Dental erosion is a type of non–carious lesion characterized by the formation of enamel and dentin defects on the vestibular surface of the teeth. Areas of dental erosion are localized symmetrically: on incisors, canines, premolars; their formation leads to a change in the color of enamel, hyperesthesia of teeth, cosmetic defect. Pathology is detected by visual inspection, after drying the tooth surface and treatment with iodine tincture. Treatment of dental erosion includes complex remineralizing therapy (ingestion of calcium, phosphorus, vitamin and mineral complexes; local applications, electrophoresis), if necessary – filling of defects or coating of teeth with crowns.
K03.2 Dental erosion
Dental erosion is a lesion of the hard tissues of the tooth, characterized by a progressive loss of enamel and dentin. In practical dentistry, dental erosion refers to non-carious lesions, along with wedge-shaped defects, enamel hypoplasia, acid necrosis, pathological erasure, fluorosis. Enamel erosion is detected in 10-23% of patients who are not engaged in harmful industries. The disease occurs mainly in middle-aged women; it has a long (up to 10-15 years) course. Dental erosion is not only an aesthetic defect, but also a serious dental problem that needs immediate treatment.
Among the concepts of the etiology of dental erosion, mechanical, chemical and endocrine are the most popular, although none of these theories is exhaustive.
- Mechanical theory. A number of researchers associate dental erosion with excessive mechanical impact on the enamel, namely, the use of hard toothbrushes, whitening toothpastes and powders with increased abrasiveness.
- Chemical theory. As the leading causes, he considers the impact on the enamel of aggressive chemical agents – acid-containing products and beverages (marinades, pickles, citrus fruits, juices, carbonated drinks, etc.). At risk for the development of dental erosion are workers of harmful industries associated with the inhalation of acid fumes, metal and mineral dust particles. A number of medications, for example, with a high content of ascorbic acid, have a damaging effect on tooth enamel. Disease can be caused by chronic gastro-esophageal regurgitation in gastroesophageal reflux disease.
- Endocrine theory. It is based on studies that have revealed the connection of dental erosion with hyperthyroidism. It was found that in patients with thyrotoxicosis, dental erosion occurs 2 times more often than in people with a normal functioning thyroid gland, and every year the course of hyperthyroidism increases the risk of erosive tooth damage by 20%.
The classification of dental erosion is based on the criteria of the activity of the process and the depth of the lesion. In the clinical course of dental erosion, there are 2 phases: active and inactive.
- In the active phase, there is a particularly rapid destruction of enamel; the size of erosion changes every 1.5-2 months; there is an increased sensitivity of teeth.
- In the inactive phase, there is a relative stabilization of the process for 9-11 months; a decrease in dental hyperesthesia.
Depending on the depth of the defect, disease of 3 degrees is distinguished:
- I (superficial, initial) – with damage to only the upper layer of enamel
- II (medium) – with enamel damage along the entire depth to the enamel-dentine border
- III (deep) – with damage to the entire enamel and the upper layer of dentin.
In the initial stage, there is a loss of enamel gloss in the area of a limited area of the vestibular surface of the tooth. At this stage, it is possible to notice signs of the erosive process that has begun only after drying the tooth surface with a jet of air or applying 5% iodine tincture to the lesion area – in this case, a yellow-brown staining of the erosion site occurs.
Initially, the erosive defect is a rounded or oval bowl-shaped focus with a hard, smooth and shiny bottom. As the focus expands and deepens, a complete loss of the enamel layer and exposure of dentin may occur. At the I and II degrees of dental erosion, the defect has a whitish color; at the III degree of the pathological process, light yellow or brown pigmentation appears.
At the initial stage of dental erosion, with a stabilized course, there are no pain sensations. In the active phase, at medium and deep degrees, hyperesthesia phenomena are noted when brushing teeth, the action of chemical and thermal stimuli. The most common lesion is the symmetrical incisors, canines and premolars. Enamel erosion is often combined with pathological erasability of hard tooth tissues. The course of dental erosion is chronic, progressive, characterized by a gradual lesion of new teeth.
Dental erosion is diagnosed during a dental examination. A clearer localization of the defect is facilitated by drying the surface of the tooth crown, an iodine test. Pathology requires differentiation with wedge-shaped defects, enamel hypoplasia, and superficial caries.
To identify concomitant endocrine disorders, patients suffering from dental erosion may need to consult an endocrinologist, conduct a thyroid ultrasound, and study thyroid hormones. To exclude GERD, an examination by a gastroenterologist is recommended.
A comprehensive approach to the treatment of dental erosion consists of local and general therapeutic measures. In the active phase, the efforts of dental therapists are aimed at achieving stabilization of the process and stopping the progressive loss of hard tooth tissues.
- Local remineralizing therapy. It involves conducting a course of daily applications of fluoride-containing and calcium-containing preparations for 15-20 days, followed by coating the surface of the teeth with fluoride. These measures also help to eliminate enamel hyperesthesia. Additional mineralization of the hard tissues of the teeth is achieved by calcium electrophoresis.
- Systemic remineralizing therapy. As part of the systemic therapy of dental erosion, an admixture of calcium and phosphorus preparations, vitamin and mineral complexes is prescribed.
- Restoration of teeth. With a pronounced loss of hard tooth tissues and a noticeable aesthetic defect, erosion is restored using a light-curing composite, a veneer or an artificial crown.
In the stabilized stage, continued intake of vitamins and trace elements is indicated. In order to eliminate hyperpigmentation, it is possible to polish the tooth with a paste, gentle whitening, followed by applying fluoro gel or fluoro varnish to erosion.
Prognosis and prevention
Unlike caries, the development of dental erosion is in no way related to poor oral hygiene. However, against the background of the progression of the erosive defect, there may be a secondary attachment of carious lesions of the teeth. Therefore, the treatment of dental erosion should be timely and complete. After achieving erosion stabilization, patients require dispensary supervision by a dentist-therapist.
Prevention of dental erosion consists of the correct selection and use of dental care products, restriction of the use of products with high erosive potential, elimination of concomitant endocrine disorders. It is very effective to use phosphate-containing toothpastes 2-3 times a week.
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