Erosive tooth wear

As a new graduate I was very much encouraged by my peers to become a member of the Irish Dental Association (IDA).

Since graduation, I have been present at a number of very informative evenings organised by the Munster branch of the IDA on various dentally-related topics. The last

presentation I attended was on the topic of tooth wear, or tooth surface loss (TSL), given by Dr Frank Burke, senior lecturer and consultant in restorative dentistry at Cork University Dental School and Hospital.

The majority of this article will focus on what I believe to be the increasing prevalence of erosive tooth wear in young children and teenage patients.

What is tooth wear?

Tooth wear is defined as the non-traumatic, non-bacterially mediated loss of tooth structure. Types of tooth wear include attrition, abrasion, erosion, abfraction and demastication.

The 1993 UK National Child Dental Health Survey reported that 52% of five-year-olds had erosion on the palatal aspects of primary incisors, while 27% of 15-year-olds had palatal erosion of their permanent incisors.

Working as a VDP has given me the opportunity to sample working life in both a general dental practice and an HSE clinic, where the majority of patients are under the age of 16, and I actually believe these figures to be much higher, especially in the teenage group. I estimate that 40-50% of teenage patients attending HSE clinics have a degree of erosive tooth wear to a greater or lesser extent.

We can subdivide the cause of erosive tooth wear as being from either an intrinsic or extrinsic source.

Intrinsic sources

Intrinsic sources of erosive tooth wear include gastro-oesophageal reflux disease (GORD), hiatus hernia and rumination, where a person actively regurgitates their food and holds it in their mouth over a period of time.

It also can be as the result of morning sickness associated with multiple pregnancies, as well as from eating disorders such as anorexia, bulimia and the new phenomenon of orthorexia, which refers to an obsession with healthy eating and a rigidly controlled dietary intake of a very limited number of foodstuffs in order to maintain weight within certain limits.

These will lead to patterns of erosion that mainly affect the palatal aspects of upper anterior teeth.

Extrinsic sources

Extrinsic sources of erosion include dietary and occupational factors, and will generally affect the labial surfaces of anterior teeth, although not always.

Carbonated drinks

Carbonated history, as we know it today, was made on 8 May 1886 in Atlanta, Georgia.

A local pharmacist, Dr John Stith Pemberton, created the syrup for Coca-Cola and carried the product down the street to Jacob’s Pharmacy, where it was sampled. It was pronounced excellent and placed on sale as a soda fountain drink for five cents a glass.

I believe one of the main dietary sources causing extrinsic erosive TSL is carbonated drink. Now, please don’t get me wrong, there really is nothing more refreshing than taking a chilled can of pop from the fridge on a hot summer’s day, filling a tall glass with ice and watching the caramel-esque bubbles of effervescence and froth as the liquid engulfs the ice cubes. So thank you, John Stith Pemberton.

However, something needs to be done in relation to the excessive level of consumption of soft drinks by our nation’s youth.

While healthy lunch campaigns and the restricted use of school vending machines to lunchtimes only is a step in the right direction, it is not enough.

Dental health education with regard to diet should be implemented in all schools.

If you ever happen to be in the area of your local supermarket or shop at lunchtime, particularly if it’s located close to a school, stop and take just one minute to observe what school children are drinking. You will probably find that it’s not bottles of mineral water, but numerous types of soft drinks.

Unless diagnosed and an aetiological agent identified, children who present with erosive tooth wear are heading towards a lifetime of continuous dental treatment, not to mention the adverse effects this will have on their general health and well-being.

As a dentist it is my responsibility to educate both the parent and child with regard to the effects of carbonated soft drinks on the dentition when consumed in excess. However, other powers must also play their role in implementing health education programmes in schools.

Prevention is very much the key to the future of dental health in this area.

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