Tooth Erosion

Tooth erosion is the loss of dental hard tissue by chemical dissolution from acids that are not produced by oral bacteria. It is distinguished from caries by its non-bacterial acid source - dietary, environmental, or gastric - and, because it interacts with mechanical wear, it is often described within the broader picture of erosive tooth wear.

Definition

Tooth erosion is the irreversible loss of dental hard tissue caused by chemical (acid) dissolution that does not involve bacteria, distinguishing it from dental caries.

Scope

This entry defines erosion and erosive tooth wear, the acid sources involved, the mechanism of dissolution, and how erosion is assessed and interacts with abrasion and attrition. It links to the related mechanical-wear topic. It is a reference description and does not give individual diagnostic or treatment advice.

Core questions

• What distinguishes erosion from dental caries?
• Which acid sources cause erosion?
• How does acid dissolve enamel and dentin?
• Why is erosion usually considered together with mechanical wear as erosive tooth wear?

Key concepts

• Non-bacterial acid dissolution
• Intrinsic acid (gastric) sources
• Extrinsic acid (dietary, environmental) sources
• Erosive tooth wear
• Surface softening and tissue loss
• Basic Erosive Wear Examination (BEWE)
• Multifactorial wear

Mechanisms

Erosion begins when acid contacts the tooth surface and dissolves the hydroxyapatite mineral of enamel or dentin. Acids may be extrinsic (from diet, such as acidic drinks and foods, or from the environment) or intrinsic (gastric acid reaching the mouth) (Imfeld, 1996). Initial contact softens the surface; with repeated exposure mineral is progressively lost. Because softened surfaces are more vulnerable to mechanical forces, erosion frequently combines with abrasion and attrition, so that observed tissue loss reflects the interaction of chemical and mechanical processes rather than acid alone - the concept of erosive tooth wear as a multifactorial condition (Lussi & Carvalho, 2014; Addy & Shellis, 2006). Standardised scoring systems such as the Basic Erosive Wear Examination have been developed to record erosive wear consistently (Bartlett et al., 2008).

Clinical relevance

Erosion is a major non-carious cause of hard-tissue loss, and recognising acid origin and the interaction with mechanical wear is part of how clinicians frame tooth-surface loss. This entry describes the process for orientation only and does not prescribe diagnosis, prevention, or treatment for any individual.

Epidemiology

Erosive tooth wear is widely reported across age groups and is described as a condition of growing concern, though reported prevalence varies considerably with the population studied and the index used to record it (Lussi & Carvalho, 2014). The introduction of standardised indices such as BEWE was motivated partly by this variability (Bartlett et al., 2008).

History

Acid wear of teeth has long been recognised, but a consolidated definition separating erosion from caries and from mechanical wear was articulated in the 1990s (Imfeld, 1996). Subsequent work reframed the problem as multifactorial erosive tooth wear and introduced standardised clinical scoring, broadening study from pure chemistry to the interaction of acid and mechanical forces (Lussi & Carvalho, 2014; Bartlett et al., 2008).

Debates

Should erosion be considered on its own or only as part of erosive tooth wear?

Because acid-softened surfaces are more readily worn away mechanically, many authors argue that erosion is best understood within a multifactorial erosive-tooth-wear framework rather than as an isolated chemical process, while a clear definitional distinction from caries and mechanical wear is still maintained.

Key figures

• Adrian Lussi
• Thomas Imfeld
• David Bartlett

Seminal works

• imfeld-1996
• lussi-2014
• bartlett-2008

Frequently asked questions

How is tooth erosion different from a cavity?

A cavity (caries) is caused by acid that oral bacteria produce from dietary sugars. Erosion is caused by acid from other sources - diet, the environment, or the stomach - acting directly on the tooth without bacteria, which is why the two are classified separately.

What kinds of acid cause erosion?

Erosion can result from extrinsic acids, such as those in acidic drinks and foods or certain occupational environments, and from intrinsic gastric acid that reaches the mouth. This entry describes these sources for understanding and is not medical advice.