Download Erosion. Causes, manifestations in oral cavity, diagnosis making

Erosion. Causes,
manifestations in oral cavity,
diagnosis making and its
therapy
 Dental erosion is defined as irreversible
loss of dental hard tissue by a chemical
process that does not involve bacteria.
 Dissolution of mineralized tooth structure
occurs upon contact with acids that are
introduced into the oral cavity from
-intrinsic (e.g., gastroesophageal reflux,
vomiting)
- extrinsic sources (e.g., acidic beverages,
citrus fruits).
Behaviour
 Acid erosion often coexists with abrasion
and attrition. Abrasion is most often
caused by brushing teeth too hard.
 Throthing or swishing acidic drinks around
the mouth increases the risk of acid
erosion
Frequently consumed foods and
drinks
 Dental erosion is the
most common
chronic disease of
children ages 5–17.
 Frequently consumed
foods and drinks
below pH 5.0–5.7
may intitiate dental
erosion.
Main causes of tooth surface loss
 Attrition
 Abrasion
 Abfraction
 Corrosion (Erosion)
Attrition
 This is natural tooth-to-tooth friction that
happens when you clench or grind your
teeth such as with bruxism, which often
occurs involuntary during sleep.
Abrasion
 This is physical wear and tear of the tooth
surface that happens with brushing teeth
too hard, improper flossing, biting on hard
objects (such as fingernails, bottle caps, or
pens), or chewing tobacco.
Abfraction.
 This occurs from stress fractures in the
tooth such as cracks from flexing or
bending of the tooth.
Corrosion (Erosion)
 This occurs chemically when acidic content
hits the tooth surface such as with certain
medications like aspirin or vitamin C tablets,
highly acidic foods, GERD, and frequent
vomiting from bulimia or alcoholism.
Extrinsic causes
 Acidic beverages, foods
 Carbonated drinks, sport drinks
 Medications-chewed and held prior
swallowing e.g C vit preparations
 calcium, phosphates, fluoride may lessen
erosive potential
 Proximity of toothbrushing after intake
 Work environment. Swimmers, winetasters
Intrinsic causes
 Gastric acids regurgitated into the
esophagus and mouth. Gastric acids, with
pH levels that can be less than 1, reach
the oral cavity and come in contact with
the teeth GERD
 Excessive vomiting related to eating
disorders.(anorexia, bulimia, alcoholism,
pregnancy, drug side effect, diabetes..)
Signs
 changes in appearance and
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sensitivity
the cutting edge of the tooth to
become transparent
the tooth has a yellowish tint
change in shape of the teeth
a broad rounded concavity, and
the gaps between teeth will
become larger
the teeth may form divots on the
chewing surfaces
include pain when eating hot,
cold, or sweet foods
Grade description
 0 No visible erosion
 1 Small pits and slightly rounded cusps,
flattened
fissures, moderate cupping, preservation of
occlusal
surface morphology
 2 Depression of cusps with severe cupping
and
grooving, restoration margins raised above level
of
surrounding tooth, flattening of occlusal surface
morphology
Grade description
 0 No erosion
 1 Loss of surface detail; change confined
to enamel
 2 Exposure of dentin affecting less than
one-third
of crown
 3 Exposure of dentin affecting one-third or
more
of crown
Making a diagnosis
 These definitions relate to different causes, it is
important to recognize that each of these types
of tooth wear rarely occur alone in a given
individual. A patient with generalized tooth wear
may be diagnosed as being a bruxer or a heavyhanded toothbrusher, without recognition of an
erosive component to the problem and clinical
research in the area of tooth wear difficult.
 Likewise, the diagnosis and management of
patients with tooth erosion remains a challenging
task.
 Many studies suggest that the incidence of
dental erosion ranges from 5 to 50% in
various populations and age groups.
Treatment
Saliva
 Saliva acts as a buffer, regulating the pH
when acidic drinks are ingested
 Fruit juices are the most resistant to
saliva's buffering effect
 Followed by, in order:
-fruit-based carbonated drinks
-flavoured mineral waters
-non-fruit-based carbonated drinks,
sparkling mineral waters
Saliva as a Modifying factor
 Buffering capacity due to the bicarbonate
content of the saliva which is in turn
dependent on salivary flow rate.
 many common medications and diseases
can lower salivary flow rate when
evaluating a patient with erosion.
Treatment
 Head elevation (extra pillows during sleep)
 Dietary modification (avoiding spicy or
fatty foods)
 Use of antacids
Anorexia, bulimia
 erosion caused by vomiting typically
affects the palatal surfaces of the maxillary
teeth
 treatment for bulimia may include use of
antidepressants or other psychoactive
medications these may cause salivary
hypofunction
 Sjogren’s syndrome is an autoimmune
condition in which chronic inflammation of
the salivary and tear glands cause dry
mouth and eyes
 a patient may use acidic beverages in
efforts to stimulate residual salivary flow
and keep the mouth moist
 Brushing immediately after the
consumption of acidic foods, or vomiting
may also accelerate tooth structure loss
because the enamel is softened by the
presence of acid
 the teeth may appear more yellow as the
underlying dentin shows through
 A patient may attempt to whiten the teeth
by more rigorous brushing with a
toothpaste that is more abrasive (e.g.,
toothpaste advertised to smokers),
compounding the erosion with abrasion.
Fluoride use should be assessed.
 Caries is generally an uncommon
occurrence in patients with erosion.
Additionally, teeth with erosion do not tend
to retain plaque.
 The location, degree and type of tooth
surface loss should be documented by
careful description.
 Radiographs, impression…
Prevention and treatment
 Identification of the etiology
 Treating the underlying medical disorder or
disease.
 Symptoms of GERD,then he/she should be
referred to a medical doctor
 With salivary hypofunction may benefit with the
use of sugarless chewing gum or mints to
increase residual salivary flow.
 The use of oral pilocarpine (Salagen) may be
beneficial in patients with dry mouth
Prevention and treatment
 Decrease abrasive forces.
 Use a soft bristled toothbrush and brush gently
 No brushing immediately after consuming acidic
food and drink as teeth will be softened. Leave
at least half an hour of time space. Rinsing with
water is better than brushing after consuming
acidic foods and drinks
 Drinking through a straw
Prevention and treatment
 A patient suspected of an eating disorder should be
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referred to a medical doctor for evaluation.
Dietary modification
Using a remineralizing agent, such as sodium fluoride
solution in the form of a fluoride mouthrinse, tablet, or
lozenge, immediately before brushing teeth
Applying fluoride gels or varnishes to the teeth
Drinking milk or using other dairy products
Using a neutralizing agent such as antacid tablets
Dentine bonding agents applied to areas of exposed
dentin
Prevention and treatment
Restorative treatment can range from
placement of bonded composites in a few
isolated areas of erosion, to full mouth
reconstruction in the case of the
devastated dentition.