Erosion – an increasingly common cause of tooth wear
Featured Products Promotional FeaturesPosted by: Dental Design 26th June 2024

The UK Adult Dental Health Survey revealed some worrying statistics about the prevalence of tooth wear among the UK population. It was found that:
- 77% of the UK population had some evidence of wear.
- Rates of moderate wear in adults increased by 4% between 1998 and 2009, affecting 15% of adults.
- 4% of 16- to 24-year-olds had moderate tooth wear, up 3% from ten years previously.
- The greatest incidence of tooth wear was among older adults. 44% of dentate adults aged 75 to 84 years had moderate wear.
- 2% of all adults in the UK had tooth wear so severe that pulp or secondary dentine was exposed.[i]
A separate survey found that 4% of 5-year-old children experience severe tooth wear that exposes dentine or pulp. Studies have shown a strong link between severe wear on primary teeth, and tooth wear on the occlusal surfaces of the first permanent molars. Screening for tooth wear in younger children is vital to ensure children and caregivers understand the importance of preventative care, as well as to enable effective advice and support.[ii]
Erosion – the progressive loss of hard dental tissues by chemical processes not involving bacterial action – is generally considered to be the main cause of tooth wear in the UK.[iii] Though there are many factors that can cause erosion, studies around the world have generally attributed its modern prevalence on the increased consumption of acidic foods and drinks.[iv] [v] [vi] Particularly implicated are fruit juices, soft drinks, sports beverages and carbonated drinks, but erosion can also take place due to gastrointestinal problems, eating disorders, or environmental factors, like chlorinated pool-water.[vii]
Treatment options
Tooth wear can affect function, aesthetics and tooth sensitivity,[viii] and these factors can impact heavily on wellbeing. Although restoration can be very complex and require a multidisciplinary approach, the improvement to quality of life for patients can be significant.[ix] Treatment to restore severely worn teeth is technically demanding, can take a great deal of time, and will require a high level of commitment from patients. It requires a holistic approach with an accurate diagnosis of the cause and an analysis of the structural damage.[x]
Restoration with direct composites is recommended for a vertical dimension loss of less than 2 mm. For vertical loss any greater, indirect ceramic veneers and overlays may be more suitable. For vertical dimension loss of more than 4 mm, indirect ceramic restorations are usually preferable.[xi]
However, before restoration can take place for patients, the habits or conditions that have led to the erosion will have to be addressed. Additionally, to treat dimension loss of this magnitude, commonly occurring occlusal issues will have to be treated, and this can take time.
For example, dento-alveolar compensation, enabling patients to maintain occlusal contacts, often accompanies severe tooth-wear. To create space for restorations, clinicians often use the Dahl approach to address limited occlusal space due to tooth wear. Direct composite resin is now commonly used as a splint, as it is inexpensive, bondable, robust and can be modified with ease.[xii] This approach is minimally invasive, and highly effective, but it is gradual, and can require a duration of up to eight months before restorative treatment can begin.[xiii]
A collaborative approach with patients to prevent and treat tooth wear
With so many complexities associated with tooth wear, patients will benefit from clear information that will enable them to make informed decisions about any action needed, as well as to prevent any further deterioration of their teeth.
Patient education is vital to increase awareness about the risk factors leading to erosion. Wear can be rapid, and patients may not realise that once enamel is lost, it is irreversible. Sensitivity in communication around lifestyle changes to prevent further damage must be balanced with the real consequences of inaction for patients. Teaching aids can be a great asset for patients and clinicians in many ways. There is less pressure on the clinician, as the information is presented in objective terms. They also help build trust, as patients can be given the evidence behind clinicians’ recommendations in accessible terms.
Chairsyde, the award-winning consultation platform created by dentists, helps patients visualise their conditions, treatment options and associated risks. A huge bank of animations and images enables patients to better understand how their treatment will work, what will be involved at every stage of the treatment plan, and what measures they can take to improve their oral health. The system additionally enables instant sharing of post-consultation summaries, so patients can reference what has been discussed at home.
