Risk Assessment and Diagnosis

It is important to evaluate the different etiological factors in order to identify which patients are at risk and to suggest preventive measures, particularly if erosion is detected early. Erosion not diagnosed in the early stages may render preventive measures too difficult. In order to assess risk, gathering information on a patient’s medical and dental case history is an important first step. Information about the patient’s dietary habits are the most useful, and it is advised that dentists ask their patients to record their complete dietary intake for 4 consecutive days, including time of day and quantity of all foods and beverages, as well as medications and supplements. In addition, it is useful to ask the patient about gastric symptoms (like vomiting, acid taste in mouth, chronic heartburn, etc.), drug use (alcohol, anti-emetics, anti-histamines, etc.), use of acidic medicines or supplements, and oral hygiene habits (like technique or frequency of brushing). It is also useful to conduct tests for unstimulated saliva flow rate, stimulated saliva flow rate, and saliva buffering capacity to determine if the amount and quality of saliva is posing a risk of erosion.2,39,40

Clinical detection of dental erosion is important once dissolution has started. In the early stages of erosion, the appearance of the teeth is the most important sign for diagnosis. Early signs include a smooth silky-glazed enamel surface and grooving on occlusal surfaces. In more advanced stages, changes in the original morphology occur. In general, buccal and lingual surfaces of the upper incisors appear smooth and shiny with a generalized loss of anatomy, while palatal surfaces of the upper incisors might show smooth exposed dentin, often with a halo of enamel surrounding the lesion.2