Non-acid Risk Factors

The presence of acid is not the only way by which ETW can occur. The non-acid factors that may predispose a person to ETW are as follows.

Excessive oral hygiene procedure: Used as directed, most toothpastes are safe. However, if used aggressively or abusively – too much force, too much paste, too frequently – the detergents and abrasive particles essential for cleaning under normal circumstances have the potential to increase physical loss of the mineralized tooth substance. Thus, frequent tooth brushing with abrasive dentifrice as practiced by some health/aesthetic-conscious individuals may render the tooth surface more susceptible to ETW due to removal of the more protective highly mineralized outer layer of tooth surface.¹⁸ Furthermore, frequent toothbrushing may cause reduction of the thickness of the acquired salivary pellicle, which would adversely affect its established protective role against ETW.¹⁹

Chelating agents: Chelation is the process by which certain agents form complex with calcium to remove it from the mineralized tooth substance or complex with calcium in saliva to reduce saliva’s supersaturation, thus triggering demineralization that leads to ETW. Products with chelating ability include mouthrinses that contain the ingredient EDTA, and food and beverages that contain citric acid. Up to 32% of the calcium in saliva can be complexed by citrate at concentrations common in fruit juices, reducing the supersaturation of saliva and driving the equation to dissolution of tooth mineral.²⁰