Major Causes and Acid-related Risk Factors

The three major causes of dental erosion are:

  1. Regurgitation, which brings erosive stomach acid into the oral cavity and can occur in bulimia or during pregnancy.
  2. Excessive consumption of acidic foods such as sweets or even healthy foods like citrus fruit.
  3. Excessive consumption of carbonated beverages.2

Especially problematic is the habit of swishing soda in the mouth to prevent the uncomfortable sensation of carbonation in the throat. This habit enhances the dissolution process because the solution on the surface layer adjacent to tooth mineral will be readily renewed. Also of concern is the increasing consumption of soda among children: It rose 20% between 1994 and 2004, and is linked to the presence and progression of erosion when other risk factors are present.2,18

As explained before, the acid that erodes teeth can come from intrinsic or extrinsic sources. An increasingly prevalent cause of intrinsic acid is the gastric acid that enters the mouth in gastroesophageal reflux disease (GERD).19 In Western populations, GERD is reported to affect up to 30% of adults,20 and an estimated 15% of people complain of weekly GERD symptoms.21 GERD is itself a multifactorial condition caused by diet, posture, overly strenuous exercise, alcohol consumption, pregnancy, or obesity. Other conditions that cause gastric acid to enter the oral cavity include chronic alcoholism and rumination, a psychological disorder in which patients regurgitate and re-chew their food and swallow again.2,22

Additional extrinsic sources of acid include excessive consumption of other acidic items such as fruit juices, alcohol, herbal teas, energy drinks, supplements such as hydrochloric acid (taken for indigestion), chewable or effervescent vitamin C, aspirin, and some oral hygiene products, including some mouth rinses.2,22