Erosion of tooth enamel: causes and treatment. Erosion of hard tooth tissues Erosion of tooth enamel treatment at home

The enamel of human teeth is one of the hardest substances on the planet. Every day she is exposed to a lot of stress: food, drinks, periodic injuries. Erosion of tooth enamel is quite common. With this pathology, the patient's tooth sensitivity increases significantly, which is often accompanied by the development of caries; in some cases, complete tooth destruction is possible.

Enamel erosion concept

Erosion of tooth enamel is a pathological condition of hard dental tissues in which enamel and dentin are destroyed. It begins with damage to the top layer and gradually penetrates deeper, reaching the bone tissue. Dentists classify this disease as non-carious lesions. The disease is common mainly among middle-aged women and lasts a long time.

Tooth erosion is not only a cosmetic defect, but also a significant dental problem that requires urgent treatment. The external manifestation of the pathology is an oval or round spot on the surface of the tooth. As a rule, the most protruding part of the tooth is affected first, after which the pathological area increases and spreads to deeper tissues.

Often the disease is recognized quite late, when erosion penetrates deep into the tooth, completely corroding its coating. Then painless treatment is no longer possible. To prevent this from happening, you need to consult a dentist in time and have your teeth treated. Often people do not attach much importance to this pathology, considering it a purely aesthetic defect. In fact, this is a real dental disease that threatens complete loss of enamel.

Causes

Tooth enamel is made up of minerals, so it is not easily destroyed. Erosion is a slow process that can take several years before it makes itself felt. An exhaustive list of causes causing erosion of tooth enamel has not been determined.

There are 3 main factors that can lead to the disease:

mechanical - the use of aggressive pastes and powders, frequent enamel whitening with aligners and whitening preparations, as well as bruxism (involuntary grinding of teeth, often at night, often leading to abrasion of the tooth shell);
chemical factor - excessive consumption of acidic foods (citrus fruits, undiluted freshly squeezed juices, vinegar marinades), carbonated drinks (Coca-Cola, Fanta);
The endocrine cause of erosion is a disruption of the thyroid gland (often due to thyrotoxicosis, changes in the composition of saliva occur, which leads to damage to the surface of the teeth).

Other causes of the disease include excessive consumption of ascorbic and folic acid, malocclusion, various bacterial diseases of the oral cavity and upper respiratory tract. Occasionally, there is a congenital predisposition to abrasion of the tooth shell.

Stages of the pathological process and their symptoms

The onset of the disease can be missed if you do not undergo a dental examination twice a year, since at the initial stage there are practically no obvious changes.

Dentists distinguish the following stages of development of enamel erosion:

Initial. The superficial area is affected, which is almost invisible upon examination.
Average. The defect penetrates into the inner layers of the teeth, which causes increased sensitivity.
Deep. The disease leads to complete destruction of the enamel, and the bone substance is gradually affected.

Symptoms of the disease vary and may not appear at all until the inside of the tooth is damaged. This largely depends on the stage of erosion.

Initially, the erosion has a round, cup-shaped shape. Its bottom is hard, smooth and shiny. Over time, the defect expands and deepens, the enamel is worn away, and dentin is exposed. At the initial and middle stages of development, erosion has a whitish tint; with a deep degree, the color changes to light yellow or brown.

At the initial stage, there is a slight darkening of the tooth coating and loss of shine. You can see changes only when the tooth surface is completely dried with air or a drop of iodine tincture is applied to it. The affected area is colored iodine. In this case, there is no pain.

The average degree is characterized by the patient experiencing discomfort when consuming hot or cold food and drinks. The shade of the teeth changes to darker.

Phases of enamel erosion and associated symptoms

The following phases of the disease are distinguished:

Active - characterized by a pronounced clinical picture. The disease develops quickly and affects almost all teeth at once - their color changes, discomfort appears, and sensitivity worsens.
Stabilized - absence of pronounced symptoms. The disease progresses slowly. Teeth form tertiary dentin, produced by the pulp. It creates a protective shell and suppresses excessive sensitivity.

Diagnostic methods

Treatment of dental erosion begins only after a thorough examination and consultation with a dentist. When independently examining the oral cavity and self-medicating, there is a high chance of making a mistake in making a diagnosis and choosing a method of therapy. Erosion must be differentiated from enamel hypoplasia, wedge-shaped defect, and superficial caries. Diagnostics consists of:

An examination of the oral cavity, thanks to which the doctor will identify the problem and determine the possible causes of erosion of tooth enamel.
Drying the damage with an air jet followed by application of iodine. This method helps to identify the location of the lesion.
Blood test for hormones and ultrasound examination of the thyroid gland. This is necessary to exclude endocrine pathology.

Features of treatment of erosion of hard dental tissues

At the dentist

Treatment of a defect such as tooth erosion requires an integrated approach. During the active phase of the disease, the dentist tries to minimize the destruction of hard tissues, stabilize the patient’s condition and stop the destructive process. It is necessary to achieve the transition of the active phase into a stabilized one. The patient is prescribed a course of vitamins and microelements, including calcium and phosphorus.

Local remineralization is carried out within 15-20 days (daily applications with fluoride and calcium preparations). After which the surface of the teeth is coated with fluoride varnish.

Physiotherapeutic methods are also used, such as electrophoresis with a 10% calcium solution. The duration of such treatment is 10-15 procedures. It is advisable to repeat the course in a year.

In case of severe damage to the hard tissues of the tooth and an obvious cosmetic defect, an artistic restoration of the crown is performed. For these purposes, a photopolymer composite or microprostheses (veneers, inlays, crowns) are used.

