Protect your teeth from enamel erosion

Posted in Health & Wellness on September 20, 2012.  Last modified on October 18, 2019. Read disclaimer.

For most of us, a "good dental checkup" probably means that no new cavities were found.

And while preventing cavities (see dental decay in sidebar) is important, something equally destructive, though less well known, may be happening in your mouth -- enamel erosion. That's the chemical softening and removal of tooth enamel due to acids from the foods and beverages we consume -- or even from our own stomach.

Can enamel erosion be reversed?

Though lost dental enamel can not be replaced or restored (since it is has no living cells), mild tooth enamel erosion can repaired or strengthened by 1) changing our dietary habits, 2) addressing any medical conditions such as GERD or eating disorders as well as medicines that may cause dry-mouth, 3) supporting healthy saliva levels (since saliva naturally remineralizes our teeth) and 4) using fluoride toothpaste (especially those containing stannous fluoride) or receiving dental fluoride treatments, prescription-strength fluoride rinses or remineralizing solutions. Extensive dental erosion may require treatments such as teeth bonding, crowns, veneers or bridges. Left untreated, extensive dental erosion results in smaller, weaker, discolored, more sensitive -- and possibly fewer -- teeth.

What causes enamel erosion?

We all have a slimy film known as pellicle adhering to our teeth. Its antibiotic and anti-acidic properties are a tooth's first line of defense. Along with saliva, this slime helps teeth stay mineralized and protected from the caustic effect of acids. But when teeth are exposed to acid frequently (such as sipping on sodas throughout the day) or for extended periods of time (like if you suck on an orange slice or drink a glass of wine just before going to bed) the beneficial saliva and slime layers get overwhelmed and a slight amount of enamel disappears. Over time, this erosion can add up and eventually the protective enamel is gone and softer, more vulnerable dentin tissue becomes exposed.

For most of us, acidic foods and drinks are the primary causes of enamel erosion, but even how they are consumed and how long they are in the mouth can affect the degree of erosion. For instance, if you swish an acidic beverage around in your mouth, there is more exposure. Suck it through a straw, however, and you may be lowering erosion risk. Plus, not everyone's mouth responds to acids in the same way.

Anything that is acidic has the potential to erode tooth enamel but the leading causes for concern include:

• Sodas and sports drinks -- In fact, diet soda is even more acidic than regular soda.
• Citrus fruits, lemonade, orange, apple and grape juices. Some herbal teas may also be erosive.
• Chlorinated pool water -- Swimmers who spend long hours in the pool may be at greater risk of enamel erosion due to the highly acidic chlorinated water in the mouth Acid reflux disease. This is a common condition in which stomach acid comes up through the esophagus and sometimes reaches the mouth, bathing the teeth in extremely acidic stomach acid. Those with this condition should consider rinsing their mouth with water or a remineralizing agent after an episode. Fortunately, there are acid reflux medicines that are quite effective in keeping the stomach acid down.
• Alcohol -- Alcoholics are more likely than non-alcoholics to have acid erosion due to the high acid content of wine or other alcoholic beverages and higher likelihood of vomiting.
• Gastroesophageal reflux disease (GERD) -- the more advanced stage of untreated "acid reflux" (GER).
• Bulimia nervosa -- This is an eating disorder in which the sufferer takes in large quantities of food, then throws up in an effort to purge themselves of this food. Since stomach acid is extremely acidic, those who vomit everyday bathe the teeth in this acid and are more likely to have severe tooth erosion than those without the disease.
• Low salivary flow -- People who produce less saliva have less defense against enamel-eating acids, plus less mineral replacement occurs. Low salivary flow is often associated with dehydration or medications. Also, certain medications, smoking and alcohol can contribute to "dry mouth.".

The signs of tooth enamel erosion

The first signs of erosion are hard to detect, but as the erosion continues, the symptoms grow worse. Below is a list of erosion symptoms starting, from early stages to advanced:

1. Your dentist may notice specific wear patterns. These can result from certain health conditions. For instance, erosion on the back side of front teeth may be a sign of frequent vomiting, while cupping on the chewing surface of molars may be an early indicator that a person suffers from gastroesophageal reflux disease.
2. Discoloration of the teeth. The more dentin (the layer under the enamel) of the teeth is exposed the more yellowed the teeth become.
3. Sensitivity of the teeth. People with tooth sensitivity to cold, heat, or pressure, often have significant enamel loss. The dentin under the enamel is more sensitive and is more exposed when erosion is great.
4. Rounded and/or shorter looking teeth. As the enamel wears away, the teeth become rounder and lose height.
5. Transparency of teeth. The tips of the front teeth become transparent instead of solid white.
6. Cracking of teeth. This is an advanced symptom of tooth erosion. The structural integrity of the tooth is compromised.
7. Tooth decay. As the protective layer of enamel is worn away, the bacteria that cause tooth decay more readily make holes in the softer dentin underneath.
8. Pulp exposure in teeth. As the dentin wears down, the pulp inside the molars begins to show. Often at this point a prosthetic crown is needed for the tooth to protect it.

How to prevent dental erosion

• First, visit your dentist to see if you're suffering from enamel erosion.
• Eliminate those factors that are causing the erosion. Cutting way back on citrus juices, sodas, diet sodas, and wine may help. At the very least, use a straw and don't swish or hold acidic drinks in your mouth.
• Stay well hydrated since dehydration can result in decreased saliva production. Dehydration often accompanies vigorous exercise.
• Finish your meal with cheese or milk, which can neutralize acids.
• Rinse your mouth with water after meals to dilute that acids left behind.
• Chew sugar-free gum after meals. This stimulates saliva production which also helps neutralize acids.
• If you suffer from acid reflux, bulimia nervosa, dry mouth, or take prescription medications that decrease saliva flow, these should be addressed with your doctor.
• Protect the teeth after exposure to acid. If you do vomit or ingest highly acidic substance, dental professionals now recommend that you wait at least 60 minutes after exposure to acid before brushing your teeth. During this time, remineralization of the teeth by saliva is allowed to occur. In addition, "remineralizing agents to protect the teeth against further erosive dissolution should be recommended for all individuals susceptible to erosion."
  
  Use a soft bristle toothbrush, don't brush too aggressively, and use fluoride toothpaste but avoid toothpastes that are highly abrasive.
• There are remineralization agents, such as Pronamel mouth rinse, that one can use after exposure to acidic substances. This is advised instead of using a toothbrush.
• Cosmetic dental tooth protectors. If erosion is extensive, a treatment called tooth bonding can help protect the most severely eroded areas. Crowns are fitted prosthetics that go over an affected tooth, strengthening it and protecting it from further damage. Protective porcelain veneers can be put over teeth but they are very costly and most often not covered by dental insurance. Full mouth reconstruction is an expensive, last resort if there is widespread, significant damage to the teeth from erosion.