Patient Age and Risk Factors
ETW is episodic throughout life and can start in infancy. It is generally accepted that deciduous ETW may be indicative of future erosion problems in the permanent dentition. Although studies in the literature have suggested the prevalence of dental erosion to be somewhere between 7-74%, an overall ETW prevalence of 30% has been found in a meta-analysis of studies in teenagers and young adults with at least one erosive lesion, and the condition becomes even more prevalent with age.44 Different etiologies typically play more of a role at different ages. Figure 9 shows a case involving erosion and attrition.
Multifactorial ETW with erosion and attrition.
Risk factors for ETW include: 1) dietary habits (amounts, frequency, manner of consuming acidic foods and beverages); 2) gastric reflux (GERD, bulimia, pregnancy vomiting); 3) xerostomia - reduced salivary flow decreases acid dilution and clearance; and, 4) exposure to mechanical insults such as hard foods, improper toothbrushing and bruxism. The severity of acid attacks varies with the pH of acid and its buffering capacity, whether a drink is swished/sipped/gulped or taken with a straw, and its contact time, the thickness of the acquired pellicle and salivation. Reduced salivary flow represents the greatest risk factor and must be evaluated. ETW is irreversible and, if observed in children or adolescents, it can be expected to progress unless intervention occurs.
In looking at minor erosion, the patient’s age, habits, and whether wear is physiological or pathological should be considered. Early diagnosis is especially important as patients typically do not seek care until they experience pain or an esthetic problem.
Conducting an evaluation for dental erosion provides dental practitioners with a window into some of the other habits of a patient. For example, recession above the NCCL lesions in Figure 10 suggests that this patient has likely been brushing with a stiff toothbrush and abrading the tissue away; this has resulted in minimally attached gingiva, recession and a very deep erosive lesion. Care must be taken to appropriately manage this type of condition, in addition to the other issues that patient is experiencing.
The presence of NCCL lesions suggests the likelihood of improper brushing habits.