35 Dental erosion
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?
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:
Can the pattern of erosion caused by dietary constituents be related to the manner in which the substrate is consumed?
This is indeed the case. ‘Frothing’ of a drink between the upper anterior teeth with its retention labially can lead to palatal, interproximal and labial erosion. Retention of a drink specifically on one side of the mouth can lead to erosion on that side only.
You have covered Tom’s dietary history. Is your history now complete or are there other questions you need to ask with relation to erosion?
It is very important to consider gastric acid as a cause of erosion, even in a younger patient. The conditions in children that are associated with chronic regurgitation are shown in Box 35.2. The acidity of the stomach contents is below pH 1.0 and therefore any regurgitation or vomiting is damaging to the teeth.