The prevalence of Dental Erosion and Associated Risk Factors Can wePrevent this Emerging Dental Problem Dr.Tahani Rashad Jamal Consultant in Advanced Restorative Dentistry Umm Al-Quraa University Medical Center Introduction Dental erosion is the pathologic, chronic, localized loss of dental hard tissue due to chemical dissolution of the tooth surface by acid and/or chelating agents without bacterial involvement (ten Cate and Imfeld, 1996). The etiology of dental erosion is considered to be multifactorial., associated with extrinsic and/or intrinsic acid that is not produced by bacteria. The chemical process of dental erosion is similar to that of caries, i.e., dissolution of hydroxyapatite by acids, the clinical manifestations and management of dental erosion are fundamentally different from caries because the erosive process does not involve acid of bacterial origin. It is often widespread and may involve the entire dentition. Dental hard tissue loss associated with erosion is almost always complicated by other forms of tooth wear such as attrition and abrasion, it accelerates tissue loss caused by tooth-to-tooth contact while chewing and grinding (attrition) , by abrasive wear while mechanically brushing or cleaning tooth surfaces (abrasion). Or by chemically when acidic content hits the tooth surface such as with certain medications like aspirin or vitamin C tablets(Corrosion), highly acidic foods, GERD, and frequent vomiting from bulimia or alcholism If dental erosion is not managed through effective interventions, it may result in substantial loss of enamel and subsequent exposure of the underlying dentin, which can in turn, lead to dentin sensitivity, loss of vertical height and esthetic problems. Effective management of dental erosion is largely dependent on understanding its etiology and early recognition of its signs and symptoms in clinical practice. Intrinsic acids in the oral cavity is mostly from the backflow of the gastric contents through the esophageal tract. Gastric juice consists mainly of hydrochloric acid, produced by the parietal cells in the stomach. The presence of the highly acidic gastric juice (pH 1.0-3.0) in the oral cavity may lead to dental erosion.Gastro-esophageal reflux disease(GERD), bu­limia and rumination are the main conditions associated with the backflow of gastricjuice to the mouth. Saliva flow and buffering capacity When acidic substances enter the mouth, salivary glands will re­flectively increase secretion and saliva flow will accelerate to clear the acids from the oral cavity. Since human saliva contains bicar­bonates and urea, it rapidly neutralizes the acidic remnants and returns the oral pH to normal – which is known as the buffering capacity of saliva, an important mechanism for oral pH regula­tion. Many factors affect saliva flow rate and buffering capac­ity, including autoimmune diseases (e.g., Sjögren’s syndrome), medications (e.g., antidepressants and antipsychotics) and ag­ing. When saliva flow rate is reduced, its clearance and buffering capacity will be negatively impacted, resulting in abnormal acid retention in the mouth, which, in turn, may contribute to dental erosion. Saliva flow rate and buffering capacity are therefore important etiological factors for erosion. Low saliva flow rate and poor buffering capacity are often found to be associated with the development of dental erosion. Risk factors for dental erosion include: Frequent use of acidic dietary products, especially soft drinks, fruit juices and acidic foods, GERD, Prolonged use of chewable acidic medications, especially vitamin C and aspirin &Low saliva flow rate and inadequate saliva buffering capacity. Erosion is considered a lifestyle issue, with both dietary selection and intake habits combining as risk factors. If no effective intervention occurs at an early stage, the eventual outcome of dental erosion is severe loss of dental hard tissues that adversely affects function and esthetics Effective strategies for prevention of dental erosion may be formulated correspondingly as follows: 1. Avoid or reduce direct contact with acids through behavioral and clinical interventions. 2. Increase acid resistance of dental hard tissues through fluoride therapy. 3. Increase resistance to hydroxyapatite dissolution through the provision of calcium and phosphates. Prevention & Management Aim Depending on the interactions of the biological, behavioral and chemical factors some individuals will exhibit more erosive tooth wear than others. The aim of the present this is to analyses potential risk factors in developing dental erosion and To develop recommendations to prevent this emerging dental problem (dental erosion). Effective prevention of dental erosion includes measures that can avoid or reduce direct contact with acids, increase acid resistance of dental hard tissues and minimize tooth brushing abrasion, The importance of erosion in dental health promotion should not be overlooked. Prevalence Dental erosion is a prevalent condition that occurs worldwide according to research done it increased compared to 5 years ago, There are indications that the prevalence of erosive lesions is increasing, especially in younger age groups (Deery et al., 2000; Linett and Seow, 2001; Nunn et al., 2003; Dugmore and Rock, 2004; Jaeggi and Lussi, 2006; Kazoullis et al., 2007). In preschool children between the ages of 2-5 years dental erosion was found to vary from6 to 50% in deciduous teeth (Al-Malik et al., 2002; Luo et al., 2005; Harding et al., 2003; Millward et al., 1994a and b). In young children in the age group of 5-12 years, 100% of the children had some signs of enamel erosion, 48% had dentinal erosion and 14% had already lesions in the permanent dentition (Jaeggi and Lussi, 2004) dental erosion is more common in the primary and permanent dentitions of Saudi Arabian boys compared with results for similar age groups from the United Kingdom(Ibrahim Al-Majed et al.,2002). It has long been recog­nized that demineralization of dental enamel will occur once the oral environmental pH reaches the critical threshold of 5.5 Acids in the mouth originate from three main sources: produced in situ by acidogenic bacteria, ingested extrinsic acids as dietary components and dislocated intrinsic acids through the backflow of gastric contents. Acids of bacterial origin cause caries, while extrinsic and intrinsic acids cause dental erosion. Clearance of acids from the oral cavity is, to a large extent, dependent on the saliva flow rate and the saliva buffering capacity. Low saliva flow rate and poor buffering capacity al­low prolonged retention of extrinsic and intrinsic acids in the mouth, which will accelerate the erosive process. Result Etiological factors Dental erosion does not always need to be treated. With regular check-ups and advice your dental team can prevent the problem getting any worse and the erosion going any further. If a tooth does need treatment, it is important to protect the enamel and the dentine underneath to prevent sensitivity. Usually, simply bonding a filling onto the tooth will be enough to repair it. However, in more severe cases the dentist may need to fit a veneer. What can patient do to prevent dental erosion? •Have acidic food and drinks, and fizzy drinks, sodas and pops, just at mealtimes. This will reduce the number of acid attacks on your teeth. •Drink quickly, without holding the drink in your mouth or ‘swishing' it around your mouth. Or use a straw to help drinks go to the back of your mouth and avoid long contact with your teeth. •Finish a meal with cheese or milk as this will help cancel out the acid. •Chew sugar-free gum after eating. This will help produce more saliva to help cancel out the acids which form in your mouth after eating. •Wait for at least one hour after eating or drinking anything acidic before brushing your teeth. This gives your teeth time to build up their mineral content again. •Brush your teeth last thing at night and at least one other time during the day, with fluoride toothpaste. Use a small-headed brush with medium to soft bristles The rapidly growing prevalence of erosion demonstrated by nationwide survey emphasizes the need for further research into the etiology of erosion and possible methods of preventing and treating this emerging dental problem. Extrinsic acids: Acidic beverages, Acidic foods and dietary ingredients and Other sources of extrinsic acids such as Acidic medications such as those containing vitamin C and aspirin Environmental and occupational factors may contribute to dental erosion in selected populations, including swimmers, workers in an environment with acidic industrial vapors.