Pathogenesis and modifying factors of dental erosion

Abstract

Dental erosion is caused by acidic solutions which come into contact with the teeth. Because the critical pH of dental enamel is approximately 5.5, any solution with a lower pH value may cause erosion, particularly if the attack is of long duration, and repeated over time. Saliva and salivary pellicle counteract the acid attacks but if the challenge is severe, a total destruction of tooth tissue follows. Ultrastructural studies have shown that erosive lesions are seen in prismatic enamel as characteristic demineralization patterns where either the prism cores or interprismatic areas dissolve, leading to a honeycomb structure. In aprismatic enamel the pattern of dissolution is more irregular and areas with various degrees of mineral loss are seen side by side. In dentin the first area to be affected is the peritubular dentin. With progressing lesions, the dentinal tubules become enlarged but finally disruption is seen also in the intertubular areas. If the erosion process is rapid, increased sensitivity of the teeth is the presenting symptom. However, in cases with slower progression, the patient may remain without symptoms even though the whole dentition may become severely damaged. Regarding the role of causative agents, present data does not allow the ranking of different acids with regard to their potential of causing erosion. Neither is there consensus as to how effective fluorides are in preventing the progression of erosive lesions, or how the chemical and structural factors of tooth tissue in general might modify this pathological process.

Relationship between fluorescence loss of QLF and depth of demineralization in an enamel erosion model

“…The demineralizing gel used in the present study produced subsurface mineral loss followed by the development of enamel defects 14,29) . In the current enamel erosion model, bovine enamel was used as a substituted material for human enamel.…”

Evaluation of some properties of fermented milk beverages that affect the demineralization of dental enamel

“…The effect of fluoride on dental erosion has been studied under various conditions with conflicting results. 19,26,27 It is possible that increasing the fluoride concentration in acidic drinks could contribute to reduce their erosive potential. However, a review paper showed that fluoride admixtures to acidic solutions in a concentration excluding toxicological side effects seem unable to arrest erosive lesions.…”

Erosive characteristics and fluoride content of cola-type drinks

“…It is important that total TA 23,24 and the relative strength of the acid which indicates how easily the acid will "actively" give up free H + ions (pKa) 25 is considered when determining the erosive potential of drinks. While TA is responsible for maintaining the H + concentration available for the interaction with the tooth surface 10,22 , its importance in the clinically erosive situation is influenced by conditions such as exposure time and the ratio of the volume of eroding solution to the area of exposed tooth surface 18 .…”