In the stabilized stage, it is necessary to continue taking vitamins and minerals. The patient undergoes depigmentation of the affected surfaces. To do this, you need to brush your teeth for several days with an abrasive toothpaste with a high fluoride content. After treatment, it is recommended to apply Fluorgel or Fluorvarnish to the teeth for 2 days.

At home

Sometimes treatment can be carried out at home, but only with the consent of the attending physician and exclusively at an early stage of the development of the disease. The basic principle of home therapy is strict adherence to hygiene rules:

use a toothbrush with medium-hard bristles - it does not damage the enamel;
after brushing your teeth, rinse your mouth with antiseptics;
use fluoride-containing toothpastes as they strengthen the lining of the teeth;
If a defect is identified, teeth should be brushed not twice a day, but after each meal - this is a temporary measure, and after the end of therapy you should return to your normal routine.

If the cause of the disease was a bacterial infection, it must be eliminated first.

Enamel destruction can be caused by lactic acid bacteria and staphylococcus that live in the oral cavity during chronic tonsillitis and stomatitis. In this case, antibiotic therapy is carried out, after which the procedures described above are performed.

Preventive measures

Erosion of enamel does not occur when the following preventive measures are taken:

Refusal to eat acidic foods. It is better to drink carbonated drinks through a straw to avoid contact with the enamel.
You should not eat very hot and very cold food at the same time. Strong temperature fluctuations provoke the appearance of cracks in the enamel.
After eating, rinse your mouth with mouthwash or warm water.
Use a soft brush and toothpaste without abrasive particles to brush your teeth. It is necessary to start cleansing from the inner surface, without pressing too hard on the bristles to avoid damaging the enamel.
Visit the dentist twice a year. This will detect pathology at an early stage and prevent undesirable consequences.

Erosion of tooth enamel is a serious dental disease that requires mandatory treatment. First there is a change in the color of the enamel, then damage occurs. Erosion leads to the complete destruction of one or more teeth. The disorder develops unnoticed by the patient, but is easily diagnosed by the dentist during examination. For a preventive examination of the oral cavity, each person is recommended to visit the dentist 2 times a year to avoid the development of dental erosion.

Those who adhere to this rule have the opportunity to receive qualified dental care on time. Timely treatment, when tooth enamel erosion is just beginning to develop, often gives a positive result.

Non-carious lesions on the surface of teeth are found everywhere in modern dentistry. In this disorder, tooth enamel is destroyed and, in rare cases, dentin is affected. Visually, tooth enamel erosion appears as an oval defect on the outer surface.

Gradually, the neoplasm expands and destroys the lower layers of dental tissue. Hard tissue problems are often more serious than superficial erosion. Without qualified therapy, the disorder quickly spreads and destroys enamel.

Patients often consider dental erosion as an aesthetic defect. In reality, this is a disease that requires proper diagnosis and treatment, leading to the destruction of tooth enamel.

The disease spreads sequentially. At the initial stage, the enamel disappears quickly, sensitivity to hot and cold food increases, when brushing your teeth, pain occurs. In the next stage, teeth decay more slowly. Therefore, people have the illusion of recovery. Decayed teeth gradually darken.

Tooth erosion is classified as follows: initial, intermediate, hard.

The disorder often spreads to the premolars and front teeth. The disease rarely manifests itself at an early stage; it is during this period that treatment is easy and painless. You need to visit your dentist regularly.

Causes

Enamel erosion is diagnosed more often in people who do not observe the rules of personal dental hygiene. The exact provoking factors of the disease have not yet been established. Experts believe that the appearance of changes in enamel can be facilitated by:

Strong mechanical impact on teeth. The habit of chewing seeds or nuts, nails, constant use of toothpastes with abrasive additives and teeth whitening with baking soda can lead to damage to the enamel.

Eating highly acidic foods. An aggressive environment is created in the oral cavity, which destroys the enamel. This is a chemical effect.
the body can also contribute to the weakening of the enamel.

Medicines, medicines, uncoated tablets, powders have side effects on the patient’s body.
Missing several teeth or create excessive stress when eating food. The enamel wears out and does not have time to recover.

Bad ecology. In the workshops of some industries, the air is saturated with suspended particles of metal, acid or other harmful substances. When inhaling, all this passes through the workers’ mouth.

The causes of tooth erosion may vary; it is important to diagnose the disease in time and begin treatment to avoid irreversible processes.

Risk factors

The work of all human organs is interconnected. Based on this, doctors believe that gastric ulcers or high acidity are directly related to the occurrence of erosion on the enamel.

Hormonal disorders of the body and diseases of any endocrine glands lead to deformation of the tooth surface. Lack of calcium in the body leads to osteoporosis and enamel destruction.

The likelihood of erosion is increased by the following factors:

Pregnancy, if there is a complication of intoxication.

Radioactive background of the area or the consequences of radiation therapy.
Addiction to alcohol.
Vegetarian diet. When a large amount of sour citrus fruits and fruits are constantly consumed.

Electromagnetic radiation. Working with a computer and other devices with a weak degree of protection.
Work in enterprises with hazardous working conditions.
Sour drinks and juices are consumed without a straw.

Consequences

Enamel erosion rarely occurs in children. Middle-aged people belong to the main category of patients. Treatment of the disease should not be delayed, because the development of enamel erosion leads to negative consequences:

teeth quickly wear out or wear out;
dark spots appear, covering an increasingly larger area over time;
the color of the edges of the teeth becomes transparent and thinned;
the patient feels pain when eating hot or cold food.

Erosion without treatment spreads in all possible directions. This leads to complete destruction of enamel and dentin. New dental diseases are emerging.

The disease may last for some time without causing any discomfort. With an inexperienced eye, the change in enamel may not be noticeable. When the hard part of the tooth is destroyed, pronounced signs of the disease will appear. The disease is not noticeable. Dull dark spots of round or irregular shape appear on the surface.

