Dental erosions. Non-carious lesions lacking in substance.

The integrity of dental structures is a condition responsible for oral aesthetics.

Teeth with symmetrical, continuous, harmonious contours give the arch a pleasing appearance that everyone wants.

There are many factors that can compromise dental aesthetics, most of which are found in daily habits and diet.

The lesions with insufficient substance can be either carious or non-carious in nature.

The latter are the result of parafunctions or bad habits that lead, over time, to loss of enamel or even dentine.

An important lesion with a lack of substance, frequently found among patients, is dental erosion.

Erosion is the process by which enamel prisms become detached by the chemical action of substances introduced into the oral cavity.

Causes of dental erosion

  • Extrinsic factors

– Low pH foods: acidic drinks and fruit can cause enamel degradation. In general, those with a pH value below 7 can be blamed.

– Enamel is the outer dental layer, visible in the oral cavity and with an increased susceptibility to local changes.

– Acids contained in low pH foods will cause the enamel to soften. Agents implicated in enamel erosion include: apples, strawberries, tomatoes, wine, natural juices (from lemons, oranges, apples) and carbonated drinks.

  • Intrinsic factors:

– Gastric disorders: regurgitation, vomiting, gastro-esophageal reflux or bulimia are pathologies involving the backflow of digested food or gastric acid into the oral cavity.

During digestion, the stomach releases a considerable amount of gastric acid, with a low pH, which is necessary to process food.

Back in the oral cavity, due to various general diseases, gastric acid irritates both the oral mucosa and the inner surface of the teeth, leading to enamel erosion.

How to recognize an eroding tooth

  • The dull, non-glossy appearance of the tooth: the enamel is organized in prisms with varying orientation to capture and transmit light differently and give the teeth their natural shine.

  • Erosive substances will detach from the surface prisms, ‘levelling’ the surface of the tooth and depriving it of its characteristic shine. Most often a group of teeth is affected.

  • Appearance of microcracks: at first, they are not visible to the naked eye.

  • Dentin hypersensitivity: as the erosion process progresses, when triggers are not removed, dentin sensitivity occurs.

The enamel is designed to protect the dentine, which is well innervated, from stimuli that may cause it to feel painful. The patient will experience painful tenderness on contact with liquids and foods with extreme temperatures, and later, as the pain progresses, it will appear spontaneously and be irreversible on the administration of painkillers.

This is usually when the patient turns to the dental surgery.

Treatment of dental erosions

Enamel that has been lost as a result of acid attack will not recover over time. Therapy includes detecting the habits that lead to dental erosion, correcting them and restoring the affected teeth.

If the lesions are small, incipient, a fluoride varnish can be applied for dentin protection to prevent pain.

For considerable loss of substance, reconstruction can be carried out with fillings or prosthetic crowns.

The patient is able to prevent erosions by correcting the diet and removing any risk factors.

Follow-up with the dentist is useful in assessing the results.

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