Dear Clinician:
Here is the information you requested (sponsored by GlaxoSmithKline Consumer Healthcare).
Dental erosion, or erosive tooth wear, is a growing concern among dental professionals.
1,2 A decline in tooth loss in the 20
th
century, along with changing dietary habits (e.g., the increased
consumption of soft drinks and acidic fruits and vegetables), among
other factors, have led to erosive tooth wear becoming an increasingly
important factor when addressing the long-term health of the dentition.
1
Tooth wear is the non-carious loss of tooth structure,
3 which typically falls into three main categories:
abrasion, attrition, and
erosion.
While tooth abrasion and attrition are caused by mechanical reasons
(bruxism, brushing, clenching, and general age-related wear from
mastication), tooth erosion is a non-bacterial chemical process which
begins when the tooth structure comes in contact with the acids in
foods and beverages.
3
Recently, a significant amount of attention has been paid to the causes
and management of dental erosion in adults; however, the pediatric
population is also affected.
1-3,4-6 Dental erosion in children is important to address, as such erosion can have life-long effects on the individual’s dentition.
1
This email provides a brief summary of the latest thinking regarding
the prevalence, etiology, and diagnosis/management of dental erosion in
the pediatric population.
Prevalence
A number of studies have reported dental erosion prevalence data for
the pediatric population; this data has recently been reviewed in
publications by Deshpande and Hugar, and Jaggi and Lussi.
5,6
There is some disparity in the data (e.g., prevalence data are not
homogeneous), thought to be attributable to differences in examination
standards and in the non-homogeneous groups examined.
6
However, the vast majority of these studies indicate that erosion is a
common condition in the juvenile population. In addition, there is an
impression among clinicians that the prevalence of erosive tooth wear
is growing, especially in children.
1,2,5,6
Etiology
The underlying cause of dental erosion in both adults and children is
multifactorial, with both extrinsic and intrinsic factors being
possible contributors (Table 1).
1,4,5,7
The excessive consumption of acid-containing foods/beverages is the
most common factor underlying dental erosion; soft drinks, in
particular, are believed to be a frequent causative factor, especially
in the juvenile population as children generally consume more soft
drinks vs. adults (although there is enormous individual variation).
4
Diagnosis/Management
In the past, minor dental erosion has often been ignored by clinicians,
who have dismissed such tooth surface loss as being an inevitable part
of day-to-day living. This thinking, however, is changing, and it is
now believed that early diagnosis and intervention are paramount,
especially when dealing with the juvenile population.
1,4,7
This is because the chances of continuous tooth surface loss over a
child’s life are great unless adequate prevention strategies are
implemented.
4 Early diagnosis/intervention is thought to be able to stop the process of erosion.
2 In addition, in the very earliest stages, it is thought that a certain amount of repair may be possible.
1
The clinical appearance of the dentition is the most important
diagnostic feature for dental erosion, especially in its early stages.
1 Clinical features of dental erosion can be seen in Table 2.
8 A very early sign of erosion is enamel with a silky, glazed appearance.
4,8 In children, the most common areas of wear are the incisal surfaces of the incisors and occlusal surfaces of the molars.
1,2,4,6
When dental erosion is suspected, the patient’s health history should be reviewed to determine possible underlying etiology.
7
Patients and their parent(s)/guardian(s) should also be questioned
regarding lifestyle factors that may be associated with erosion. Such
an investigation into possible causative factors can assist clinicians
in identifying underlying problems, and in the subsequent
development/implementation of an overall patient care plan.
7
Once dental erosion has been diagnosed, preventative counseling
regarding lifestyle changes that can limit exposure to causative
factors is imperative.
2
Such counseling is especially important in light of the fact that many
patients are unaware of the connection between certain foods/beverages
and dental erosion.
1
While generally initiation of restorative procedures in response to
acid erosion is not called for in the pediatric population (especially
if there are no complaints of pain, sensitivity, function, or
aesthetics), patients should be counseled and progress evaluated on a
semiannual basis.
Summary
Dental erosion, or the pathological wear of teeth from a
chemical/dissolving process, is common in children, and international
research suggests its prevalence is increasing. Causative factors can
be intrinsic or extrinsic, with excessive consumption of acidic
foods/beverages being the most commonly identified underlying
etiological factor. Early diagnosis and management of dental erosion in
children is paramount, as without intervention such loss can continue
over a lifetime and cause great harm to the individual’s dentition.
Counseling strategies are generally recommended, as lifestyle changes
can be associated with a halting of the erosion process.
References
1. Lussi A. Erosive tooth wear – a multifactorial condition of growing concern and increasing knowledge.
Monogr Oral Sci. 2006;20:1-8.
2. Milosevic A, O'Sullivan E; Royal College of Surgeons of England.
Diagnosis, prevention and management of dental erosion: summary of an
updated national guideline.
Prim Dent Care. 2008 Jan;15(1):11-2.
3. Abrahamsen T. The worn dentition – pathognomonic patterns of abrasion and erosion.
International Dental Journal. 2005;55:268-277.
4. Lussi A, Jaeggi T. Dental erosion in children.
Monogr Oral Sci. 2006;20:140-51. Review.
5. Deshpande SD, Hugar SM. Dental erosion in children: an increasing clinical problem.
J Indian Soc Pedod Prev Dent. 2004 Sep;22(3):118-27.
6. Jaeggi T, Lussi A. Prevalence, incidence and distribution of erosion.
Monogr Oral Sci. 2006;20:44-65. Review.
7. Bassiouny MA, Zarrinnia K. Dental erosion: a complication of pervasive developmental disorder.
J Clin Pediatr Dent. 2004 Spring;28(3):273-8.
8. Lussi A (ed): Dental Erosion.
Monogr Oral Sci. Basel, Karger, 2006;20:32-43.
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