Dental Erosion in Children: A literature review

Meghan Sullivan Walsh December 21, 2010

Literature Review - St. Joseph/LMC Pediatric Dentistry

Dental Erosion in Children: A literature review

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Dental Erosion in Children: A literature review

Authors:Vivienne Linnett, BDSc, MDSc; W. Kim Seow, BDSc, DDSc, PhD, FRACDS

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s; 23:1, 2001, pages 37-43

Major Topic: Review of Dental Erosion; diagnosis, causative factors, prevention and restorations.

Overview of Method of Research: Literature Review.

Findings: Studies have shown the prevalence of dental erosion in children to range from 2-57%. Dental erosion can cause tooth sensitivity, occlusal problems and even pulp exposures and abcesses in severe cases. The paper compiled literature regarding dental erosion to help establish the prevalence, clinical manifestation and etiology of pediatric dental erosion and to provide guidelines for patients and their restorative dentist.

Prevalence: Four studies were looked at with a wide range of prevalence on dental erosion in both primary and permanent dentition. All of these studies had a relatively small number of subjects which may have accounted for the wide range of numbers. In compiling the numbers, erosion in dentin showed prevalence of 30% in primary molars of 5 year olds and 2% in incisal surfaces of permanent incisors in 14 year olds. Children with CP showed a nigh prevalence of tooth erosion which was attributed to both parafunctional activity and GERD.

Clinical manifestation:

Appearance: Initially the tooth may show slight loss of surface luster when the enamel is clean and dry or show sensitivity or fracturing of thinned incisal edges. Once the erosion process has progressed the tooth will have a dished out, hard, smooth appearance where the dentin may be exposed. One scoring method for dental erosion in children with GERD scores the tooth from 0-3 where 0 is no erosion to 3 where dentin is exposed at the bottom of the holes on the occlusal surfaces.

Complications: Severe erosion can cause enamel fracture and compromise esthetics. Loss of tooth structure can also account for tooth shortening and loss of VDO. Dentin sensitivity, problems with eating, pulpal inflammation and pulpal exposures also account for a person with a more severe case of erosion.

Etiology: A source of intrinsic or extrinsic acid acting of the tooth structure as well as parafunctional habits all contribute to tooth wear.

Extrinsic sources: Workers in factories with toxic acidic fumes or aerosols, wine tasters or competitive swimmers all have shown tooth wear due to occupational exposure of acid. Dehydration following sports, followed by consumption of acidic drinks, chewable Vitamin C tablets and persons who chew Aspirin over long periods of time also have shown to have dental erosion.

Titratable acidity of foods and drinks: As the pH in the oral cavity falls below 5.5, or the critical pH, erosion will occur. The actual H+ concentration of acidic substances has been found to be more important than the actual pH of the food or drink.

Types of acidic foods and drinks associated with erosion: A study of acidic drinks reported that the first appearance of enamel wear occurred between the fourth and sixth weeks of use. Orange juice was found to cause less erosion than grapefruit juice or carbonated cola. Sports drinks are also found to be highly erosive.

Frequency: Those who consumed these acidic drinks more than twice a day or consumed at bedtime showed the highest signs of erosion.

Intrinsic sources: GERD is the most common source of intrinsic acids in the mouth. Findings have shown that clinical symptoms are not seen until gastric acid has acted on the teeth for a period of 1-2 years. Other conditions have shown erosion such as metabolic and endocrine disorders, medication side effects, drug abuse, and psychosomatic disorders such as stress induces vomiting, bulimia, anorexia, and rumination.

Factors modifying erosion: Swallowing habits, buffering capacity of saliva, chemical makeup of enamel, shape and contour of teeth, duration of contact.

Saliva: Saliva is known to have the most important properties in prevention of dental erosion, but the nature of the role is not completely understood.

Oral hygiene: Erosion is frequently seen in individuals with a high level of oral hygiene. Also, brushing immediately following consumption of acidic beverages is strongly discouraged.

Fluoride: Addition of fluoride to acid solutions decreases the erosion. Applying sodium fluoride solutions immediately before tooth brushing reduces abrasion.

GUIDELINES:

Diagnosis: Thorough medical and dietary history of several days to elicit causative factors. Referral to a gastroenterologist is desirable is GERD is suspected.

Monitoring: Determining if your diagnosis is correct and if the erosive process is ongoing or decreasing. The author suggests study models, clinical photographs and rubber indexes as well as 6 month recalls.

Dietary modification: Decreasing the total acid intake or allowing time for remineralization in between meals. In addition finishing meals with something neutral or alkaline has proven beneficial. Also patients should be told to avoid brushing immediately after consuming acidic foods.

Fluoride: Used to minimize tooth loss and diminish sensitivity.

Restorative Treatment: Primary teeth are often restored with SSCs and composites to improve esthetics, restore VDO, prevent sensitivity and early exfoliation.

Key Points: Summary: Dental erosion can be caused by acidic foods, drinks, environmental exposures or GERD. The manifestation of erosion can be sensitivity, loss of VDO and poor esthetics. Children should be evaluated to identify the source of the acid and appropriate referrals and restorative care should be made.

Assessment of the Article:

The was a great overview of dental erosion. They broke the process down into the many factors which cause erosion, what we as clinicians should look for and appropriate care for these patients. The article was titled as Erosion for Children, however, the paper was really written more as a general assessment on erosion.