This article is based on an original article in Swedish which can be found here

BACKGROUND

Dental erosion has long been defined as the loss of tooth substance due to a chemical influence that does not involve bacteria.

An acidic influence leads to the dissolution of the tooth surface layer by layer, resulting primarily in a surface lesion and a virtually irreversible damage.

Tooth wear is often a combination of several different types of wear. Today, there is consensus that erosion is the most significant of these and often a prerequisite for other types of wear to occur. In severe tooth wear, erosion is almost always present as the most important factor. A consensus report from 2020 confirms this and defines erosive tooth wear as wear with dental erosion as the primary causative factor. This clarifies that tooth wear often has multiple components that interact and that erosion is usually the component that causes the greatest loss of tooth substance in connection with tooth wear. The terms dental erosion and erosive tooth wear are often used synonymously (as in this document), although it has been suggested that the term dental erosion should only refer to erosion that has occurred in the laboratory and is induced solely by acid influence.

The concept of tooth erosion includes, in addition to dental erosion, the subcomponents of attrition and abrasion. Dental attrition refers to wear that has occurred through tooth-to-tooth contact, while dental abrasion refers to wear on the tooth that has occurred due to a foreign object, such as a toothbrush or a pen, contributing to the wear, but does not include the influence of factors such as caries, resorption, or trauma. The different subcomponents of tooth wear interact, and it is very difficult to cause wear through attrition and abrasion alone or together unless erosion is present as a subcomponent.

The degree of tooth wear that can be expected over a lifetime is referred to as physiological, and wear that exceeds physiological tooth wear is referred to as pathological. This is assessed in relation to the individual's age and their own perception of aesthetics.

Additionally, abfraction, a simultaneous influence of erosion and "flexing movement" during occlusion, can also contribute to cervical wear of teeth.

Like many other oral problems, erosion is strongly lifestyle-related and has, for example, been particularly noted in groups of children and young people who consume a lot of acidic beverages, such as soda and juice, in recent decades. However, tooth wear in general is not a new phenomenon but has been documented in skull materials from millennia ago, related not only to acid influence but also to wear accentuated by coarse food and the fact that teeth were often used as tools.

The early diagnosis of erosion is easy to overlook, and many early erosive lesions are therefore never recorded. More pronounced erosion is easier to diagnose, but when it is recorded, it is often a result of long-term wear that has been overlooked for many years. This means that the opportunity for prophylaxis has often been lost for a long time.

Prevalence

The occurrence of erosion, especially among children and young people, has been studied in many countries since the mid-90s. Damage to dentin has been reported in 1-30% of children with primary dentition. Among teenagers, the corresponding figures are 12-30%.

In Sweden, the prevalence of erosion into dentin has been shown to be 13% among 5-6-year-olds, 12% among 13-14-year-olds, 22% among 18-19-year-olds, and 18% among 20-year-olds.

If erosion in enamel is also included, the prevalence of erosion is significantly higher.

A study on adults from Malmö found that nearly 80% of individuals showed signs of erosion.

Etiology

Traditionally, the etiology behind erosion is divided into external and internal factors.

External factors refer to acidic products that reach the teeth from the outside. This is often acidic influence stemming from what we eat and drink but can also be work-related, such as acidic particles in the air associated with battery manufacturing.

Today, the increased consumption of both soda and juice among children and adolescents is primarily recognized as the largest causative factor for erosion among the young.

Internal factors include gastric contents that reach the teeth in connection with various diseases and habits/unhabits. Examples of this are acidic influence associated with gastroesophageal reflux (involuntary regurgitation), eating disorders (voluntary vomiting), and rumination (voluntary regurgitation of swallowed gastric contents).

Medications can contribute to erosion in various ways. Medications that are acidic and therefore have the potential to erode the tooth are counted among the external causative factors, while those that contribute to acidic regurgitation and affect the tooth surface through gastric acid are counted among the internal factors.

CLINICAL APPEARANCE

Early erosion often presents no symptoms and does not cause any change in color or upon probing compared to the healthy tooth. The enamel surface can be either shiny or matte and exhibit varying degrees of change.

In a more advanced stage, the tooth's macromorphology is affected, which sometimes means that dentin is exposed, and in more severe cases, the entire tooth may be lost. An erosive lesion can affect both aesthetics and function and cause varying degrees of pain, with sensitivity in the teeth being a common symptom.

Diagnosis and Grading