Dental ‘Erosion’ Revisited. JADA

This article offers a comprehensive overview of dental erosion, differentiating it from other forms of tooth wear and exploring its causes, diagnosis, and treatment implications. The authors focus on the increasing prevalence of erosion in both younger and older populations and argue that early recognition and biologically appropriate intervention are key to preventing long-term damage. Through clinical examples and scientific analysis, the article provides practical strategies for managing erosive cases in a way that preserves tooth structure and restores function and esthetics.

Understanding Dental Erosion

Dental erosion is defined as the progressive loss of tooth structure caused by chemical processes—typically acids—not involving bacteria. Unlike abrasion (caused by mechanical wear) or attrition (resulting from tooth-to-tooth contact), erosion stems from dietary acids, gastric reflux, or environmental exposure to low pH substances.

The article emphasizes that erosion can be insidious, often going unnoticed until significant damage has occurred. Early symptoms include enamel thinning, surface smoothness, cupping on cusp tips, and increased sensitivity. The progression of erosion can severely impact both anterior and posterior teeth, compromising esthetics, bite function, and patient comfort.

Etiology and Contributing Factors

The primary contributors to erosion include acidic foods and beverages (such as citrus, soda, and wine), chronic vomiting or acid reflux, and lifestyle factors like frequent snacking or dry mouth. The authors point out that patients may be unaware of the damaging effects of “healthy” habits like consuming lemon water or sports drinks, which lower oral pH and soften enamel.

Intrinsic acids from gastrointestinal issues such as GERD (gastroesophageal reflux disease) also play a significant role. For these patients, erosion often affects the palatal surfaces of maxillary teeth—a pattern distinct from dietary erosion. Understanding the etiology is crucial for selecting the right treatment and providing effective patient education.

Diagnostic Tools and Clinical Examination

The article outlines a structured diagnostic approach for identifying and staging dental erosion. This includes a thorough medical and dietary history, intraoral photos, transillumination, and study models. Clinicians are encouraged to use erosion indices and classification scales to document severity and progression over time.

Surface texture, color changes, and dentin exposure are all indicators of erosion. In early stages, preventive measures may be sufficient. In advanced cases, restorative intervention becomes necessary to protect dentin and restore occlusion and esthetics.

Conservative Treatment Planning

When addressing erosion, the authors advocate for a conservative, additive approach that preserves remaining enamel and rebuilds lost tooth structure. This includes using bonded resin composites or minimally invasive ceramics in cases where vertical dimension has been affected. Restorations should reestablish anterior guidance and posterior support while respecting the patient’s biologic envelope of function.

Importantly, treatment should begin with stabilization: managing the cause of acid exposure (e.g., working with a physician for GERD), improving salivary flow, and modifying dietary habits. Without addressing the underlying cause, restorations are likely to fail prematurely.

Bioesthetic Considerations in Erosive Cases

For patients showing system-wide breakdown due to erosion, Bioesthetic Dentistry provides a diagnostic and restorative framework. Using MAGO splint therapy, clinicians can identify joint position, deprogram muscles, and evaluate vertical dimension. This allows for biologic wax-ups that reflect unworn natural dentition, guiding both provisional and final restorations.

The goal is not only to repair worn teeth, but to restore harmony across the system—joints, muscles, and occlusion. When vertical dimension is reestablished and anterior guidance is restored, patients experience improved esthetics, function, and comfort.

Prevention and Patient Education

The article concludes by stressing the importance of prevention and ongoing patient education. Identifying at-risk behaviors and providing clear guidance on diet, oral hygiene, and acid exposure timing (e.g., not brushing immediately after acidic meals) can significantly slow erosion progression. Remineralizing products, fluoride treatments, and regular monitoring are essential for maintaining oral health.

Clinicians are encouraged to take a proactive stance, recognizing the early signs of erosion and helping patients understand the systemic and lifestyle links. By combining preventive strategies with biologic restorative techniques, erosion can be managed successfully over the long term.

Key Clinical Takeaways

• Dental erosion is a chemical, non-bacterial loss of tooth structure caused by intrinsic or extrinsic acids.
• Common sources include acidic diets, GERD, chronic vomiting, and environmental exposure.
• Early detection is key—look for smooth surfaces, enamel thinning, and palatal wear patterns.
• Conservative, additive restorations protect dentin and restore function and esthetics.
• Addressing the underlying cause (dietary, medical, behavioral) is critical for long-term success.
• Bioesthetic planning helps restore system harmony in complex erosive cases.

This article provides a complete, practical framework for managing dental erosion through biologic understanding and minimally invasive intervention. It empowers clinicians to identify early signs, engage patients in prevention, and design restorations that honor the natural design of the oral system.

Read the full article here.