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Diagnoses

Chemical erosion

About this diagnosis

Diagnoses are associated with common findings which are used to prescribe appropriate treatment.

Alternate terms: Acid erosion; Erosion, acid; Erosion, chemical.

Tooth enamel is over 90% mineral, which dissolves in acid. Any acid can dissolve tooth enamel, including those found in food and drink. These may include citric acid (found at especially destructive pH in lemons), phosphoric acid (a common ingredient in soda pop) and ascetic acid (found in vinegar).

Another non-bacterial source of acid that can be destructive to the teeth is stomach acid (hydrochloric acid). Bulimic patients and those with gastro-esophageal reflux disorder (GERD) are at risk for the destruction of their teeth from their own stomach acid. Edentulism can result if the cause is not brought under control.

Severe enamel demineralization from chronic exposure to acids

Figure 1: These teeth exhibit acid erosion secondary to bulimia. The lingual surfaces (not shown) are commonly even more eroded than the facial surfaces (shown) in bulimic patients. Acid eroded teeth are easy to spot. The enamel appears uniformly thin and transparent, even on areas that do not wear against an opposing tooth, and once-sharp edges are uniformly rounded. Normal surface convexity may become flattened or concave (see arrow), and caries may or may not be present, depending on the patient's oral hygiene.

Sometimes tooth restorations (which are generally acid-resistant) will be elevated above the surface contours of the acid-eroded teeth.

Molar tooth eroded by chronic exposure to stomach acid

The lower six-year molars have been eroded by stomach acid in this patient, who suffered from a chronic gastroesophageal reflux (GERD) condition. GERD can predispose patients to esophageal cancer, and when suspected should be diagnosed and treated by a physician. Dentists can observe this pattern and make an appropriate referral to a gastroenterologist physician for evaluation. Note that The 12-year molars are not as involved, for two reasons.

First, they had been in the mouth for less than two years when the condition was diagnosed; second, they have been protected from stomach acid by the tongue, which falls back in the mouth when the patient is sleeping. This patient's GERD condition was especially active while the patient was sleeping, and was caused by presence of a sliding hiatal hernia. The white area on the affected six-year molar is an oversized sealant.

There is an overused term known as "idiopathic erosion", which is used when specific causes for the observed erosion cannot be identified. Such cases can be frustrating for the provider and the patient, because the success of treatment is difficult to predict.