Preventive Strategies

Referral for treatment of any implicated medical conditions: Patients that have underlying medical conditions (GERD, bulimia, substance abuse, etc) that predispose them to the risk of ETW should be referred to the medical practitioner responsible for treatment while implementing dental preventive measures.⁵¹

Use of patient-applied remineralizing agent: Patients should be advised to use a remineralizing oral care product, rather than toothbrushing, immediately following the intake of an erosive product. This will enhance the saliva remineralizing capacity to speed up the remineralization of the softened mineralized tooth substance, prior to toothbrushing. Although some practitioners recommend 60 minutes delay before toothbrushing, the saliva remineralizing rate is not fast enough to accomplish the rehardening of the tooth tissue within this period. Remineralization can be accomplished by using fluoride mouthrinses (or dairy products in absence of a fluoride mouthrinse) or fluoride gels.^51,52

Use of professionally applied remineralizing agent: Further progression of the ETW can be arrested by periodic professional application of fluoride varnishes or gels to increase the resistance of the affected tooth tissue to further erosive attack.^51,53

Condition/method of drinking: Taking an erosive drink ice-cold reduces its erosive effect,³⁵ while the use of a straw would reduce the contact of the teeth with the erosive agent as well as enhance the rate of clearance of the agent from oral cavity.⁵⁴ The drink should be swallowed quickly and not sipped slowly or 'swished' around the mouth.^35,51,54

Use of modified products: Studies have shown that a drink which contains citric acid that was supplemented with calcium, phosphate, and fluoride reduced the erosive potential of the solution.^44,51,55-57 The same was true when acidic carbonated drinks were modified with these three minerals.^44,51,58 Yogurt, which is acidic with a pH of 4 hardly has any erosive effect due to its high calcium and phosphate content, which makes it supersaturated with respect to the hydroxyapatite in enamel.^44,51,58

Use of protective devices: A close-fitting mouth guard with a neutralizing agent, such as antacid suspension, applied to the fitting surface, may protect those who are at high risk of ETW due to their occupation (while on duty) or medical condition (e.g. GERD during sleep, anorexia/bulimia during vomiting).^51,59,60