Tooth erosion is the progressive, irreversible loss of tooth structure resulting from chemical dissolution of enamel and underlying dentin by acids that are not produced by oral bacteria. Unlike dental caries, erosion is not driven by microbial metabolism — it occurs through direct acid contact with tooth surfaces, independent of plaque activity.

Common Causes

Acid sources responsible for tooth erosion are broadly classified as extrinsic or intrinsic:

• Extrinsic (dietary): Carbonated beverages, energy drinks, citrus juices, and vinegar-containing foods with low pH are leading culprits.
• Intrinsic (gastric): Gastric acid reaching the oral cavity — through gastroesophageal reflux disease (GERD), bulimia nervosa, or recurrent vomiting — can cause severe palatal and lingual erosion.
• Environmental and occupational: Prolonged exposure to acidic aerosols or certain medications (e.g., chewable ascorbic acid) can also contribute.

Clinical Significance

As enamel dissolves, the softer dentin beneath is exposed, producing a range of consequences that affect both function and esthetics:

• Dentinal hypersensitivity: Exposed dentin tubules transmit thermal, osmotic, and tactile stimuli, causing sharp or lingering pain.
• Altered tooth morphology: Cupping, grooving, and flattening of occlusal and incisal surfaces are characteristic signs.
• Esthetic changes: Teeth appear shorter and more yellow as translucent enamel is lost and the warmer hue of dentin becomes visible.
• Loss of vertical dimension: Widespread erosion can reduce occlusal height, leading to complex restorative and occlusal challenges.

Diagnosis and Management

Clinicians use validated indices such as the Basic Erosive Wear Examination (BEWE) to score severity across sextants. Early erosion may present only as a loss of surface luster on enamel; advanced cases show significant cupping and frank dentin exposure.

Management centers on three priorities: identifying and eliminating the acid source, protecting remaining tooth structure, and restoring lost tissue when necessary. Saliva plays a critical buffering and remineralization role, so strategies that stimulate salivary flow — such as sugar-free xylitol gum — are often recommended alongside high-fluoride topical agents. Severe cases may require composite resin or ceramic restorations to re-establish occlusal form and vertical dimension.

Early identification of the underlying acid source is the single most impactful step in halting tooth erosion and preserving long-term dental health.