In most cases, small molars, incisors and canines are damaged.

Initially, it cannot be said that erosion is present. In the second stage, the disorder reaches the dentin, but does not affect it. The defect becomes visually distinguishable. At the last stage, the hard tissue begins to break down, causing discomfort and pain.

Diagnostics

To identify the defect, the tooth enamel is dried with air, then a little iodine is poured onto it. To identify concomitant disorders, patients are offered a consultation with an endocrinologist and gastroenterologist, an ultrasound scan of the thyroid gland is prescribed, and a hormonal analysis is performed.

Erosion must be distinguished from a mild form and a wedge-shaped defect. Erosion is distinguished from caries by location, shape of the lesion and a smooth surface; with caries, the surface becomes rough and uneven. The wedge-shaped defect will be distinguished by its shape and location at the root. Once an accurate diagnosis is established, treatment begins.

This disorder occurs as a result of exposure to harmful microbes in the body. They interact with food debris remaining between the teeth after lunch. Organic acids formed as a result of decomposition negatively affect tooth enamel. As a result, calcium salts are washed away by aggressive acid, and demineralization of the tooth surface occurs after some time.

Tooth enamel is the hardest tissue in the body. It includes minerals, hydroxyapatites, which are sensitive to acids. Therefore, the destruction process starts at a pH level of 4.5.

Without noticeable reasons, caries does not appear. Often, pathological symptoms are the main link in the process of manifestation of carious formations. This could be a deterioration of the immune system, gastrointestinal disorders, or a poor diet. In modern medicine there are approximately 400 theories of the development of this disease, but the main reason is bad.

Therapy

Local and general procedures are prescribed to transfer the disease from the active phase to the stable phase. This prevents the destruction of hard dental tissues.

For erased enamel, local therapy is proposed, including additional treatment with minerals, daily applications of fluoride and calcium-containing products. The course of treatment lasts 2-3 weeks. Finally, the surface of the teeth is lubricated with fluoridated varnish. All these processes remove the increased sensitivity of the enamel to the action of irritants.

It is carried out using calcium electrophoresis. If the tooth is severely damaged, restoration is carried out using a light-curing composite, veneer or crown.

The patient is prescribed medications: calcium, fluorine, vitamins.

General therapy involves continued use of the vitamin complex. To restore color, the affected teeth are polished with a special paste, gently whitened, and fluoride-containing varnishes and gels are applied to the eroded areas.

Filling a tooth cured after erosion is not always effective due to poor fit of the restoration and the formation of a defect around the filling.

Treatment of dental erosion is considered effective if pain disappears during eating and after exposure to cold air.

It should be remembered that the appearance of enamel erosion is associated with internal diseases and aggressive external influences. Therefore, you must adhere to simple rules:

reduce the consumption of foods and drinks with high acidity;
remember that hot drinks and food have a negative effect on tooth enamel;
after meals, use chewing gum without sugar;
rinse your mouth immediately after eating;
Hygienic procedures in the oral cavity should be performed with a soft toothbrush, alternating an abrasive one with a regular one;
Carry out regular dental examinations;
Do not use pastes with an abrasive or whitening effect.
do not drink sparkling water or drink only through a straw;
rinse your mouth after eating. You can use water or antibacterial agents.

It is possible to prevent the development of tooth enamel erosion with timely and high-quality treatment. After the transition from the active to the stable phase of the disease, the patient should undergo regular monitoring by a specialist.

limit the consumption of ballast products;
take vitamins;
Healthy food;
lead a healthy lifestyle;
control the intake of hormonal drugs;
monitor the endocrine and digestive systems.

Let's figure out what you shouldn't eat at the first signs of erosion: sour juices, carbonated drinks, canned food, marinades, fermented foods.

Doctor about tooth enamel erosion - video

Erosion of tooth enamel is an unpleasant disease, but not a death sentence. In medical practice, there are few cases of patients presenting at the initial stage. Timely visits to the dentist and prevention are the main methods of combating the disease. Following all the doctor’s advice helps to avoid severe forms of erosion.

ID: 2016-06-5-A-6685

Original article (loose structure)

Aidemirova M.A., Petrova A.P.
Scientific supervisor: candidate of medical sciences, associate professor Firsova I.V., associate Lebedeva S.N.

GBOU VPO Saratov State Medical University named after. IN AND. Razumovsky Ministry of Health of Russia Department of Pediatric Dentistry and Orthodontics.

Summary

Summary. This article discusses the factors contributing to the development of erosive dental defects, their pathogenesis, as well as the impact of erosion on the quality of life of patients.

Keywords

Key words: erosion, non-carious lesions of teeth, abfraction.

Article

Introduction. Currently, dental erosion occupies a significant place among diseases of hard dental tissues. There are many opinions about the origin of erosive defects, and this issue has not been fully studied. This topic gives rise to a lot of controversy and questions among scientists and doctors, and therefore requires more attention. Research results indicate a significant increase in the prevalence of dental erosion in the last 10 years. Thus, when examining a population group, 47.2% of people with dental erosion were identified, while 10-15 years ago there were no more than 5-7% of such patients. When analyzing the frequency of non-carious dental lesions, based on patients’ visits to the dental clinic, 29.5% of people with dental erosion were identified. Meanwhile, 10-15 years ago there were only 24 such patients. Moreover, the disease was observed mainly in women (84.9%) aged 25-30 years. The combination of erosions with hormonal disorders (including dysfunction of the thyroid and gonads) accounted for more than 75% of cases.

Objective: to analyze literature data on the etiology of erosive defects and their impact on the quality of life of patients.

