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Cariology Unit, Department of Community Dentistry, University of Texas Health Science Centre
at San Antonio, MC 7917, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
b
Cariology Group, Department of Clinical Dental Sciences, School of Dentistry, Edwards Building,
Daulby Street, Liverpool L69 3GN, UK
Received 1 October 2004; accepted 4 October 2004
KEYWORDS
Dental erosion;
Aetiology;
Prevention;
Protection;
Erosive agents;
Oral health;
Control
Introduction
0300-5712/$ - see front matter q 2004 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jdent.2004.10.014
244
Table 1
erosion.
Age (years)
% affected
Evidence
14
20
45
56
38
52
11
25
1114
2630
4550
57
30
42.6
UK Toddlers
Survey3
Millward et al.4
UK Child Dental
Health Survey5
UK Child Dental
Health Survey5
Bartlett et al.6
Lussi et al.7
Lussi et al.7
245
Figure 1 Facial erosion with smooth and shiny appearance. Courtesy: Professor Adrian Lussi, Univ. Bern,
Switzerland.
246
247
Figure 3 Microradiograph of softened enamel lesion (a) with demineralised surface before intraoral exposure to
saliva. Following intraoral exposure to saliva, the demineralised surface (a) was remineralised (b) in the lesions
protected with an erosion model (Figure 4a), but abraded (c) in the unprotected lesions with consequent loss of tooth
tissue softened by erosion. XZpreviously demineralised surface. YZpreviously nail-varnish-coated sound surface with
varnish worn following intra-oral exposure.
248
249
the damage is done. Pharmacologists, on the other
hand, should be urged to include, in the list of sideeffects, the potential dental consequences of some
medications when used under certain conditions (for
instance, frequent and prolonged use) and how to
minimise such side-effects (such as rinsing with a
remineralising agent while using the medication).
Patients with such disorders or prescriptions that
may predispose them to erosion should be advised by
all healthcare personnel involved in their management (doctors, clinical psychologists and pharmacists) to visit their dentist for regular dental
examination. This would enable early detection of
dental erosion and appropriate management could
be instituted immediately.
Dental school curricula should include training on
the causes and consequences of dental erosion, and
how to prevent or minimise it. The students/dentist
should pass on this information to the patients and
general public, as part of dental health education.
Counseling should be individualised and relate to
the observed aetiological factor. The following key
points may be considered as a guide:
The hazard of brushing immediately following
acidic challenge should be stressed and advice
given for the use of either remineralising or
neutralising agents or milk, as an alternative to
brushing.
The need for change of attitude towards acidic
dietary drinks and fruits should be explained. The
consequences of frequent and prolonged intake of
these foodstuffs should be explained and advice
given on the importance of reduction in amount
and frequency.
The intake of acidic foods or drinks immediately
before bed should be avoided.
The practice of continuous or bedtime baby bottle
feeding with baby fruit juices as a means of
comforting a child should be discouraged, with
explanation of the dental consequences.
Advice should be given on health and safety at
work with the aim of preventing erosion. Use of a
protective guard while on duty might be advised.
The guard should be used with the fitting surface
smeared with an alkali (such as milk of magnesia)
or a neutral fluoride gel to neutralize any acid
pooling underneath the appliance.
High-risk individuals should be urged to change
their oral hygiene procedures; using a low
abrasive toothbrush (soft brush) with a high
fluoride- or bicarbonate-containing toothpaste
with low abrasivity. Toothbrushes are marked
with different bristle textures (soft, medium,
hard brush), and it has been demonstrated that,
with the same dentifrice, the rate and degree of
250
enamel and dentine abrasion varies with the
texture of the bristle and the shape of bristle
cut.6769
References
Dentine bonding agents, Seal and Protect (Dentsply, UK) and Optibond Solo (Kerr, UK), have been
shown to offer protection against erosion and
reduce the rate of tooth wear in vitro and in situ70,
71
without adverse effect on pulpal circulation (in
rat studies).72 This can be applied to protect
erosively exposed dentinal tissues.
Adhesively retained resins (composite resin or
glass ionomer cement) can be used in areas that
are not susceptible to high loads.8
Porcelain veneers may be used to improve
appearance as well as provide protection against
further damage.73
Concluding remarks
Perhaps due to lack of devices for in vivo assessment
of the effect of preventive agents on eroded lesions,
there is shortage of in situ and in vivo studies on
erosion to support some of the in vitro findings.
Hence, there is a need for development of a
diagnostic device, which can detect an early eroded
lesion and quantifiably monitor the progress of
the lesion on a longitudinal basis. A remineralising
agent (mouthrinse or lozenge) specific for dental
erosion should be formulated for effective prevention of erosion. Health education programmes
targeted towards reduction of the prevalence of
dental erosion and involving all healthcare personnel
should be developed. The qualities of acidic dietary
251
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