Tooth Erosion: Symptoms, Types, Causes and Treatment

Tooth erosion, or dental erosion, is a growing and often overlooked dental health issue that affects children and adults alike. It is the irreversible loss of tooth substance caused by chemical processes—primarily acid attacks—not involving bacteria. Understanding how to spot the early signs, differentiate between types, identify causes, and choose effective treatments is crucial to preserving your smile and oral health. This article provides a comprehensive, evidence-based look at tooth erosion, bringing together the latest research and clinical insights.

Symptoms of Tooth Erosion

Tooth erosion often develops gradually, and its symptoms can be subtle at first. Recognizing these changes early can make all the difference in preventing severe, irreversible damage. People may notice increased sensitivity or changes in the appearance of their teeth, but sometimes, erosion progresses silently until major issues occur.

Symptom	Description	Severity	Sources
Sensitivity	Discomfort or pain from hot/cold/sweet	Mild to severe	2 3 5
Surface Change	Loss of enamel texture; glossy look	Early	5 7
Cupping	Small indentations on chewing surfaces	Moderate	5
Color Change	Yellowing as enamel thins	Progressive	3 5
Pain	Severe pain, especially if pulp exposed	Advanced	3
Tooth Shape	Shortening or flattening of teeth	Advanced	2 6

Table 1: Key Symptoms

Early Signs: What to Watch For

The earliest symptom is often increased tooth sensitivity, especially to cold, hot, or sweet foods and drinks 2 3. Alongside this, the enamel surface may lose its normal texture and take on a silky or glossy appearance—sometimes described as the "whipped clay effect" 5. Some people notice a dulling of the tooth surface or that old fillings seem to "stand proud" as the surrounding enamel wears away.

Progression: From Sensitivity to Pain

If erosion continues, you may observe small "cupping" indentations on the chewing surfaces, especially of molars. Over time, the teeth can appear shorter, flatter, or even thinner at the edges 5 6. The underlying yellow dentin starts to show as the white enamel erodes, causing a visible color change 3 5. In severe cases, erosion can expose the dental pulp, leading to intense pain or even abscess formation 3.

Why Symptoms Vary

Some individuals with slow-progressing erosion may not experience symptoms until significant damage has occurred 2. Conversely, rapid erosion—common with frequent acid exposures—often triggers immediate sensitivity.

Types of Tooth Erosion

Tooth erosion is not a one-size-fits-all condition. Understanding its types helps to pinpoint the underlying cause and choose the best management strategies. Dental professionals categorize erosion based on its origin, severity, and clinical pattern.

Type	Characteristic Feature	Common Location	Sources
Extrinsic	Caused by external acids (diet, env)	Facial/anterior teeth	4 6 10
Intrinsic	Caused by internal acids (gastric)	Lingual/posterior	4 6
Idiopathic	Unknown origin	Variable	6
Severity	Class I (mild) to III (severe)	Any	6

Table 2: Erosion Types

Extrinsic Tooth Erosion

This type results from acids that come from outside the body. Common sources include:

• Acidic foods and drinks (e.g., citrus, sodas)
• Certain medications (such as chewable vitamin C)
• Environmental exposures (like swimming in improperly chlorinated pools or working with industrial acids) 4 10

Extrinsic erosion typically affects the outer (facial) surfaces of front teeth, especially the upper incisors, due to frequent direct contact with acids 4.

Intrinsic Tooth Erosion

Intrinsic erosion is caused by acids originating inside the body, mainly through:

• Frequent vomiting (as in gastrointestinal diseases or eating disorders)
• Gastroesophageal reflux disease (GERD) 4 6

The classic pattern involves erosion on the tongue-facing (lingual) surfaces of upper teeth, since this is where gastric acids make the most contact 4.

Idiopathic Erosion and Other Classifications

Sometimes, no clear cause can be identified, and the erosion is labeled "idiopathic" 6. Additionally, clinicians may classify erosion by its severity (from early surface changes to deep tissue loss) or by location, such as "perimolysis" for erosion due to gastric acids 6.

Overlap With Other Tooth Wear

Erosion often occurs alongside other types of tooth wear, like abrasion (from brushing) or attrition (from grinding). These processes can interact and accelerate overall tooth loss 6 7.

Causes of Tooth Erosion

Tooth erosion is multifactorial, meaning several chemical, biological, and behavioral factors contribute to its development. Identifying the primary cause is crucial for effective prevention and management.

