Acid Erosion/Tooth Surface Loss

What you should know?

This leaflet is provided to explain the causes and consequences of acid erosion. There is practical advice to help you minimise the damaging effects of acid erosion to the tooth surfaces.

What is acid erosion?

Acid erosion is the process whereby acids in the mouth soften the tooth surface, so that it is more easily worn away by eating or tooth brushing.
The acids come primarily from the food and drink we consume, but may also come from the stomach if acid reflux or repetitive vomiting is a problem.

The list of acidic food and drink is a long one, and it is not always obvious which are high in acid.

All carbonated (fizzy) drinks are acidic, including mineral water.

Most dry white wines are acidic.

Foods you might not expect to be acidic are salt and vinegar crisps and many fruit smoothies.

Like many health matters it is difficult to give any really hard and fast rules: each person’s mouth varies in the ability to fight against the acid attack, and  the type of acid and frequency of intake vary. It is also difficult to tell if the damage is recent and/or ongoing.

So what do I look for?

Front Teeth

In the early stages, the teeth will look very smooth and have a glossy appearance as the surface detail is lost. The edges become more rounded, and the tips can become thin and be transparent grey in appearance.
The teeth may appear more yellow in colour and possibly feel more sensitive to hot or cold temperatures.

As the tooth surface loss progresses a small area of enamel is lost completely, usually near gum level, and a dip, groove, or notch can appear in the tooth. This is usually cold sensitive and may react to a fingernail.

In severe cases, the enamel is mostly lost from the front of the tooth, the tip is worn and sharp, and any fillings stand proud of the surface. The colour of the tooth is quite dark and solid looking except around the edges, which are grey and translucent. There may be pronounced notching as well.

Back teeth

If the biting surface is affected, the enamel thins down and is lost in several places; small round hollows appear, which are usually darker and often cold sensitive. The loss of enamel is usually clearly visible on x-rays.

The top of the tooth will be darker in colour, with a translucent grey around the edges (haloing). Any fillings will be proud of the tooth surface if the problem is ongoing.

If the side of the tooth is affected then the teeth develop notching or rounded hollows at gum level, which are usually sensitive to cold.

Stomach Acid

If stomach acid is the cause, then the internal surfaces of the teeth are affected, with extensive loss of enamel on surfaces adjacent to the palate on all the upper teeth. The front teeth usually become very sharp and the edges are unevenly chipped.

 So what to do?

Once the tooth surface is lost it will not regenerate.

We try and decide if the problem is ongoing or historical, and will monitor the situation. The remaining enamel can be protected with a simple composite filling.

Patients need to be made aware that poor food & drink choices, eating disorders, stress related grinding and overly aggressive tooth brushing can all cause irreversible tooth substance loss.

Practical Advice

  • Wait at least 30-60 minutes before brushing your teeth after having acid-containing food and drink.
  • Drink soft drinks through a straw aimed at the back of your mouth so the drink bypasses the teeth.
  • Try to limit the number of times a day your teeth are exposed to acidic food and drink (ideally no more than 4 times per day).
  • Allow acidic food & drink to pass quickly through your mouth.
  • Alternating water and acidic drinks can help.
  • Chew sugar-free, xylitol- or sorbitol-sweetened gum to help neutralise acid.
  • Brush your teeth twice a day with a circular motion (avoid scrubbing) or get an electric toothbrush as these are gentlest.
  • Use a low-abrasion fluoride toothpaste (do not choose whitening or smokers brands).

Web Sites:

There are many useful websites available which provide advice on food & drink that can cause erosion. Use your usual search engine (i.e. Google, Bing) and search for ‘drinks that cause tooth erosion’. Be aware that if you find a non-UK site, they may refer to drinks which are not even available in the UK. You can find information of acidic foods using the same search method.

Youtube has many videos that discuss erosion. Try searching for ‘Damage from Soft Drinks’

Wikipedia (acid erosion) has a useful chart on the pH of common drinks

Confused?

The amount of information available can be very confusing, and often misleading. Your dentist or hygienist would be happy to give advice.