Dental erosion

5.0–5.7 may initiate dental erosion. Extrinsic acidic sources Extrinsic acid erosion is when the source of acid originates from outside of the body. Acidic food and drink lowers the pH level of the mouth resulting in demineralisation of the teeth. A variety of drinks contribute to dental erosion due to their low pH level. Examples include fruit juices, such as apple and orange juices, sports drinks, wine and beer. Carbonated drinks, such as colas and lemonades, are also very acidic and hence have significant erosive potential. Foods such as fresh fruits, ketchup and pickled food in vinegar have been implicated in causing acid erosion. Saliva acts as a buffer, regulating the pH when acidic drinks are ingested. Drinks vary in their resistance to the buffering effect of saliva. Studies show that fruit juices are the most resistant to saliva's buffering effect, followed by, in order: fruit-based carbonated drinks and flavoured mineral waters, non-fruit-based carbonated drinks, sparkling mineral waters; mineral water being the least resistant. Because of this, fruit juices in particular may prolong the drop in pH levels. A number of medications such as chewable vitamin C, aspirin and some iron preparations are acidic and may contribute towards acid erosion. This is often secondary to conditions such as anorexia nervosa, bulimia nervosa, gastroesophageal reflux disease (GERD) and rumination syndrome. The main cause of GERD is increased acid production by the stomach. Behaviour Acid erosion often coexists with abrasion and attrition. Abrasion is most often caused by brushing teeth too hard. Any frothing or swishing acidic drinks around the mouth before swallowing increases the risk of widespread acid erosion. Sucking citrus fruits can also contribute to acid erosion. ==Diagnosis==

In-vivo studies are advantageous in assessing erosion directly from the patient's mouth. There are numerous signs of dental erosion, including changes in appearance and sensitivity. Colour One of the physical changes can be the colour of teeth. Dental erosion can lead to two major tooth colour change – the first being a change of colour that usually happens on the cutting edge of the central incisors. This causes the cutting edge of the tooth to become transparent. A second sign is a yellowish tint on the eroded tooth. This occurs because the white enamel has eroded away to reveal the yellowish dentin beneath. Shape A change in shape of the teeth is also a sign of dental erosion. Teeth will begin to appear with a broad rounded concavity, and the gaps between teeth will become larger. There can be evidence of wear on surfaces of teeth not expected to be in contact with one another. Dentists may also employ dental indices to guide their diagnosis and management of the condition. A scoring system referred to as Basic Erosive Wear Examination (BEWE) grades the appearance or severity of wear on the teeth by the extent of hard tissue loss. It is noted that indices are useful in monitoring the most severe clinical changes in tooth wear. However, they lack comprehensiveness as they cannot measure the rate of progression and cannot monitor all teeth affected by erosion. There is also a lack of an index which is universally accepted and standardised. One of the most severe signs of dental erosion is cracking, where teeth begin to crack off and become coarse. Optical properties On the basis of the optical changes induced in eroded tissue by the lesions, in 2015 Koshoji et al. also demonstrated in a novel method that by using laser speckle images (LSI) it is possible to acquire information on the microstructure of the enamel and detect minimal changes, such as early non-carious lesions. No clinical data has been published to demonstrate the effectiveness of this technique in vivo. == See also ==