1) characterize the hypotheses of the origin of erosions of hard dental tissues

2) to study the mechanism of occurrence of erosions of enamel and dentin

3) assess the quality of life of patients with erosive dental defects

4) create a draft treatment plan for patients suffering from erosive dental changes.

Materials and methods: scientific articles and works, domestic and foreign scientific literature on dentistry were analyzed, clinical cases of erosion of hard dental tissues of varying severity of the pathological process were analyzed.

Results and discussions. Erosion of hard tissues (erosion) (from the Latin erosio - “corrosion”) is the progressive loss of tooth enamel and dentin. In foreign literature, both narrow terms are used: “attrition”, “abrasion”, “erosion”, “abfraction”, and broader ones: “toothwear” and “tooth surface loss”. In European literature, the most common point of view is that erosion is a more important factor in the loss of hard dental tissues than abrasion due to contact of tooth surfaces. Occurs after teething. The affected area can be located on the vestibular and palatal surfaces and has a round, cup-shaped shape with dense, smooth, flat edges. This is a differential diagnostic feature when making a diagnosis. The upper incisors are primarily affected, less commonly the canines and premolars. It is extremely rare that erosions occur on the teeth of the lower jaw. Probing and percussion are painless. EDI 2-4 µA. The oral mucosa is without visible pathological changes.

2. The causes of erosion have not been clearly established.

According to ICD-10, the pathological condition of hard dental tissues is divided into two large groups:

· “Disorders of development and teething”

· “Other diseases of dental hard tissues.” K03

Tooth erosion refers to diseases of the hard tissues of teeth. K03.2

K03.2 Tooth erosion:

K03.20 Professional;

K03.21 Caused by persistent regurgitation or vomiting;

K03.22 Due to diet;

K03.23 Caused by drugs and medications;

K03.24 Idiopathic;

K03.28 Other specified dental erosion;

K03.29 Dental erosion, unspecified.

The first four causal factors of this classification reflect the chemical theory of the development of dental erosion present in the medical literature of previous years, which in turn considers the impact of aggressive chemical agents on the enamel as the leading causes:

I. External factors:

1) type of diet: consumption of acid-containing foods and drinks (marinades, pickles, citrus fruits, fruit and berry juices, sweet carbonated drinks, etc.)

2)work in hazardous industries associated with inhalation of acid fumes, metal and mineral dust particles

3) The effect of a number of medications on tooth enamel, for example, acid (acetylsalicylic and ascorbic), gastric juice preparations, hydrochloric acid.

II. Internal factors:

4) Dental erosion can be caused by chemically aggressive contents of the stomach and duodenum with a low pH content in chronic gastroesophageal regurgitation that occurs with gastroesophageal reflux disease, as well as with combined duodeno-gastroesophageal reflux disease. Erosive lesions are observed in individuals with hiatal and diaphragmatic hernias and those suffering from bulimia.

Damage from internal factors usually occurs on the palatal surfaces, and from external factors - on the buccal surfaces.

D. A. Entin saw the cause of erosion in neurodystrophic processes that cause decalcification of hard tooth tissues. However, no one can explain why erosions occur in some cases and wedge-shaped defects in others. Their occurrence may be associated with a violation of mineral metabolism due to endocrine or other disorders in the body and, accordingly, in the dental pulp. This is confirmed by the results of clinical observations and data from radioimmunological studies, which indicate the presence of clear preceding and concomitant dysfunctions of the thyroid gland in patients with erosions of dental enamel. Thus, Yu. M. Maksimovsky et al., analyzing the causes of erosions, assign an important role to endocrine disorders and, above all, hyperfunction of the thyroid gland. It was noted that dental erosions in patients with thyrotoxicosis were detected 2 times more often than in persons with normal thyroid function; a direct connection was established between the intensity of dental damage and the duration of thyrotoxicosis. As the duration of the disease increases by 1 year, the number of patients with erosion of hard dental tissues increases by 20%.

Dr. Kim McFarland, a dental surgeon and professor at the College of Dentistry at the University of Nebraska Medical School in Lincoln, USA, notes an increase in the number of patients with erosion of tooth enamel over the past 25 years, which is associated with uncontrolled consumption of carbonated sugary drinks.

A number of researchers (Baume, Port and Eidler) associate tooth erosion with excessive mechanical stress on the enamel, namely the use of hard toothbrushes, whitening toothpastes and powders with increased abrasiveness, as well as improper brushing techniques - the predominance of horizontal movements.

The combination of several predisposing factors accelerates the course of erosion and aggravates its severity. For example, drinking large amounts of very low pH drinks causes tooth surface loss when combined with brushing immediately after an acid attack on the teeth.

Yu. M. Maksimovsky details the clinical manifestations of erosions and distinguishes three degrees of damage, based on the depth of the hard tissue defect:

I degree (superficial, initial) - with damage to only the upper layer of enamel

II degree (medium) - with damage to the enamel throughout the entire depth up to the enamel-dentin border.

III degree (deep) - with damage to the entire enamel and the upper layer of dentin.

E.V. Borovsky et al., distinguish two stages of damage: initial (enamel erosion) and severe (enamel and dentin erosion).

In degrees 1 and 2, the lesion is white with a shiny surface; in degrees 3, brown or light yellow pigmentation appears.

Dental erosion is usually characterized by a chronic course, but there are two clinical stages of erosion: active and stabilized.

The active stage is characterized by a progressive course and loss of tooth tissue, accompanied by hyperesthesia and the disappearance of the shine of the erosion surface. In the active phase, changes in the size of erosion occur every 1.5-2 months.

The stabilized form of erosion of hard tooth tissues is characterized by a calmer, slower course, and the shiny surface of the enamel in the affected area is preserved. There is no change in its size for 9-11 months. A transition from a stabilized form of erosion to an active one is possible, especially if the background pathology worsens.

