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Dental Erosion

Tooth Surface Loss

Abrasion, attrition, abfraction and erosion are forms of tooth surface loss that frequently appear together.

• Abrasion: loss of tooth structure by mechanical forces from a foreign element.
• Attrition: loss of tooth structure by mechanical forces from opposing teeth.
• Abfraction: a special form of wedge-shaped defect at the cemento-enamel junction of a tooth as a result of tensile or shear forces provoking micro-fractures or fatigue.
• Erosion: the superficial loss of the surface of dental hard tissue by a chemical process which does not involve bacteria (Pindborg).

Prevalence

This varies worldwide from 30–50% (UK), 48% (Ireland), 32% (Germany), 30–35% (Saudi Arabia) to only 5.7% (China).

Pathogenesis

In caries, demineralisation of the crystallites by plaque acid is often followed by remineralisation from saliva. However, erosion is almost irreversible because the organic matrix, on which the hard tissue architecture depends, has also usually been destroyed by overwhelming acid quantities. Both caries and erosion are acid-related diseases with the acid coming from different sources. Bacterial metabolism to produce acid is required for caries but not for erosion. Dietary and behavioural factors are important for both disease processes.

Aetiology

Intrinsic Factors

• Gastro-oesophageal reflux disease (GORD): affects 7% of the adult population daily. The most common symptom of GORD is “heartburn”.
• Vomiting: either spontaneous or self-induced. It is often associated with an />
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