Elsevier

Journal of Dentistry

Volume 33, Issue 3, March 2005, Pages 243-252
Journal of Dentistry

Dental erosion: possible approaches to prevention and control

https://doi.org/10.1016/j.jdent.2004.10.014Get rights and content

Summary

Objectives

To discuss the key elements for establishment of a preventive programme for dental erosion.

Data and sources

The data discussed are primarily based on published scientific studies and reviews from case reports, clinical trials, epidemiological, cohort, animal, in vitro and in vivo studies. References have been traced manually or by MEDLINE®.

Study selection

The aetiology, pathogenesis and modifying factors of dental erosion were reviewed. Strategies to either prevent the occurrence or limit the damage of dental erosion or protect the remaining tooth tissues from further erosive destruction were reviewed and discussed. These includes: (A) measures to (1) enhance remineralisation and acid resistance of enamel surface softened by erosive challenge, (2) reduce the erosive potential of acidic products, (3) enhance salivary flow, (4) protect and restore erosively damaged tooth, and (5) provide mechanical protection against erosive challenge. (B) Health education geared towards (1) diminution of frequency of intake of dietary acids, and (2) change of habits and lifestyles that predispose teeth to erosion development.

Conclusions

It may be easier to gain patients' compliance with the advice that immediately following an acidic challenge, a remineralising agent, such as fluoride mouthrinses, fluoride tablets, fluoride lozenges or dairy milk, should be administered to enhance rapid remineralisation of the softened tooth surface as well as serve as a mouth refresher, or an alternative, a neutralising solution should be used. Effective counselling on erosion preventive regimes should involve all healthcare personnel, dentists, doctors, pharmacist, nurses/hygienists and clinical psychologists.

Introduction

Dental erosion, otherwise known as erosive tooth wear, is the loss of dental hard tissue through either chemical etching and dissolution by acids of non-bacterial origin or chelation. The occurrence of this condition was reported as early as the 19th century,1 and since then the incidence and prevalence of dental erosion is increasingly being reported.2 This is evident from prevalence studies conducted in two different parts of the world within the last decade that showed the percentage of individual affected by erosion (Table 1) among various age groups.3, 4, 5, 6, 7 Especially with the decline in caries rate in some countries, erosion is now becoming a focus of increasing interest both in clinical dentistry and research. The management of dental erosion is an area of clinical practice that is undoubtedly expanding.8 The past two decades have seen numerous investigations and reports on the prevalence,2 the aetiology,9 the pathogenesis and the modifying factors10, 11, 12, 13, 14, 15, 16 of dental erosion. It is now time for development of a preventive programme to control the prevalence of this dental destructive disorder. Therefore, the key elements required for designing and the achievement of an effective preventive programme are discussed and recommended in this paper. These are discussed under the following headings:

  • 1.

    Erosion predictors—conditions identified as to predispose teeth to the development of dental erosion.

  • 2.

    Guidelines for prevention and control—recommendations for preventing and controlling dental erosion.

  • 3.

    Guidelines for protection—recommendations for the protection of remaining tooth tissues from further damage and deterioration.

Section snippets

Use of erosion predictors

An important step towards prevention of dental erosion should be the identification of those individuals who are at risk of dental erosion. Evidence based on case reports, clinical trials, epidemiological, cohort, animal, in vitro and in vivo studies have described acids that could cause dental erosion as originating from gastric, dietary or environmental sources. Based on this fact, certain factors have been identified as the predictors of susceptibility to dental erosion.

Concluding remarks

Perhaps due to lack of devices for in vivo assessment of the effect of preventive agents on eroded lesions, there is shortage of in situ and in vivo studies on erosion to support some of the in vitro findings. Hence, there is a need for development of a diagnostic device, which can detect an early eroded lesion and quantifiably monitor the progress of the lesion on a longitudinal basis. A remineralising agent (mouthrinse or lozenge) specific for dental erosion should be formulated for effective

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