3. Pathogenesis

Unlike dental caries, where there is superficial, subsurface demineralization of the enamel, during erosion, superficial foci of demineralization are formed, which gradually cover the tooth enamel layer by layer. The microhardness of the enamel in the area of erosion is significantly reduced, and foci of demineralization of the enamel surface are noted. When studying the ultrastructure of enamel during tooth erosion using a scanogram, it was noted that the enamel in the area of erosion and in adjacent areas is characterized by a reduced degree of mineralization and the presence of destructive changes: in some areas, enamel prisms are clearly visible, interprismatic spaces are pronounced, and in others, enamel prisms and interprismatic spaces indistinguishable due to demineralization. Hydroxyapatite crystals of various shapes. In areas adjacent to erosion, they do not have clear boundaries or have a regular shape, but are large. Crystals of enamel hydroxyapatite with varying densities are visible on the surface of the enamel, indicating uneven mineralization. There are also distinct changes in dentin during tooth erosion: areas with a dense arrangement of crystals are observed. Dentinal tubules can be obliterated or non-obliterated. The structure of the substance that obliterates the dentinal tubules is specific and close to that during abrasion, however, along with the indicated areas of demineralization, accumulations of bacteria were found that mask the contours of the enamel prisms.

Comparative electron microscopy (SEM) of the central erosion zone also showed the presence of significant structural changes in both the superficial and deeper layers of damaged dental tissue. The active stage of the process is characterized by the loss of both enamel substance and dentin in large areas that have undergone destructive changes.

In the cervical region of teeth with erosive defects, an intermittent but quite clearly visible boundary between the crown and root is visible. In all studied cases, the crown enamel was layered on the root cement.

4.Quality of life of patients with dental erosion.

Enamel is the protective shell of the tooth. The process of enamel erosion is irreversible and creates problems for a person for life.

Patients complain of aesthetic defects, the presence of a defect in the cervical area, tooth sensitivity, and tissue loss.

According to our data (based on the number of visits to the clinic), about 15% of patients are aged 16-42 years.

We observed 3 patients with varying degrees of dental erosion.

1) Patient A., 23 years old; preliminary diagnosis: dental erosion, stabilized form; mild severity according to ICD-10 K03.2. Complaints about dissatisfaction with the color of teeth. Objectively: on the vestibular surface in the cervical area of 1.1 and 2.1 teeth there is a defect affecting only the upper layer of enamel, the oral cavity is sanitized, the oral mucosa is without pathological changes, IG - 1.7 (satisfactory).

History: consumption of freshly squeezed citrus juices, professional cleaning with Air-flow 2 times, tried to use whitening toothpastes.

2) Patient K., 28 years old; preliminary diagnosis: active stage of dental erosion, moderate to severe degree according to ICD-10 K03.22

Complaints about tooth sensitivity, aesthetic defects, yellow teeth.

Objectively: on the vestibular surface in the cervical region of 1.1 teeth there is a pronounced defect within the enamel and 2.1 teeth with damage to the entire enamel and the upper layer of dentin. The oral cavity is sanitized, the oral mucosa is without pathological changes IG-2.2 (unsatisfactory).

History: consumption of citrus fruits, incorrect selection of oral hygiene products and items, incorrect method of brushing teeth with a predominance of horizontal movements.

3) Patient L., 42 years old; preliminary diagnosis: active form of dental erosion, severe degree according to ICD-10 K03.21

Complaints about the presence of defects in the cervical area, tooth sensitivity and aesthetic defects.

Objectively: erosive defects in the frontal group of teeth of the upper and lower jaw, in the cervical area there are lesions of brown pigmentation. The oral cavity is sanitized, the oral mucosa is without pathological changes, IG-1.6 (satisfactory)

History: occupational hazards, chronic gastroesophageal regurgitation, traumatic occlusion, crowded teeth.

Thus, regardless of the severity of erosion, the quality of life of these patients suffers to one degree or another. Even if practically nothing bothers the patient at first, in the future, in the absence of correction of etiological factors and specialist interventions, the symptoms increase like an avalanche (according to patients with more pronounced defects), which forced us to try to create an algorithm for treatment and preventive measures (draft treatment plan) for this group patients.

Enamel erosion is not just an external problem, but a serious disease, and therefore the attitude towards treatment is no less serious.

A thorough ascertainment of the patient’s history and current condition with the involvement of related specialists (therapist, gastroenterologist, endocrinologist, pediatrician, etc.), gastronomic preferences, and characteristics of professional activity will significantly identify the possibility of correcting patient-dependent factors or, at a minimum, recording them in the outpatient dental record. sick.
Treatment of patients with erosion should be comprehensive and long-term.
Strict diet (except citrus fruits, berries, sweets, carbonated drinks, fresh juices containing vitamin C, canned foods). Include protein in your diet to strengthen the protein matrix of enamel and collagen fibers.
Select products (pastes containing organic calcium, with hydroxyapatite) and hygiene items (correction of the rigidity and structure of the brush bristles, excluding the use of toothpicks), as well as teach the correct method of brushing teeth (vertical movements).
Remineralizing therapy (Rocs medical minerals gel, Remars gel, Clinpro™ White Varnish,) Tooth Mousse, “Belagel Sa/R” “VladMiVa”) in a clinical setting in the form of applications and mouth guards (preferably individually). At home daily, possibly constantly, but necessarily regularly, depending on the degree - in-office in combination with fluoride applications to prevent concomitant caries and to strengthen the crystal lattice of hydroxyapatite.
Avoid ultrasonic teeth cleaning, home and professional whitening, and Air-Flow teeth cleaning.
For professional hygiene, use pastes with minimal abrasiveness “fine”.
Restoration if necessary, after complex treatment. It is possible to use the Icon technique, as well as the use of a desensitizer (SHIELD FORCE PLUS).
clinical examination with photographic recording of the result.

