It is recommended that patients with ETW brush for no more than 2 minutes and a maximum of twice-daily. Normally, manual and powered brushing cause virtually no enamel loss and minimal dentin loss. Some studies have suggested that power brushes, due to their ability to control the force of brushing, may be preferred over manual brushes.69,70 A common question is with respect to when is the best time to brush; before or after an erosive acid challenge. In a recent in situ study using enamel slabs, it took about 2 hours after an acid challenge before the enamel surfaces began to recover;71 this suggests that it may be wise to wait for at least 2 hours after an erosive acid challenge before brushing. If brushing before an acid exposure, make sure to use a product that provides an acid resistant barrier layer, such as a SnF2 toothpaste, to protect the teeth against erosive acid attack. Without that barrier layer, the teeth could be susceptible to erosive softening, due to the effect of the brushing on pellicle thickness. Not brushing at all, of course, leads to other issues.
Patients with erosion can benefit from twice-daily use of SnF2 toothpaste, because polyvalent metal ions interact with the tooth surface to form an acid-resistant insoluble layer. In fact, the recent consensus report by the European Federation of Conservative Dentistry notes that oral hygiene products containing stannous fluoride or stannous chloride, such as toothpastes or mouth rinses, have the potential to slow the progression of ETW.66 Additional options include recommending a calcium phosphate-based or bioactive glass home use product to promote remineralization.