Dental erosion and its growing importance in clinical practice: from past to present

Abstract

Since the mid-1990s, the focus of studies on tooth wear has steadily shifted from the general condition towards the more specific area of dental erosion; equally, a shift has occurred from studies in adults to those in children and adolescents. During this time, understanding of the condition has increased greatly. This paper attempts to provide a critical overview of the development of this body of knowledge, from earlier perceptions to the present. It is accepted that dental erosion has a multifactorial background, in which individual and lifestyle factors have great significance. Notwithstanding methodological differences across studies, data from many countries confirm that dental erosion is common in children and young people, and that, when present, it progresses rapidly. That the condition, and its ramifications, warrants serious consideration in clinical dentistry, is clear. It is important for the oral healthcare team to be able to recognize its early signs and symptoms and to understand its pathogenesis. Preventive strategies are essential ingredients in the management of patients with dental erosion. When necessary, treatment aimed at correcting or improving its effects might best be of a minimally invasive nature. Still, there remains a need for further research to forge better understanding of the subject.

Figure 1

Extensive tooth wear of maxillary teeth in a medieval man estimated to be 35 to 45 years old. The loss of the first right molar was most likely caused by wear penetrating into the pulp subsequently leading to an inflammatory process in the periapical jawbone [6].

Figure 2

Severe tooth wear on the mandibular first molars in an approximately 20-year-old individual from the 16th century (third molars are impacted). Looking carefully, NCCLs can be seen indicating either abrasive or erosive influences, which, in combination with the wear seen on the first molars, resembles the pattern seen in modern erosive wear [11].

Figure 3

(a) A 6-year-old boy with dental erosion associated with a high intake of soft drinks and juice. Note the “melted” appearance of the buccal surfaces on teeth nos. 51–61. (b) Palatally on the maxillary front teeth the pulp is visible through the remaining tooth substance. Published with permission from the Swedish Dental Journal [2].

Figure 4

A 12-year-old boy who has a high intake of cola. (a) Note the severe damage with shoulder formations palatally on maxillary front teeth. (b) First molars also exhibit pronounced wear. Published with permission from the Journal of the Swedish Dental Association (Tandläkartidningen) [12].

Figure 5

A 40-year-old woman who had suffered from Bulimia Nervosa since she was a teenager. Frequent vomiting followed by intense and meticulous toothbrushing in combination with a high intake of light cola-type soft drinks have resulted in severe erosive tooth wear. A number of “raised” amalgam fillings have developed resulting in an unstable occlusion. At the time that these photographs were taken, she had for a long time been free of her eating disorder but suffers a lot from tooth sensitivity [11].

Figure 6

A 40-year-old woman with inoperable hiatus hernia, and despite long-term antireflux medication developed severe damage on her posterior teeth. Note the relatively intact amalgam fillings “raised” above the eroded occlusal surfaces [11].

Figure 7

Very severe erosive damage in an intellectually disabled 17-year-old boy with a habit of frequent rumination. In addition to rumination he also suffers from GERD [11].

Figure 8

A 13-year-old girl who has a high intake of soft drinks. (a) Buccal erosion and crown shortening of the maxillary front teeth. Note the typical “inverted V-sign” often seen in cases of soft-drink-induced dental erosion. Mandibular incisors are relatively intact. (b) Severe erosive damage, with shoulder formation on the palatal surfaces of maxillary anterior teeth. Published with permission from the Journal of the Swedish Dental Association (Tandläkartidningen) [12].

Figure 9

Examples of “cupping” of different severities in 3 individuals. (a) Cuppings of lesser extent on 36 mesiobuccal cusp in a 20-year-old man who has high intake of cola drinks. (b) Cuppings on 36 in a 22-year-old man with congenital agenesis of salivary glands. (c) Fused cuppings on teeth nos. 84 and 85 in a 5-year-old boy. Published with permission from the Journal of the Swedish Dental Association (Tandläkartidningen) [12].

Figure 10

Erosion in the primary dentition in a 6-year-old girl who has high intake of juice, fruit drink, cola, and fruit. (a) Shortening of the crown height on teeth nos. 51–61 as a consequence of dental erosion. (b) Note that the pulp is visible through the remaining tooth substance of teeth nos. 51–61 palatally. Published with permission from the Swedish Dental Journal [2].

Figure 11

(a) A 15-year-old girl with dental erosion confined mainly to maxillary anterior teeth caused by excessive soft drink consumption. (b) Substantial loss of toots substance palatally on teeth nos. 12–22 with shoulder formation. (c) Vertical dimension established by composite restoration on 12 allowing adequate space for restorative material. (d) Coverage with composite on teeth nos. 13–23. (e) Just after placement of composite. Note the nonoccluding posterior teeth. (f) After a short period of time, reestablishment of the posterior occlusion utilizing the Dahl principle [11].

Figure 12

A 19-year-old man with extensive tooth wear affecting maxillary anterior teeth caused by excessive soft drink intake, drunk by the “retaining” drinking technique (a–c). Note the pronounced wear on palatal and buccal surfaces with shoulder formations (b). Patient is provided with palatal acrylic onlays ad modum Dahl (cemented with resin cement) producing posterior disclusion (d, e). After 4 months the posterior occlusal relationship has normalized (f) and after preparation there is enough space for the restorations (g). Full ceramic Empress crowns cemented on teeth nos. 14–24 (h–j) [13, 14].