We can all identify with the image of waves beating against the shore and the abrasive action of sand and pebbles.
Similarly, dental erosion is a form of tooth wear caused by softening of tooth tissue due to the presence of acid in the mouth.
The softened tissues are progressively eroded by the usual chewing, brushing activities and tooth-to-tooth contacts.
If erosive toothwear is not diagnosed and stabilised, a child may suffer tooth sensitivity, over closure and poor aesthetics due to severe tooth surface loss.
Restoration of lost enamel and dentine can be difficult, expensive and requires intensive maintenance and continual monitoring.
Acids causing dental erosion can be various and multiple. Dietary acids are the principle source of extrinsic acids. The excessive consumption of low pH carbonated beverages, sports drinks, wines and fruit juices have been associated with dental erosion.
The regular use of acidic medicaments is also a cause of dental erosion. These include chewable vitamin C tablets, iron preparations and some of the powder versions of asthma preventer therapies and relief bronchodilators.
Furthermore, research has also reported an increased severity of tooth wear in abusers of Ecstasy. This is attributed to the dry mouth, jaw tension and tooth-clenching side-effects of this drug together with the increased consumption of carbonated drinks per trip.
International studies show that younger age groups are being increasingly affected by dental erosion and at a more progressive rate.
In 1994, 27 per cent of examined British 12-year-olds were affected by dental erosion, this increased to 42 per cent of 11-14-year-olds by the year 2000 and to 59.7 per cent of 12-year-olds in 2004. In the year 2000, 58 per cent of British four to six-year-old children examined were affected.
Local data is not yet available. However, one must consider that a WHO study in 2008 reported that Maltese youngsters have a higher- than-average rate of daily consumption of soft drinks, and that the European School Survey Project on Alcohol and Other Drugs (ESPAD, 2003) listed Malta as having the highest ranking of all 35 participating European countries in terms of the percentage (35 per cent) of 16-year-old-boys and girls with themost frequent wine consumption figures.
Additionally, the International Study on Asthma and Allergies in Children (ENHIS, 2007) has shown that Maltese children report a higher prevalence of asthma symptoms when compared with the European region average. This leads us to conclude that dental erosion is potentially an issue of local concern.
Numerous preventive measures include:
• Diminishing the frequency and severity of the acid challenge by decreasing the amount and frequency ofacidic drinks, drinking quickly rather than sipping and using a straw.
• Enhancing the defence mechanisms of the body by increasing salivary flow by the use of sugarless lozenges or gum.
• Enhancing the acid resistance, and rehardening of the tooth surface by daily use of a fluoride toothpaste and mouthwash.
• Improving chemical protection by neutralising acids in the mouth by dissolving sugar-free antacids or keeping a high calcium and phosphate food such as cheese in the mouth.
• Decreasing abrasive forces by using softer toothbrushes and less abrasive toothpastes in a gentle manner, and rinsing with water rather than brushing right after an acidic episode.
• Providing mechanical protection by asking your dentist about applying protective coatings to eroded enamel and dentine.
Dr Gatt is a paediatric dentist.