Managing Dental Erosion: Current Understanding and Future Directions
Course Number: 517
While caries and dental erosion involve the loss of mineral, there are differences between caries and erosive processes. Caries occurs under plaque and is the direct result of bacterial acids. The primary acid that causes caries is lactic acid, a byproduct of the breakdown of fermentable carbohydrates (primarily sugar) by plaque bacteria. Erosion, on the other hand, is a result of the direct action of extrinsic, dietary acids; such as those found in carbonated drinks and fruit juices or intrinsic acids, such as from GERD. With caries, the mineral structure remains intact. Thus, fluoride and other mineral are able to penetrate into the enamel crystal matrix and rebuild or remineralize the challenged enamel. However, dental erosion is different. Once erosive factors overwhelm the pellicle, the result is an initial, relatively fast softening of the enamel followed by abrasive insults that result in complete and permanent removal of the enamel crystal. Net, there is no crystal structure to rebuild.
Dental erosion, a major component under the umbrella term of ETW, is multifactorial and its prevalence is increasing, especially in adolescents and older adults. Advanced ETW causes patients to experience problems with esthetics, function, and pain, and creates treatment dilemmas for dental professionals. Effective management of ETW includes screening and evaluation of all etiological factors, preventive and restorative care, and using the least invasive therapy possible. Dentifrices containing stabilized SnF2 have been shown to be very effective at inhibiting both the initiation and progression of dental erosion. ETW must be effectively managed, with a focus on preventive care at the earliest stages, and monitoring and evaluation of ETW management should be performed regularly during recall sessions. This will help reduce the need for extensive and expensive restorative care in the future.