1. In the etiology of erosion of hard dental tissues, the following factors interact: exogenous (occupational hazards, dietary habits) and endogenous factors (metabolic disorders, endocrinopathies, bruxism, diseases of the gastrointestinal tract) in combination with improper oral care.

2.The main mechanism is demineralization of the enamel.

3. Regardless of the severity of erosion, the quality of life of these patients suffers to one degree or another. Even if at first there is practically nothing bothering the patient, in the future, in the absence of correction of etiological factors and specialist interventions, the symptoms increase like an avalanche.

4. The algorithm of treatment and preventive measures for this group of patients should include:

Correction of both external and internal etiological factors;

Specialized treatment by a dentist before the required restoration with the use of remineralizing and fluoride-containing drugs up to restoration (using filling materials from the group of compomers or GIC);

Your rating: No

Tooth erosion is a progressive loss of dental tissue (enamel and dentin) of insufficiently understood etiology. Some authors believe that tooth erosion, like a wedge-shaped defect, arises solely from the mechanical action of a toothbrush and powder. Others believe that erosion is caused by eating large quantities of citrus fruits and their juices. Yu. M. Maksimovsky (1981) assigns an important role in the pathogenesis of erosion of hard tissues of teeth to endocrine disorders and, in particular, hyperfunction of the thyroid gland.

According to him, one of the symptoms of this disease is an increase in saliva secretion and a decrease in the viscosity of oral fluid, which cannot but affect the condition of the hard tissues of the tooth. It was found that tooth erosion in patients with thyrotoxicosis occurred 2 times more often than in persons with normal thyroid function. Even with an increase in the duration of the disease by 1 year (from 3 to 4 years), the number of patients with erosions of hard tissues increases by 20%. Yu. A. Fedorov et al. (1990) also found that tooth erosion in more than 40-50% of cases is detected against the background of an enlarged thyroid gland and impaired function.

Erosion of hard dental tissues appears mainly on the symmetrical surfaces of the central and lateral incisors of the upper jaw, as well as on the canines and small molars of both jaws. There are practically no erosions on the incisors and large molars of the lower jaw. The lesion is observed mainly in middle-aged people and is characterized by a long course - up to 10-15 years. With age, a large number of teeth are involved in the process. Currently, due to the impact of unfavorable environmental factors, including the Chernobyl disaster, the number of cases of dental erosion in young people (18-25 years old) is increasing.

The cause of enamel erosion has not been fully established, however, undoubtedly, an important role is played by the chemical factor in combination with mechanical stress. At the same time, a weakening of the remineralizing effect of oral fluid cannot be ruled out.

Clinical picture of tooth erosion

Erosion is an oval or rounded enamel defect located in the transverse direction of the most convex part of the vestibular surface of the tooth crown. The bottom of the erosion is smooth, shiny and hard. The gradual deepening and expansion of the boundaries of erosion leads to the loss of all the enamel of the vestibular surface of the tooth and part of the dentin. Sometimes the erosion takes on a less regular shape, which is compared to a fluted chisel, i.e. the lesion element is slightly concave, and the edges of the erosion gradually move onto the intact surface of the tooth crown. This form of enamel damage is due to the fact that the dentin in the central part of the crown wears off faster, since at the edges it is limited by the preserved enamel of the contact surfaces of the tooth crown.

There are two stages of damage: initial (enamel erosion) and severe (enamel and dentin erosion).

There are three degrees of erosion based on the depth of the lesion:

degree I, or initial, - damage to only the superficial layers of enamel;

degree II, or average,- damage to the entire thickness of the enamel of the tooth up to the enamel-dentin junction;

degree III, or deep,- when the surface layers of dentin are also affected.

E. V. Borovsky et al. (1978), as well as Yu. M. Maksimovsky (1981) propose to distinguish between two clinical stages of erosion - active and stabilized, although in general any erosion of enamel and dentin is characterized by a chronic course.

For active stage A rapidly progressing loss of hard dental tissue is typical, which is accompanied by increased sensitivity of the affected area to various kinds of external stimuli (the phenomenon of hyperesthesia).

Stabilized stage of erosion characterized by a slower and calmer flow. Another sign is the absence of plaque and tissue hyperesthesia. The shiny surface of the enamel in the affected area is preserved. The transition from the stabilized stage of erosion to the active stage is possible.

Enamel erosion, unlike other types of abrasion, in most cases is characterized by severe pain under the influence of various factors, especially cold air and chemical irritants. In the active stage there are more complaints than in the stabilized stage.

Pathological picture of dental erosion

A microscopic examination of an area with enamel erosion reveals changes in the surface layer. Polarizing microscopy revealed changes in the form of a dark stripe on the surface of the enamel without any changes in the subsurface layer characteristic of caries. Electron microscopic studies revealed the presence of an organic film on the surface of the lesion, the loss of a clear crystalline structure of the enamel and the appearance of significant amorphous areas.

Polarizing microscopy reveals a significant difference in the nature of focal demineralization during initial caries and erosions. So, if caries in the spot stage is characterized by partial subsurface demineralization, then with erosions it is precisely the superficial, layer-by-layer demineralization of the enamel that occurs.

Changes in dentin are also localized in the superficial layers of the affected area. The dentinal tubules are filled with crystalline structures, in the intertubular areas the correct orientation of the crystals is disrupted, and the size of the structureless areas is increased.

Differential diagnosis of dental erosion

Enamel erosion should be differentiated from superficial caries and wedge-shaped defect. Erosion differs from caries in localization, shape of the lesion, and most importantly - in surface (with erosion it is smooth, and with caries it is rough). A wedge-shaped defect differs from erosion in the form of the lesion, localized at the neck at the border of the enamel with cement, often when the root is exposed.

