Erosive Tooth Wear

From Diagnosis to Therapy

A. Lussi, C. Ganss, Adrian Lussi, Marilia A. R. Buzalaf

• Publisher: S. Karger
• Year: 2014
• Print ISBN: 978-3-318-02552-1
• eBook ISBN: 9783318025538
• Topic: Medicine
• Subtopic: Dentistry

Erosive tooth wear is a multifactorial condition of growing concern to the clinician and the subject of extensive research. Since the publication of the first edition of the book with the title Dental Erosion, new knowledge for a better understanding of this important subject has been gathered. The new and more detailed insights resulted in this second, extended publication. It presents a broad spectrum of views, from the molecular level to behavioural aspects, as well as trends in society. In particular, the issues concerning chemical and biological factors as well as dental erosion in children are covered more extensively in this second edition. The first chapters include topics such as the definition, diagnosis, interaction, epidemiology and histopathology of tooth wear. Further, the aetiology of dental erosion, including nutritional and patient-related factors, and dental erosion in children are discussed. This book is a valuable and indispensable guide to better oral health and is highly recommended to faculty members, researchers, dental students, practitioners and other dental professionals.

Erosive Tooth Wear: A Phenomenon of Clinical Significance

Lussi A, Ganss C (eds): Erosive Tooth Wear. Monogr Oral Sci. Basel, Karger, 2014, vol 25, pp 1-15
DOI: 10.1159/000360380

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Erosive Tooth Wear: A Multifactorial Condition of Growing Concern and Increasing Knowledge

Adrian Lussi · Thiago S. Carvalho

Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland

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Abstract

Dental erosion is often described solely as a surface phenomenon, unlike caries where it has been established that the destructive effects involve both the surface and the subsurface region. However, besides removal of the surface, erosion shows dissolution of mineral within the softened layer - beneath the surface. In order to distinguish this process from the carious process it is now called ‘near surface demineralization’. Erosion occurs in low pH, but there is no fixed critical pH value concerning dental erosion. The critical pH value for enamel concerning caries (pH 5.5-5.7) has to be calculated from calcium and phosphate concentrations of plaque fluid. In the context of dental erosion, the critical pH value is calculated from the calcium and phosphate concentrations in the erosive solution itself. Thus, critical pH for enamel with regard to erosion will vary according to the erosive solution. Erosive tooth wear is becoming increasingly significant in the management of the long-term health of the dentition. What is considered as an acceptable amount of wear is dependent on the anticipated lifespan of the dentition and is, therefore, different for deciduous compared to permanent teeth. However, erosive damage to the teeth may compromise the patient's dentition for their entire lifetime and may require repeated and increasingly complex and expensive restorations. Therefore, it is important that diagnosis of the tooth wear process in children and adults is made early and that adequate preventive measures are undertaken. These measures can only be initiated when the risk factors are known and interactions between them are present.

© 2014 S. Karger AG, Basel

Change of Perception

Erosive tooth wear was for many years a condition of little interest to clinical dental practice, dental public health or dental research. Diagnosis was seldom made, especially in the early stages, and there was little, if anything, that could be done to intervene at this stage. However, perceptions have now changed. Problems and questions concerning erosive tooth wear now cover an ample area of research in dentistry, and it is a daily concern in the clinical practice. This will undoubtedly expand in the future, similarly to what has been occurring in the last decades.

A literature search in PubMed was carried out using the term ‘tooth erosion’ (MeSH terms) for the number of publications throughout the years. A steady increase can be observed in the number of publications, where less than 5 papers were published in 1970 and the number of studies increased to just over 10 in 1980. In 2000, the number of studies had increased considerably to almost 60 studies, whereas more recently, in 2012, the number had reached 100. Such an increase in the number of publications was also observed when the search on PubMed included all non-carious dental hard tissue defects, where terms related to abrasion and attrition were also incorporated in the search: [‘tooth wear’ (MeSH terms) OR ‘tooth attrition’ (MeSH terms) OR ‘tooth erosion’ (MeSH terms) OR ‘tooth abrasion’ (MeSH terms)]. A total of almost 40 studies were published in 1970 and this number increased to almost 50 in 1980. However, the number of studies doubled in 2000, when more than 100 studies were published on tooth wear, and more recently, in 2012, almost 250 studies appeared on PubMed. This goes to show that dental erosion and erosive tooth wear are becoming increasingly more significant both in research and in the clinic.

