When the enamel surface is pathologically challenged by acidic insult and demineralized, erosive toothwear is the result. This is different from dental caries because dental erosion is generated by non-bacterial acids (often dietary) that can dissolve the fluorapatite structure. 111 This condition has linkages to dentinal hypersensitivity due to acid exposure of dentin tubules and similar estimated prevalence rates.112As with hypersensitivity, the exact numbers of individuals with erosive toothwear is difficult to specify with exactness but is estimated to be high and appears to be growing – especially in younger adults – because of high dietary acid exposure, e.g., erosive sugary energy drinks, sports beverages, and sodas.113-116It is important to strive for erosion prevention, because the condition is often not diagnosed until a later stage, and lost tooth structure is not reversible and thus costly to address via restorative dentistry.117
To that end, one of the three commonly utilized fluoride agents in dentifrices – stannous fluoride – has been shown to be uniquely advantageous in preventing erosive toothwear. The mechanism of action is the deposition on the enamel pellicle surface of an acid-resistant protective barrier layer.118 In situ investigations of bioavailable SnF2 exposure have found up to 80% greater enamel erosion protection benefits compared to a control.119-121
In seeking a toothpaste with SnF2 anti-erosion benefits, the choices will be the same as those described previously in the course for other conditions where a stabilized stannous fluoride multi-indication dentifrice has demonstrated proven therapeutic benefits (caries, gingivitis, dentinal hypersensitivity). See also Figure 3.