields advice that demands no sacrifice and is therefore followed: drink quickly rather than sipping, use a straw, do not hold it in the mouth, do not brush for half an hour afterwards.

That last point is counter-intuitive and needs explaining: enamel softened by acid abrades easily, and brushing straight away removes tissue that saliva would have remineralised.

In summary: erosion is recognised by smooth surfaces and restorations standing proud, buccal distribution indicates dietary origin and palatal indicates gastric origin, contact time matters more than quantity, and one does not brush for half an hour after acid exposure.