Cause	Example/Source	Modifying Factor	Sources
Diet	Acidic drinks, fruits	Frequency, timing	9 10 12
Gastric Acid	Reflux, vomiting, eating disorders	Salivary flow, pH	1 3 4
Saliva	Low flow or buffering capacity	Hydration, medication	1 8 11
Environment	Industrial acids, swimming pools	Exposure duration	4 10
Behavior	Oral hygiene habits, lifestyle	Brushing timing	9 10 12

Table 3: Erosion Causes

Dietary Factors

Acidic foods and beverages—such as sodas, sports drinks, citrus fruits, and wine—are major culprits. Not only the acidity (pH), but also the "titratable acidity" (total acid content), mineral composition, and how long acids stay in the mouth influence their erosive potential 9 10. Frequent sipping or holding acidic drinks in the mouth increases risk 9.

Intrinsic Factors: Gastric Acids

Stomach acids are extremely potent. Conditions like GERD, chronic vomiting (as seen in bulimia), or frequent regurgitation expose teeth to low pH, leading to rapid enamel loss 1 3 4. Studies have shown a strong association between diagnosed reflux disease and dental erosion, especially when combined with low salivary buffering 1.

Saliva’s Protective Role

Saliva acts as a natural buffer, neutralizing acids and supplying minerals for remineralization 8 11. Low salivary flow—due to dehydration, certain medications, or medical conditions—reduces this protection and accelerates erosion 1 8.

Environmental and Lifestyle Contributors

Exposure to airborne acids in workplaces, or swimming in pools with low pH, can cause localized erosion 4 10. Overzealous brushing, especially after acid exposure, can worsen tooth loss by removing softened enamel 9 10.

Behavioral Factors

Habits such as frequent snacking on acidic foods, sipping drinks slowly, or brushing immediately after consuming acids all increase risk 9 10 12. Regular exercise with dehydration and even chronic alcoholism can decrease saliva, further predisposing to erosion 12.

Treatment of Tooth Erosion

Because tooth erosion is irreversible, early intervention focuses on halting progression, addressing causes, and restoring lost tooth structure where necessary. Treatment is individualized and may involve both preventive and restorative measures.

Treatment	Approach/Method	Effectiveness	Sources
Preventive	Reduce acid exposure, diet modification	Highly effective	5 7 12
Saliva Support	Hydration, stimulate flow	Supports prevention	8 11
Topical Agents	CPP-ACP, fluoride varnishes	Variable; CPP-ACP best	13 14 16
Restorative	Fillings, crowns, composite resins	Needed for severe cases	3 5

Table 4: Erosion Treatments

Prevention: The First Line of Defense

• Dietary Modifications: Reduce frequency and contact time of acidic foods and drinks. Use a straw, avoid swishing, and rinse with water after consuming acids 5 9.
• Timing of Brushing: Wait at least 30 minutes after acid exposure before brushing to avoid abrading softened enamel 9 10.
• Hydration: Stay well hydrated and use sugar-free chewing gum to stimulate saliva 8 11.

Saliva-Enhancing Strategies

Ensuring optimal salivary flow is critical. This may involve addressing medical conditions, adjusting medications, or using saliva substitutes in severe cases 8 11.

Topical Agents and Remineralization

• Fluoride Toothpaste and Varnishes: While widely used, studies show mixed results for preventing further erosion; their main benefit is for caries prevention 16.
• CPP-ACP (Casein Phosphopeptide-Amorphous Calcium Phosphate): Shown in studies to significantly increase enamel hardness and reduce further erosion, especially when used before or after acid exposure 14 16.
• Hydroxyapatite-based Products: Recent research supports their role in remineralizing enamel and managing mild erosion in at-risk individuals, such as athletes 13.

Restorative Treatments

For advanced erosion with significant tooth structure loss:

• Composite Resin Fillings: Restore aesthetics and function in mild to moderate cases 3 5.
• Crowns (e.g., Stainless Steel in children): Used to restore lost vertical dimension and protect severely eroded teeth 3.

Individualized Management Plans

A thorough assessment to identify risk factors is essential. Regular monitoring with diagnostic models or photographs helps track progression and effectiveness of interventions 5 7 12.

Conclusion

Tooth erosion is a complex, multifactorial condition that requires early recognition, ongoing monitoring, and a tailored approach to prevention and treatment. By understanding the symptoms, types, causes, and available therapies, patients and dental professionals can work together to maintain oral health and prevent irreversible damage.

Key Takeaways:

• Symptoms: Range from subtle sensitivity and glossy enamel to severe pain and tooth loss 2 3 5 6.
• Types: Classified by acid source (extrinsic or intrinsic), pattern, and severity 4 6.
• Causes: Include dietary acids, gastric reflux, low saliva, environmental exposures, and lifestyle habits 1 3 4 8 9 10.
• Treatment: Focuses on prevention (diet, saliva, behavior), use of remineralizing agents (CPP-ACP, hydroxyapatite), and restoration in severe cases 3 5 13 14 16.

Protecting your teeth from erosion starts with awareness and early action. If you notice any warning signs, consult your dental professional for a personalized prevention and treatment plan.