(Erosive) tooth wear is also of increasing importance in the long-term health of the dentition and the overall well-being of those who suffer its effects. Following the decline in tooth loss in the 20th century, the increasing longevity of teeth in the 21st century will render the clinically deleterious effect of wear more demanding on the preventive and restorative skills of the dental professional [1]. Awareness of dental erosion is still not widespread in the public, although in some countries there is knowledge and awareness concerning acidic foods and beverages [2-5]. In its early stages, and for the vast majority of the population, the changes seen in tooth erosion are of only cosmetic significance. In a survey in England, 34% of the children were aware of tooth erosion but only 8% could recall their dentist mentioning the condition [6]; 40% of children believed incorrectly that the best way to avoid erosion was regular toothbrushing, which shows some misunderstanding or lack of information. In addition, the awareness of dentists was considered low [6]. A recent study carried out with young adults from Norway (aged 19-20 years) showed that, although a great majority of the participants were aware of erosion, had knowledge about the causes of the condition (93.5%) and believed that the condition can be prevented (84.9%), a reasonable number of them still drank sugary soft drinks (17.5%) and juices (34.1%). This indicates the need for effective intervention strategies to reduce the level of consumption [2].

Change of Knowledge

Dental caries is a well-known phenomenon, where the destructive effects occur both on the surface as well as within the subsurface region. Unlike caries, dental erosion is more often defined as a purely surface phenomenon. Although most of the demineralization does occur on the tooth's surface, the pathophysiology of dental erosion is more complex than previously described. Initially, when a solution comes into the oral cavity, it first has to diffuse through the acquired enamel pellicle before it can interact with the enamel itself [see chapters by Shellis et al., this vol., pp. 163-179 and Hannig and Hannig, this vol., pp. 206-214]. The pellicle is a thin acellular biofilm, free of bacteria, that covers both hard and soft oral tissues and functions as a perm-selective barrier. It is mainly composed of proteins (mostly mucins) and peptides derived from saliva, but it can also include enzymes, glycoproteins, carbohydrates and lipids [7, 8]. Once the acid diffuses through the acquired enamel pellicle, it reaches the surface of enamel, where hydrogen ions (H⁺) will start to dissolve the enamel crystals. The effect of the H⁺ ions first triggers the dissolution of the prism sheath, and later of the prism core, thus leaving the well-known honeycomb appearance [9]. However, much emphasis has been placed solely on the effect of the H⁺ ions on the interface between solution and enamel; nevertheless, Gray [10] in the 1960s and Featherstone and Rodgers [11] in the 1980s also argued for the importance of the undissociated (non-ionized) form of organic acids in the carious process.

When organic acids are present in solution such as saliva, part of acid molecules will remain in its undissociated form, whereas another part will dissociate [R-COOH (aq)

R-COC^- (aq) + H⁺ (aq)]. Gray [10] and Featherstone and Rodgers [11] suggested that, during the formation of the subsurface lesion in the early caries process, the undissociated form of the acid could penetrate the enamel pores faster than the dissociated form because of its lack of charge. Once within the enamel, these molecules then dissociate, thus acting as carriers of H⁺ into the enamel mineral [10, 11]. These H⁺ ions present within the enamel pores would then dissolve the mineral crystals. In the first issue of this book, this mechanism was also proposed to be valid for the d...

Table of contents

• Cover Page
• Front Matter
• Erosive Tooth Wear: A Phenomenon of Clinical Significance
• Epidemiology
• The Histopathology of Dental Erosion
• Aetiology of Dental Erosion: Nutritional Factors
• Aetiology of Dental Erosion: Patient-Related Factors
• Preventive and Restorative Therapy
• Dental Erosion in Children
• Author Index
• Subject Index