Dietary Acids Are a Chief Cause of Enamel Erosion

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Enamel erosion is the result of a pathologic, chronic localized loss of dental hard tissue, chemically etched away from the tooth surface by acid and/or chelation without bacterial involvement. Caused by contact of acidic solutions with mineral crystals, it can be moderated by the protective effects of saliva and the acquired enamel pellicle. The initial stages of acid erosion involve the demineralization of enamel, leading to surface-softened lesions that still have the potential to remineralize. However, softened enamel is more susceptible to tooth wear (mainly abrasion and attrition) than sound enamel, and once lost is irreversible.

While various sources of acid can demineralize enamel, dietary acids are the main risk factor for most individuals. Many acidic foods and drinks have the potential to cause dental erosion. Fresh fruits, fruits juices and soft drinks present the greatest risk because of their widespread use. The erosive potential of foods and beverages is influenced by their total acid level (titratable acid), type of acid and calcium-chelating properties, as well as calcium, phosphate and fluoride concentration. Given the possible combinations of foods and beverages, it is challenging to attribute enamel erosion to any one dietary factor.

Lifestyle and behavioral influences also determine who develops diet-related enamel erosion and who does not. The frequency and duration of consuming acidic foods and beverages are the most important lifestyle factors. Frequent consumption of acidic vegetables, fruits and fruit juices, and the frequent or prolonged consumption (sipping) of acidic carbonated and uncarbonated beverages and sports drinks — especially in association with strenuous sporting activities and exercise — have all been implicated in dental erosion.

In addition, certain behaviors during an erosive challenge (such as swishing acidic beverages), and after an erosive challenge (such as overzealous oral hygiene practices, especially with high-abrasive whitening toothpastes) can accelerate erosive tooth wear. Bedtime consumption of acidic beverages is also a risk factor, especially for children. Patients with evidence of enamel erosion (Figure 1) and/or those at risk should be educated about the role of diet and other etiologic factors in enamel erosion. These patients will benefit from the preventive effects of a low-abrasive fluoride dentifrice and professionally applied topical fluoride.

From Decisions in Dentistry. June 2019;5(6):50.