Whether a patient’s erosion is still at a stage where severe wear can be avoided, or whether they need to understand options for complex restorative treatment, they will need detailed information. This will enable them to be participants in their care by facilitating greater understanding, leading to truly informed consent.
For more information, or to book a Chairsyde demo, please visit www.chairsyde.com
or call 020 3951 8360
[i] Tooth Wear. Gov.UK. Guidance. November 2021. Available at: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-7-tooth-wear#tooth-wear-in-the-uk. Accessed May 2024
[ii] Harding MA, Whelton HP, Shirodaria SC, O’Mullane DM, Cronin MS. Is tooth wear in the primary dentition predictive of tooth wear in the permanent dentition? Report from a longitudinal study. Community Dental Health. 2010;27(1):41-5
[iii] Paryag A, Rafeek R. Dental Erosion and Medical Conditions: An Overview of Aetiology, Diagnosis and Management. West Indian Med J. 2014 Sep;63(5):499-502. doi: 10.7727/wimj.2013.140. Epub 2014 May 15. PMID: 25781289; PMCID: PMC4655683.
[iv] Johansson AK, Omar R, Carlsson GE, Johansson A. Dental erosion and its growing importance in clinical practice: from past to present. Int J Dent. 2012;2012:632907. doi: 10.1155/2012/632907. Epub 2012 Mar 7. PMID: 22505907; PMCID: PMC3312266.
[v] Hasselkvist A, Johansson A, Johansson AK. Dental erosion and soft drink consumption in Swedish children and adolescents and the development of a simplified erosion partial recording system. Swed Dent J. 2010;34(4):187-95. PMID: 21306084.
[vi] Tooth Wear. Gov.UK. Guidance. November 2021. Available at: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-7-tooth-wear#tooth-wear-in-the-uk. Accessed May 2024
[vii] Lutovac M, Popova OV, Macanovic G, Kristina R, Lutovac B, Ketin S, Biocanin R. Testing the Effect of Aggressive Beverage on the Damage of Enamel Structure. Open Access Maced J Med Sci. 2017 Dec 1;5(7):987-993. doi: 10.3889/oamjms.2017.180. PMID: 29362633; PMCID: PMC5771309.
[viii] Paryag A, Rafeek R. Dental Erosion and Medical Conditions: An Overview of Aetiology, Diagnosis and Management. West Indian Med J. 2014 Sep;63(5):499-502. doi: 10.7727/wimj.2013.140. Epub 2014 May 15. PMID: 25781289; PMCID: PMC4655683.
[ix] Li MHM, Bernabé E. Tooth wear and quality of life among adults in the United Kingdom,. Journal of Dentistry, Volume 55, 2016. Pages 48-53, ISSN 0300-5712, https://doi.org/10.1016/j.jdent.2016.09.013.
[x] Kumar V, Reddy S, Kumari V S, Basha R, Mitra N. Restorative Rehabilitation of a Patient With Tooth Wear: A One-Year Clinical Follow-Up Report. Cureus. 2023 Apr 18;15(4):e37798. doi: 10.7759/cureus.37798. PMID: 37213952; PMCID: PMC10195644.
[xi] Kumar V, Reddy S, Kumari V S, Basha R, Mitra N. Restorative Rehabilitation of a Patient With Tooth Wear: A One-Year Clinical Follow-Up Report. Cureus. 2023 Apr 18;15(4):e37798. doi: 10.7759/cureus.37798. PMID: 37213952; PMCID: PMC10195644.
[xii] Poyser, N., Porter, R., Briggs, P. et al. The Dahl Concept: past, present and future. Br Dent J 198, 669–676 (2005). https://doi.org/10.1038/sj.bdj.4812371
[xiii] Tew IM, Ho EHT. Minimally Invasive Rehabilitation of Posterior Erosive Tooth Wear: Two Case Reports of the One-Stage Dahl Approach. Cureus. 2022 Feb 15;14(2):e22235. doi: 10.7759/cureus.22235. PMID: 35340518; PMCID: PMC8929473.
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