DIAGNOSIS OF EROSION
Abfraction ● Buccal/labial cervical areas of teeth affected. ● Deep, narrow V-shaped notch.
Because few signs and fewer, if any, symptoms accompany early forms of erosion, diagnosis may be difficult (Sengupta, 2018). However, typical signs include a smooth, glazed, silky, or sometimes dull enamel surface without perikymata (ridges and grooves on the enamel surface); intact enamel along the gingival margin; smooth, flat facets on buccal or palatal surfaces; and localized dimpling on the occlusal surfaces (Davis et al., 2019; Mitrani, 2019; Schlueter & Luka, 2018). Attrition, abrasion, and abfraction also exhibit features that might be used to differentiate these processes from erosion—although, as noted earlier, there is often interplay among these factors, and erosion that complicates the diagnosis (Erpacal et al., 2018). Following are the principal features of erosion, attrition, abrasion, and abfraction (Badavannavar et al., 2020; Rappeport & Coleman, 2018; Wu et al., 2017). Erosion ● Smooth surface enamel and broad concavities/defects. ● Dentin exposure due to cupping of occlusal surfaces. ● Increased translucency of incisal edges. ● Nonoccluding surfaces with worn appearance. ● Amalgam restorations that appear raised. ● Amalgams with nontarnished appearance. ● Preservation of enamel “cuff” in gingival crevice. ● Hypersensitivity. ● Pulp exposure in deciduous teeth. Attrition ● Occluding surfaces with matching wear patterns. ● Shiny facets on amalgam contact surfaces. ● Wear rates for enamel and dentin that are the same. ● Fractured cusps or restorations. Abrasion ● Cervical areas commonly involved. ● Lesions that are wide rather than deep. ● Premolars and cuspids most frequently involved. History and salivary assessment The clinical examination should begin with a thorough history with respect to general health, diet, and habits and with an assessment of saliva flow rates and buffer capacity (American Dental Association, 2021; Delgado & Olafsson, 2019): ● Dietary questionnaire : Given that a high intake of acidic foods and beverages is an identified risk factor for erosion, patients should complete a dietary questionnaire focused on acidic foods and beverages. ● Dental history : A history of jaw parafunction and bruxism may increase the possibility of attrition in addition to erosion. The patient should be asked about grinding noises during sleep and whether they experience morning tenderness Head and neck/oral examination Signs of tenderness or hypertrophy of the masticatory muscles on the head and neck examination may indicate a bruxism habit (Tarca et al., 2022). Suspicion of Sjögren’s syndrome, chronic alcoholism, or bulimia should be raised by enlarged parotid salivary glands (Cleveland Clinic, 2022). Inflammation, dryness, and the inability to express saliva from gland orifices may be signs of decreased salivary flow. Erosion caused by GERD usually is seen in the posterior dentition and on the palatal surfaces of maxillary anterior teeth (Davis et al., 2019). The appearance of raised amalgam restorations is common (Santhiya et al., 2019). The loss of tooth structure eventually can lead to decreased vertical dimension, change in the occlusal plane, and tooth sensitivity, while thinning enamel can cause both discoloration of the teeth and chipping of the incisal edges (Chockattu et al., 2018; Warreth et al., 2019). People with bulimia frequently hide their disease from family and friends, and dentists may be the first healthcare providers to diagnose the disease, as reports indicate a 90% prevalence of erosion among patients bulimia (American Dental Association,
The early signs of erosion can include incisal translucency and cupping of the occlusal surfaces, which can progress larger lesions, occlusal instability, and a decreased vertical dimension of occlusion (Chockattu et al., 2018). Progression of occlusal erosion results in rounding of the cusps and the appearance of raised restorations, reflecting the loss of adjacent tooth surfaces. The entire occlusal morphology can be obliterated in severe cases (Santhiya, 2019). To quantify the severity and progression of wear, different techniques are available, ranging from sophisticated optical and laser scanning methods to relatively simple ordinal scales. One such clinical index is the Basic Erosive Wear Examination (BEWE). It is an index that has been developed to assess and record the severity of erosive tooth wear. This is a scale that assigns 0 to no erosive wear, 1 to initial loss of surface texture, 2 to hard tissue loss of <50%, and 3 to hard tissue loss >50% (Delgado & Olafsson, 2019). This can be adapted for clinical use. Besides the morphological variations of tooth wear, clinical symptoms may also appear—for example, sensitivity or even pain that can eventually affect eating, appearance, and quality of life. Another simple scale grades the severity of dental erosion on the buccal and palatal surfaces of maxillary anterior teeth ranging from 0 (no visible changes to enamel, developmental structures remain, macromorphology intact) to 4 (changes to enamel and exposure of dentin surface or pulp visible through the dentin; Badavannavar et al., 2020). Both of these scales provide a quantitative assessment of the extent and severity of erosive tooth loss as well as a basis for comparison at recall appointments. or fatigue in the jaw muscles. To determine the extent that toothbrushing habits may contribute to tooth wear, the dental practitioner should inquire about frequency and method of brushing, as well as the type of dentifrice used. ● Occupational/recreational history : The characteristics of the patient’s work environment and hobbies such as wine tasting should be ascertained. People who swim frequently in chlorinated pools should obtain information about the pool water’s acidity. ● Salivary function : The salivary flow rate should be assessed in patients with erosion. 2021). Signs of erosion can appear in the dentition of a patient with bulimia within six months of onset, and the most common clinical appearance is severe erosion on the palatal surfaces of maxillary anterior teeth (May & Seong, 2020; Santhiya et al., 2019). Compared to the smooth and even wear that results from attrition, the incisal edges of the maxillary anterior teeth of a person who routinely induces vomiting are irregular and chipped (Jarkander et al., 2018). The palatal and occlusal surfaces of maxillary premolars and molars tend to display moderate erosion, making raised restorations a possibility (May & Seong, 2020). Occlusal surfaces may display scooped-out dentin or highly polished wear facets from a combination of chemical and mechanical wear (Martini, 2018). Gastric acids usually do not affect mandibular anterior teeth because they tend to be protected by the tongue, although erosion occasionally is evident in this area (Nijakowski et al., 2022). Patients who have been bulimic for long periods of time commonly display generalized erosion and moderate to severe sensitivity. Long-
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