Treatment of tooth erosion

Treatment for erosions of dental tissue should be carried out taking into account the activity of the process and the nature of the concomitant somatic disease. In complex dental treatment, one should not forget about general treatment, which involves the administration of calcium and phosphorus preparations internally when their levels in the blood of patients decrease. Vitamins alone or in combination with microelements are also useful.

Treatment for the stabilized stage of dental erosion, which is often accompanied by a change in the color of the enamel in the affected area, should consist of several procedures aimed at tissue depigmentation. For this purpose, the affected surface should be treated with an abrasive paste, also containing up to 1.23% fluoride, for two or three visits. In the next two visits, fluoride gel or fluoride varnish should be applied to the erosion.

In the active stage of the disease, the task is to stabilize the pathological process. This can be achieved with additional mineralization of hard dental tissues using the method of applications or calcium electrophoresis. To replenish tooth tissues with calcium and phosphorus salts, patients with erosions of hard dental tissues are prescribed 3-4 daily (or every other day) paste applications with a procedure duration of 15-20 minutes. In the next three visits, acidified fluorine gel in a 0.1 M solution of orthophosphoric acid is applied to the area of erosion for 2-3 minutes. The treatment is completed by coating the affected surface with fluoride varnish. When several teeth are affected by erosion, it is more convenient to apply fluoride gel using an individually made spoon, and in case of single lesions, you can use a soft brush. Also, in case of erosion of hard dental tissues, it is proposed to use a 10% solution of calcium gluconate and a 2% solution of sodium fluoride for the purpose of remineralization. With the application method, the number of visits is 15-20. For the remineralization of hard tissues, we can recommend a two-component remineralizing solution consisting of 10% solutions of calcium nitrate and ammonium acid phosphate.

Electrophoresis of a 10% calcium gluconate solution on the area of erosion is carried out after isolating the teeth from saliva, freeing them from plaque and drying the tooth crown. The active electrode is placed at the site of erosion, and the passive electrode is clamped in the hand. When carrying out this procedure, you can also use a device for electrical anesthesia (ELOZ-1) with a current value in the range of 30-50 μA and a procedure duration of 5-10 minutes. After electrophoresis, a swab moistened with a 2% sodium fluoride solution should be applied to the area of erosion for 2-3 minutes. The course of treatment of erosion using electrophoresis is 10-15 procedures.

According to Yu. M. Maksimovsky (1981), filling teeth during erosion is often ineffective due to the frequent violation of the marginal seal of the fillings and the formation of a defect around the filling. In this regard, it is recommended to carry out remineralizing therapy using one of the above methods before filling the erosion. Composite materials should be used as filling materials. If there is a significant area affected by erosion of the tooth crown, it is more advisable to make an artificial crown.

Erosion of tooth enamel is a process of destruction of dental tissues with the appearance of destroyed areas in the form of rounded cavities. The defect resembles a caries infection, but in fact has nothing to do with caries.

The process begins with the formation of a small cavity in the cervical area of the tooth, which gradually increases in size. At the initial stage, the problem is difficult to notice, since it is close to the color of the tooth enamel and does not manifest itself in any way. Symptoms begin to appear as the cavity deepens, causing discomfort and tooth sensitivity. The patient feels sharp pain when mechanical irritation, contact with sweet or sour food on the tooth, as well as under the influence of high or low temperature. An independent visual examination is perplexing, since there are no signs of caries. In this case, the cause of discomfort may be erosion of tooth enamel.

Risk factors

There are several main reasons that can trigger erosion.
These include:

mechanical pressure;

teeth grinding (bruxism);

abuse of sour foods;

gastrointestinal diseases.

Uneven load distribution

Wearing braces can be one of the factors that creates favorable conditions for the occurrence of such a defect on the teeth as erosion of tooth enamel.

When a person is missing one or more teeth, not everyone is in a hurry to get dentures. Patients are not always willing to resort to orthodontic treatment, even when there are clear indications. Some people are scared by the prospect of wearing braces, as well as the cost of the corrective structure. These circumstances can become favorable conditions for the occurrence of a defect such as erosion on the teeth.
The fact is that when chewing food, a person does not think about how this load will be placed on his teeth. It may seem that only 2-3 teeth are involved in the process, on which a particular piece of food falls, but this is not so. In fact, the stability of the dentition and high-quality grinding of food is achieved by a uniform load on the entire dentition. This is ensured by the presence of all teeth that support each other, providing support for the neighboring ones.

Important! Often a person, having several teeth removed on one side, uses mainly the other side for chewing, thereby causing it to be double overloaded. This is fraught with weakening of teeth and, in particular, the occurrence of erosion.

Mechanical pressure

Brushing your teeth is in itself an uneven mechanical pressure on the tooth enamel in order to remove the plaque that has formed. And using a toothbrush with hard bristles can aggravate the impact, leading to mechanical damage.

Many people are surprised by the fact that you can damage your teeth with a regular toothbrush. When buying a tool for daily cleaning of the oral cavity, you must pay attention to the specified stiffness of the bristles. For regular hygiene, you should give preference to products with medium-hard bristles. Some buyers do not pay attention to the labels on the packaging, while others deliberately choose a brush with high hardness, considering it the most effective. However, such a brush will not help you achieve the best results; on the contrary, it will have a negative effect on your teeth. Hard bristles can wear off the enamel, and the sensitive cervical area can be easily injured.

Important! Teeth brushing technique is also of great importance. A common mistake is intense movements in the horizontal plane along the outside of the dentition. Such cleaning is not effective and, in addition, can cause injury to the tooth enamel in the cervical area.

