Tooth wear

There are a number of causes of tooth wear. The most common is erosion of the outer surface (enamel) of your tooth due to acid eating it away. Tooth enamel can’t be replaced naturally, but there are treatments to repair damage and you can make changes to stop it getting worse.

Key points

  1. Enamel is the hard coating of each tooth. If the enamel is worn away, it uncovers the dentine underneath, which can lead to pain and sensitivity.
  2. There are 3 main types of tooth wear: erosion, abrasion and attrition, but erosion is the most common. 
  3. Erosion is caused by exposure to acids, such as those in fizzy drinks, sports drinks, wine, fruit juice and sugary foods. It is a slow process that you generally do not notice until you’ve lost quite a bit of enamel.
  4. Once lost, enamel can't be replaced naturally, but there are treatment options to rebuild the enamel or protect your tooth from further erosion.
  5. You can prevent further enamel loss by removing sugary and acidic food and drink from your diet and following good dental hygiene practices. 

What are the different types of tooth wear?

Tooth wear is the umbrella term for tooth erosion, abrasion and attrition.

  • Dental erosion is the most common form of tooth wear. Most of this article will discuss dental erosion.
  • Abrasion is damage to your teeth and gums by an external source, such as over-vigorous brushing.
  • Attrition is caused by an internal source, such as tooth grinding.

What are the causes of dental erosion?

When your teeth come into contact with something acidic, the enamel becomes softer for a while, putting it at risk of being eroded. Your saliva is alkaline and slowly balances out this acidity until your mouth gets back to its natural balance.

If acid attacks happen too often, your mouth doesn’t get time to repair itself and, over time, you start to lose the surface of your teeth.

An acid attack can come from:

  • fizzy drinks, sports drinks, fruit juices, wine or apple cider vinegar
  • food high in sugar or acid such as citrus fruit
  • high intake of caffeine-containing products
  • vomiting often, because of bulimia, hiatus hernia or oesophageal problems or drinking too much alcohol
  • medications such as aspirin, antihistamines, Vitamin C, some iron supplements and antibacterial mouthwashes
  • a dry mouth or low flow of saliva
  • insufficient water intake or severe dehydration following extreme exercise
  • gastrointestinal (digestive) problems such as acid reflux disease (GORD)
  • physical wear and tear from brushing your teeth too hard or flossing incorrectly, biting on hard objects (such as fingernails, bottle caps or pens), or chewing tobacco. 

You can also get a combination of erosion and abrasion from brushing straight after eating or drinking something acidic or vomiting.

What are the symptoms of dental erosion?

Erosion usually shows up as hollows in your teeth and the tooth surface and edges wearing away. Your teeth become more yellow, as this is the colour of the dentine underneath the enamel. Because the dentine is sensitive, you may notice your teeth being more sensitive to heat and cold, or acidic foods and drinks. This sensitivity may increase as the erosion gets worse.

How is dental erosion diagnosed?

See your dentist who will do a physical examination. Children and adults should visit your dentist or dental hygienist once a year and more often if your dentist recommends it.

How is dental erosion treated?

Once the enamel of a tooth is lost, it cannot be replaced naturally, so prevention is better than cure. However, you can help rebuild the enamel coating through fluoride treatment such as toothpaste, Tooth Mousse, varnish or restorative material.

Other treatments may include fillings or crowns to protect the tooth from further decay and make your teeth look better.

If your dental erosion is caused by another condition, such as GORD or bulimia, this condition also needs to be treated.

Following the prevention steps below will also help your dental erosion.

How can I prevent dental erosion?

  • Follow dental hygiene recommendations to brush your teeth twice a day with a fluoride toothpaste and to floss them once a day.
  • Cut out highly acidic foods and drinks from your diet, such as carbonated sodas, lemons, and other citrus fruits and juices. Drink milk or water instead.
  • Rinse your mouth immediately with clear water after eating acidic foods, drinking acidic drinks or taking medication. Do not rinse with flavoured water as this contains sugar.
  • Drink more water throughout the day, especially if your mouth is dry.
  • Use a straw when you drink acidic drinks. The straw pushes the liquid to the back of your mouth, avoiding your teeth.
  • If you eat or drink anything acidic, wait for about one hour before brushing your teeth. Brushing straight after acidic foods and drinks may cause even more enamel damage.
  • Avoid snacking between meals. Your mouth is acidic for a few hours after eating foods high in sugar and starches, so snacking increases the chance of tooth decay.
  • Chew sugar-free gum after meals. This boosts saliva production to up to 10 times the normal flow.

Learn more

The following links provide further information about dental erosion. Be aware that websites from other countries may have information that differs from New Zealand recommendations. 

Food and drinks for healthy teeth Ministry of Health, NZ, 2017
Dental erosion Better Health, Australia, 2017
Taking care of your teeth Health Navigator, NZ, 2017

References

  1. Dental erosion Oral Health Foundation, UK
  2. Dental remineralization – simplified Oral Health Group, US, 2012
  3. Erosion University of Adelaide, Australia

Reviewed by

Associate Professor Jonathan Broadbent is an Associate Professor in Dental Public Health, Department of Oral Sciences, University of Otago. He is a dental public health specialist.
Credits: Health Navigator Editorial Team. Reviewed By: Jonathan Broadbent, Associate Professor in Dental Public Health, Department of Oral Sciences, University of Otago