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What is Enamel Erosion?

Enamel erosion, also referred to as dental erosion, is most simply described as the loss of tooth enamel. However, there is nothing simple about the importance of healthy tooth enamel.

Tooth enamel is the hard outer surface of your teeth, and its main purpose is to protect the dentin layer (the interior of the tooth). Despite being the hardest mineral in the human body—yes, even harder than bone—tooth enamel can become permanently damaged and eventually wear away.

The tooth enamel layer is exceptionally tough and about 2.5 mm thick, but certain factors can directly or indirectly cause excessive wear, eventually leading to the sensitive dentin layer being exposed. You might be surprised to learn that sugar isn’t always the cause of enamel erosion and tooth decay. In fact, the primary cause of enamel erosion is related to calcium.

Causes of Enamel Erosion

You’re probably already aware of how important calcium is for bone health, but it’s also vital for healthy teeth and strong enamel. When calcium is leached from your teeth, your enamel will weaken and eventually become damaged. And what is the primary factor behind calcium leaching? Acid!

Acidic conditions in the mouth, whether caused by diet or unrelated health issues, lead to softened enamel. When tooth enamel is soft, it’s very vulnerable to decay, which is where tooth decay related to sugar comes into play. Combine both acid and sugar, and you can experience even more enamel erosion than either alone.

Diet plays a significant role in chronic enamel erosion issues in children and adults. Some common food items that contribute to enamel erosion include:

  • Alcohol: Alcoholic drinks can be both dehydrating and loaded with sugar. Wine, in particular, can be quite acidic and can cause dry mouth.
  • Fruit Juice: Fruit juice is often thought of as healthy, but some fruit juices can be like battery acid in terms of how acidic they are. Lemon, orange, grapefruit, cranberry, and apple juice are all fairly high in acid, which can weaken enamel.
  • Citrus Fruit: Fresh citrus fruit, especially oranges, lemons, and limes, can all wear down teeth, as well. Although not a citrus fruit, tomatoes are also very acidic.
  • Sour Candy: The acidity in these candies will weaken your enamel, allowing the sugar to stick much more easily. Add in a gummy factor, and you’re looking at perhaps one of the most damaging types of candy you could eat.
  • Carbonated Drinks: Soda is one of the worst drinks when it comes to protecting tooth enamel. Not only are sodas loaded with sugar, but the carbonation causes these drinks to be high in acid. This means even your diet and sugar-free carbonated beverages can still contribute to enamel erosion.
  • Sports Drinks: Sports drinks are nearly as bad as sodas due to their high sugar content. Sports drinks can also have added ingredients that are acidic in nature, like citric and phosphoric acid.

The easiest way to remember which food or drink items contribute to enamel erosion is to ask yourself if it’s citrus, alcoholic, carbonated, or sour.

Health issues can also play a role in tooth enamel erosion, particularly those involving the digestive system. Some common health conditions linked to tooth enamel erosion include:

  • GERD/Acid Reflux: Your dentist can often notice that you have issues with acid reflux without being told. GERD and chronic acid reflux can cause serious enamel erosion, particularly on the back of your teeth.
  • Eating Disorders: Bulimia and anorexia can cause permanent damage to tooth enamel but in different ways. Enamel erosion caused by bulimia is linked to the teeth’s exposure to stomach acid from vomiting. Enamel erosion caused by anorexia is linked to the depletion of minerals in the body, primarily calcium.
  • Diabetes: Being an inflammatory disease that can affect the entire body, diabetes can also cause a number of oral health issues. These issues include enamel erosion, tooth decay, tooth loss, and gum disease.
  • TMD: Temporomandibular Disorders or TMD relates to issues involving the jaw joints and muscles within that area. Symptoms of TMD include tooth grinding, clenching, abnormal chewing, etc. This disorder can cause physical damage to the tooth enamel layer in the form of excessive wear, chipping, and even cracked teeth.

Medications, in general, can affect calcium levels in the body, so it’s important to speak with both your doctor and dentist to ensure your bases are covered.

Symptoms of Damaged Enamel

Enamel erosion can sometimes be seen as physical damage to the teeth, but it tends to first be felt in the form of a toothache or sensitivity to hot and/or cold foods or drinks.

The most common symptoms of enamel erosion include:

  • Tooth pain and sensitivity
  • Discoloration in the form of yellowing
  • Transparency, especially around the edges of the front teeth
  • Small cracks or dents on the surface of the teeth
  • An odd rounded appearance to the teeth
  •  A roughed-up appearance on the tooth’s surface

Enamel erosion and related tooth decay are fairly common. If you experience even slight discomfort or sensitivity, visit your dentist to address the issue as soon as possible.

Treatment of Existing Enamel Erosion

Treatment of existing enamel erosion varies widely, as many factors can be at play. Typically, a patient will schedule an appointment with their dentist for a toothache, a chipped tooth, or some other symptom similar to those listed earlier. During the appointment, the dentist will examine the suspect tooth and likely find enamel erosion issues. From there, the dentist will evaluate the extent of the damage, what may have caused the damage, and how to address the damage and decay that’s present.

The most common treatment options include:

  • Fillings for minor enamel erosion and decay, often localized in one small area
  • Crowns for major decay spots too large for a filling
  • Dental bonding to protect surfaces of multiple teeth
  • Veneers for more permanent protection of multiple or all teeth

Depending on the type of enamel erosion present and how much damage has been done, your dentist may need to perform a root canal or, in the most severe cases, an extraction. In the event of a root canal, your dentist will likely recommend a crown. In the event of an extraction, you’ll have options for a bridge or a permanent implant.

Prevention of Future Enamel Erosion

Enamel erosion is permanent, which means any enamel damage that occurs can only be managed and not reversed. This is why prevention is incredibly important, especially if you already have tooth decay and erosion issues occurring.

Some of the most effective tips for preventing enamel erosion include:

  • Reducing consumption of sugary, acidic, and/or carbonated beverages. Switch to unsweetened tea, water, and other options instead.
  • Drinking water when eating citrus fruits and other acidic foods to help rinse away the juice and other particles.
  • Chewing xylitol dentist-recommended gum frequently to inhibit bacterial growth, stimulate saliva, and clean acid residue off your teeth.
  • Pairing acidic foods with other meals to reduce acidity levels in the mouth. For example, if you enjoy grapefruit at breakfast, consider having yogurt, as well.
  • Rinsing your mouth after having high-acidity food. But be sure not to brush right away, as your enamel will be soft. Brushing on softened enamel can actually cause more damage, so wait at least an hour.
  • You’ll naturally want to brush right away after vomiting or experiencing acid reflux, but resist the urge for the same reason mentioned above. Rinsing thoroughly and waiting at least half an hour can really help protect your teeth.
  • Consider using a straw when drinking juice or soda, and swallow immediately rather than swishing it around your mouth.
  • Using a dentist-recommended toothbrush and fluoride toothpaste. Brush at least twice a day and floss after big meals. Consider not rinsing with water after brushing so the residual fluoride is left on your teeth.

If you suspect you’re experiencing the effects of enamel erosion or would like to learn more about how to protect your teeth from future enamel erosion, schedule an appointment with your dentist. Remember: Enamel erosion is irreversible. The better you take care of your smile now, the less chance you have of experiencing permanent enamel damage in the future.