Dentists never tire of repeating that brush movements should be vertical, in the direction from the gums to the edge of the tooth. Thus, contaminants are effectively swept away from the enamel surface.
When using a toothbrush, you should not forget about the force used. Don't think that pressing too hard on the brush handle will help clean your teeth properly. In fact, this does not improve the quality of cleansing at all, and the risk of injury increases many times over. A sign of excessive zeal is rapid wear of the brush. If the product becomes disheveled after a few weeks, you should think about changing the procedure technique.
The key to good hygiene is careful, correct technique and regular implementation of procedures. It is recommended to brush your teeth twice a day.

Teeth grinding

Bruxism is periodically occurring paroxysmal contractions of the masticatory muscles during sleep, which are accompanied by clenching of the jaws and grinding of teeth; attacks are repeated many times and may be accompanied by breathing problems, changes in blood pressure, and heart rate.

Dentists call involuntary jaw clenching and teeth grinding the term “bruxism.” It is quite difficult to notice such a problem on your own. During the daytime, teeth grinding occurs infrequently. But if you observe yourself, you will notice that in emotional moments there is an involuntary clenching of the jaw with noticeable force. This is precisely the phenomenon called bruxism.

Attention! At night, bruxism is more pronounced. During REM sleep, the jaw tenses and the sound of teeth grinding can be heard. A person himself is unlikely to notice it; rather, his loved ones who are nearby in the bedroom will help to do so.

There are also external signs of bruxism. If you carefully examine the surface of the teeth, you will notice horizontal stripes and cracks located longitudinally on their crowns. This sign is indirect, but indicates the possible presence of teeth grinding.
This habit is not a serious medical problem. Bruxism, to one degree or another, is observed in many modern people, since the rhythm of life is often associated with emotional overload. However, this habit is not entirely harmless, because strong mechanical stress on the teeth can lead to damage, including erosion.

Acidic environment

Eating a large amount of vegetables and fruits can provoke the maintenance of a constant acidic environment in the oral cavity, which leads to erosive destruction of tooth enamel.

Currently, one of the fashionable trends is the raw food diet and other diets that involve the consumption of large amounts of raw vegetables and fruits. It should be understood that in addition to vitamins and nutrients, such products often contain large amounts of acids, which can negatively affect teeth.
If you have increased tooth sensitivity and a tendency to erosion, you should be careful about the products you eat.

Attention! Many folk recipes for teeth whitening involve the use of substances that are highly acidic. You should not get carried away with applications made from fresh strawberries, lemon and similar products, otherwise, instead of the expected result, you may get increased sensitivity and erosion of tooth enamel.

It is unlikely that such bleaching will please you.

Gastrointestinal diseases

Gastrointestinal disease can lead to disruption of the integrity of tooth enamel; gastric juice entering the oral cavity disrupts the acid-base balance and leads to zero protective function of the produced saliva.

The condition of the gastrointestinal tract has a direct impact on dental health. The oral cavity is located in close proximity to the stomach and is directly connected to it through the esophagus. To carry out the process of digesting food, gastric juice is constantly present in the stomach, which is an acidic medium. Various types of diseases can lead to acid imbalance and acid entering the oral cavity. As mentioned above, an acidic environment can have a detrimental effect on teeth, causing erosion. In addition, chronic gastritis can change the composition of saliva produced, disrupting its protective function.

Important! Erosion that appears on teeth as a result of gastrointestinal diseases often has a characteristic brownish color.

A separate category is occupied by patients with eating disorders. Anorexia and bulimia, accompanied by constant vomiting, lead to a pathology of such magnitude that the patient’s smile turns into a continuous brownish erosion.

Therapeutic measures

To keep your teeth healthy, hygiene is not enough; you need to eliminate “food waste”, which impairs the functioning of the body as a whole, destroying its protective reactions.

Before you begin to eliminate the consequences of the resulting erosion, you need to get rid of the reason why it arose. Thus, the main therapeutic measures are:

Restoration of missing units of the dentition using prosthetics or implantation technologies.
Correction of bite defects using orthodontic structures.
Monitoring proper compliance with hygiene rules. Dental care should be regular, and teeth should be brushed carefully using a properly selected toothbrush. Toothpastes should be selected taking into account individual characteristics, while products labeled “whitening” should not be used at all.
Conducting an examination of the gastrointestinal tract and necessary treatment of identified diseases.
Proper nutrition, including foods rich in minerals and vitamins. Eliminating highly acidic foods from your diet, limiting fast food and sweets, and avoiding excess coffee - all this helps maintain a healthy smile.
Solution to the problem of teeth grinding. In this case, complex work of a dentist and a neurologist is required.

To help the patient, natural sedative complexes of plant origin can be prescribed, which promote relaxation before bed. Fighting stress and controlling your own emotions help reduce the occurrence of bruxism during the daytime. If all efforts are in vain, then you can use individual mouthguards made of silicone. These products are worn at night and protect teeth from injury by acting as a soft buffer between the upper and lower jaws.

Attention! If erosion has already formed, then it is impossible to restore lost dental tissue naturally. The defect requires treatment in a dental office using modern filling techniques.

Most often, light-curing composite materials are used for these purposes, which are matched to the shade of tooth enamel.
Such a filling solves not only the aesthetic problem of erosion, it also eliminates the patient’s discomfort caused by increased sensitivity in the affected area of the tooth. To ensure complete painlessness, local anesthesia is used. It is worth noting that the use of a drill in the case of erosion treatment is minimal, since the tissue surrounding the defect is not infected, as happens with caries.
Proper treatment will restore the naturalness of your smile, but do not forget that it will not protect against the risk of relapse of the disease if the cause of tooth enamel erosion is not eliminated.