35 Dental erosion

Summary

Tom is 9 years old. He is a new patient to your practice. On examination you are concerned by the appearance of the occlusal surfaces of his lower primary molars. What has caused this and how may it be managed?

What do you see (Fig. 35.1)?

There is erosion of the cusps of Tom’s primary molars giving cupping or perimolysis of the cusps with loss of enamel and visible underlying dentine.

Fig. 35.1 Erosion of cusp tips of primary molars.

How would you define erosion?

An irreversible loss of tooth substance brought about by a chemical process that does not involve bacterial action.

What foods and drinks have erosive potential?

See Box 35.1. While a wide range of food and drinks is implicated in the problem, the bulk of the damage is done by soft drinks, especially carbonated drinks, which are increasingly available from vending machines in schools and recreational facilities. All carbonated drinks and fruit-based drinks have lowered pH values but the direct relationship between pH and erosion is unclear. Other factors such as titratable acidity, the influence of plaque pH and the buffering capacity of saliva will all influence the erosive potential of a substrate. Three things, however, are clear with erosive loss:

• It is worse if consumption is high.

• It is worse if consumption occurs at bedtime.

• It is worse if brushing occurs directly after consumption.

Box 35.1 Foods and drinks with erosive potential

• Citrus fruits, e.g. lemons, oranges, grapefruits.

• Tart apples.

• Vinegar and pickles.

• Yoghurt.

• All fruit juices including fresh juice and fruit-based squashes.

• Carbonated drinks, including low-calorie varieties, ‘sports drinks’ and sparkling mineral water.

• Vitamin C tablets.