There are a number of factors that contribute to enamel wear/erosion.

Chemical causes

• Acid produced by plaque bacteria¹
• Acidic, carbonated or sugary drinks^2,3
• Acidic or sugary foods^2,3
• Reflux of gastric acid (GORD)⁴
• Vomiting^2,3
• Low salivary flow rate²

Mechanical causes

• Over brushing³
• Brushing too hard³
• Brushing too soon after acid challenge⁵
• Bruxism³

Downgrading of prophylactic measures

• Rinsing with water after brushing with fluoridated toothpaste¹
• Dental plaque may constitute a barrier to fluoride uptake^6,7

Understanding these factors leads to potential measures to combat enamel wear and dental caries in at-risk patients. Dental professionals should reinforce brushing with fluoridated dentifrice and review technique where necessary. Additionally, it is important to ensure that patients do not rinse with water after brushing.¹

In the surgery, plaque removal should be maximised to optimise fluoride uptake and reduce cariogenicity.

The use of an adjunctive 'high fluoride' mouth rinse to increase fluoride levels above brushing alone may be beneficial.⁸

The patient can be advised on diet:
– Reduce fruit acid intake and 'swishing' of sugary/carbonated drinks⁵
– Drink acidic beverages through a straw⁴

The use of sugar-free chewing gum after food can be suggested, which stimulates saliva flow and reduce the likelihood of postprandial reflux.⁵

References

1. Pitts N et al. Post-brushing rinsing for the control of dental caries: exploration of the available evidence to establish what advice we should give our patients. Br Dent J 2012; 212(7): 315–320.
2. Jarvinen VK et al. Risk factors in dental erosion. J Dent Res 1991; 70: 942–947.
3. Abrahamsen TC. The worn dentition – pathognomic patterns of abrasion and erosion. Int Dent J 2005; 55: 268–276.
4. Touyz LZG et al. Dental erosion and GORD – Gastro Oesophageal Reflux Disorder. International Dentistry SA 2010; 12(4): 18–26.
5. Lussi A et al. Erosive tooth wear: diagnosis, risk factors and prevention. Am J Dent 2006; 19(6): 219–225.
6. Watson PS et al. Penetration of fluoride into natural plaque biofilms. J Dent Res 2005; 84: 451–455.
7. Alves ARB et al. Clinical and laboratory evaluation of the ability of fluoride gels to reach approximal dental regions. Braz Dent J1993; 4(2): 119–126.
8. Duckworth RM et al. Effects of flossing and rinsing with a fluoridated mouthwash after brushing with a fluoridated toothpaste on salivary fluoride clearance. Caries Res 2009; 43: 387–390.