Tooth Erosion Treatment

Symptoms of Tooth Erosion

This pathology is more common in people aged 30-40 years. It develops gradually, sometimes taking 10-15 years from the onset of the first signs to the exposure of the dentin. A characteristic feature of the disease is that visible changes may not appear immediately. Often, enamel destruction occurs slowly and can only be noticed during a dental examination using magnifying devices. Therefore, it is important to visit the dentist at least twice a year to detect the early signs of the disease, allowing for easier treatment.

Visible manifestations of the disease resemble caries but have significant differences. Affected areas are round or oval, with a smooth, hard, shiny bottom. Initially, the color of the enamel remains unchanged, just losing its luster, but over time, the cavities turn yellow or brown. Usually, erosion affects at least two symmetrical teeth, most often the upper incisors, and less frequently the canines and premolars of both jaws. Lower jaw incisors and molars are generally not affected by this disease.

As the disease progresses, tooth sensitivity increases. They react painfully to touch during brushing and to hot, cold, or acidic foods.

Pathogenesis of Tooth Erosion

Tooth enamel is the hardest tissue in the human body. It is a thin transparent shell that covers dentin and pulp, serving a protective function. The enamel layer withstands mechanical and chemical impacts and temperature changes but can crack and chip. Unlike bone tissue, it does not regenerate.

An additional protective layer called the pellicle forms on the enamel surface after eating, composed of components from saliva. The pellicle protects the hard tissues of the teeth from acid impact but also contributes to bacterial plaque formation. Erosion starts when acids, metabolic disturbances, or strong mechanical impact remove the pellicle.

The next stage is the gradual demineralization of the enamel, losing substances that give it strength. At the neck of the tooth, where enamel is particularly thin, characteristic defects of a saucer-like shape with a smooth shiny bottom appear.

The affected area grows in width and depth. When enamel thins, the disease spreads to the dentin, forming concave defects because dentin is less strong.

Gum fluid partially slows down erosion by neutralizing acidic environments and replenishing mineral deficiencies in the enamel. However, without proper treatment, if aggressive factors continue to affect the teeth, the disease will progress.

Classification and Stages of Tooth Erosion

There are two forms of the disease – active and stabilized. They are often considered as phases that follow one another. Signs of the active form include:

• Rapid destruction of the enamel layer, increasing erosion focus every 6-8 weeks;
• Sharp increase in tooth sensitivity, prompting patients to visit a dental clinic;
• The surface of the teeth becomes matte when dried, forming a plaque that is difficult to remove.

In the stabilized form:

• The disease progression slows down;
• Increased sensitivity, discomfort, and pain are almost absent;
• The affected area stabilizes, potentially remaining unchanged for 9-11 months.

Three stages of erosion development are also distinguished.

• Stage I – initial or superficial. At this stage, only the upper enamel layer is affected, covering no more than 1/3 of the tooth surface. The patient does not feel pain or discomfort when brushing or eating.
• Stage II – middle or transitional. The affected area increases, covering 1/3 to 2/3 of the tooth surface. The enamel layer is significantly damaged, down to the dentin, causing hypersensitivity and pain.
• Stage III – deep. Erosion affects the upper layer of the dentin, covering more than 2/3 of the tooth surface, with dark, highly visible spots.

Complications

Regardless of the erosion degree, the patient's quality of life deteriorates. Although there is no pain at the initial stage, the aesthetics of the smile worsen: dull spots appear on the tooth surface that resemble plaque but cannot be removed by brushing. Such spots indicate the onset of enamel destruction, making it softer and more sensitive to external factors.

As dentin becomes exposed, cosmetic defects become more noticeable. Yellow or brown spots appear, sharply contrasting with the light enamel. The disease more often affects the upper jaw's incisors, molars, and premolars, making the affected areas highly visible when smiling or talking.

Exposed dentin is sensitive to touch, causing pain while chewing. If the cause of the pain is not eliminated, gastrointestinal diseases may develop.

Dentin gradually deteriorates, involving the pulp, leading to other diseases such as pulpitis and periodontitis, potentially resulting in tooth loss.

Diagnosis of Tooth Erosion

Early signs of enamel layer destruction can only be noticed during a dental examination. If not detected early, the patient may visit the clinic with complaints of pain and discomfort, indicating that the disease has reached the second degree of severity.

The dentist listens to complaints and collects the medical history. Accurate responses help in diagnosing. At this stage, the specialist can identify the cause of erosion: for example, working in harsh, harmful conditions, a stomach disease causing acid reflux, or excessive citrus consumption.

The dentist then conducts an examination using a mirror and probe, identifying characteristic disease signs:

• Hard bottom, no pain when touched by the probe;
• Painful reaction to drying with air;
• Staining when exposed to iodine solution.

It is essential to confirm that it is erosion and not caries. Therefore, the dentist considers:

• The patient’s age – non-cariogenic enamel layer damage is typical for middle-aged people;
• Location of affected areas – usually symmetrical teeth, with defects on the most convex surface;
• Shape of the cavity – cup-shaped or saucer-shaped, with clear boundaries.

If enamel layer destruction is linked to endocrine disorders or gastrointestinal diseases, consultation with an endocrinologist or gastroenterologist is required to identify and eliminate the causes of tooth defects.