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Distinguishing and Diagnosing Contemporary and Conventional Features of Dental Erosion Mohamed A

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Distinguishing and Diagnosing Contemporary and Conventional Features of Dental Erosion Mohamed A Oral Medicine, Oral Diagnosis, Oral Pathology Distinguishing and diagnosing contemporary and conventional features of dental erosion Mohamed A. Bassiouny, PhD, DMD, MSc The vast number and variety of erosion lesions encountered today erosion lesions are distinguished from similar defects, such as require reconsideration of the traditional definition. Dental erosion mechanically induced wear, carious lesions, and dental fluorosis, associated with modern dietary habits can exhibit unique features which affect the human dentition. that symbolize a departure from the decades-old conventional Received: February 21, 2013 image known as tooth surface loss. The extent and diversity of Revised: June 18, 2013 contemporary erosion lesions often cause conflicting diagnoses. Accepted: June 24, 2013 Specific examples of these features are presented in this article. The etiologies, genesis, course of development, and characteristics of Key words: erosion, definition, contemporary features, these erosion lesions are discussed. Contemporary and conventional conventional signs, brown lesions he increased incidence of dental ero- Recognizing the unique characteristics The commonly known definition and the sion associated with dietary sources of each, and identifying their respective classical description of conventional erosion has become a growing universal etiologies, could facilitate their differen- lesions allude to TSL of enamel with or T 1-7 concern for dental health care providers. tiation from similar lesions of nonerosion without dentin involvement. This enamel/ The severity of this widespread issue has origins. Examples of these are noncarious dentin defect is presented clinically as a gained the attention of clinicians, research- defects, carious lesions at various stages smooth surface with either partial or com- ers, the media, and the public in both the of development, and acquired anomalies plete loss of topographic and anatomic con- United States and worldwide.1-7 Published such as dental fluorosis and tetracycline- figurations. The TSL could appear in the literature has indicated that acidic con- stained hard tissues.24-27 form of a flat or saucer-shaped defect that stituents of dietary ingredients—especially Distinguishing and decoding contem- is usually limited to enamel, but may also acidulated carbonated beverages, con- porary erosion lesions is fundamental involve dentin in the affected region.23,28,29 sidered to be the single most prominent for achieving an accurate diagnosis and Progression of the enamel defect leads to etiology—have considerable impact on planning a proper course of management. removal of the entire enamel thickness, the development of dental erosion.7-14 The The most clinically satisfactory, economi- exposure of dentin, and further invasion excessive consumption of these beverages cal, and practical approach is prevention. into the dentin core.14,23,28-30 These defects among younger generations renders these However, proper identification of these are often seen on the cervical to middle consumers extremely vulnerable to this lesions may present a clinical challenge. segments of the tooth crown, although their dental hard tissue disease.5-15 Likewise, This is primarily due to an inadequate vertical expansion may lead to either crown excessive consumption of highly acidic awareness of the specific characteristics and/or root surface involvement. These citrus fruit and juices increases the poten- of each type of lesion. It can also be due erosions are commonly seen on the facial tial for dental erosion in a large segment of to the shortage of relevant information aspects of the dentition and should be dif- the senior population.16-19 from patients’ health and dietary histo- ferentiated from defects due to toothbrush An overwhelming variety of dental ries, as well as their oral hygiene care. abrasion and abfraction (Fig. 1). Their erosion lesions are encountered by clini- These factors collectively could negatively presence on the lingual aspect of a tooth is cians.16,17,20-22 The clinical features of impact the diagnostic process and result etiology-specific. In severe cases, they may these contemporary lesions transcend the in an impulsive and potentially incorrect also affect the biting surfaces of teeth. definition of conventional tooth surface conclusion. Arming dental professionals Examples of erosion lesions that present loss (TSL) that has been known for more with the ability to recognize the wide features of TSL on the lingual aspects of than half a century.8,14,16,23 The range of spectrum of these newly emerged erosion dentition are those that develop as a result these lesions is associated with numerous lesions, and familiarizing them with the of either extrinsic or intrinsic sources. sources of acidic dental erosion, the most specific features of each, could expedite The former could be caused by excessive predominant of which are nutritional identification and alleviate confusion. sipping of lemonade; sucking slices of sources.8,14,16,17,23 Each type of erosion The objectives of this article are to iden- lemon, orange, or grapefruit; or soaking lesion possesses specific clinical signs tify and precisely describe the assortment the dentition in pooled soda for a while and a unique appearance. These signs of contemporary erosion lesions observed before swallowing.8,14,16 Erosion lesions differ widely from each other, but their today, and clearly differentiate between from intrinsic sources that appear on the spectrum defines the general character- their clinical features and those of lesions lingual aspects of the anterior maxillary istics of contemporary dental erosion. with closely similar characteristics. incisors and canines may be an indicator 46 May/June 2014 General Dentistry www.agd.org Fig 1. Anterior view of mandibular premolar/canine segment Fig. 2. Lingual view of maxillary anterior segment showing tooth showing erosion defects associated with gastroesophageal reflux surface loss associated with pyloric sphincter obstruction. disease combined with aggressive toothbrushing and mastication of fibrous food. Fig. 3. Occlusal view of the anterior maxillary region showing tooth Fig. 4. Facial view of the lower dentition showing tooth surface surface loss associated with bulimic purging of stomach contents. wear that is characteristic of erosion caused by acidic drinks. of involuntary purging of the stomach another.24-26,30 The radiographic image This definition falls short of encom- contents, as in the case of severe chronic of the eroded enamel defect may display passing the variety of erosion lesions gastroesophageal reflux disease (GERD) grades of radiolucency that correspond associated with a modern day diet, known or pyloric sphincter stenosis obstruction with the extent of the surface defect and as contemporary lesions. The clinical (Fig. 2).23,28,29 Similar signs of dental ero- the type of tissues lost. In general, the features of contemporary erosion lesions sion might be manifested by perimolysis radiolucency corresponds with the lesion’s are diverse. The variety of clinical signs (erosion from gastric acids due to regurgi- location and dimension. This radiolucent epitomizes the uniqueness of contempo- tation) associated with voluntary purging image is frequently seen bordered by a rary erosion lesions. For identification by bulimic persons (Fig. 3).23 definitive line of demarcation, character- and differentiation purposes, they may be The patients’ health and dietary histo- izing dental erosion from tooth decay, categorized into 3 types that incorporate a ries in these cases, combined with clinical although it is a common feature in tooth- select range of features. signs, often disclose the causative etiology. brush abrasion defects. The aforemen- The typical amalgamated features of these tioned manifestations of TSL of enamel Type I erosion lesion erosion lesions are that they maintain and possibly dentin precisely fit the clas- This lesion correlates to the conventional normal tissue color, translucency, texture, sical description of dental erosion defined dental erosion lesion. It is characterized and surface hardness. Accordingly, they by Hubert Stones in 1954 as: by TSL involving enamel and/or dentin. may bear much resemblance to mechani- This type of lesion maintains normal tissue cal wear defects caused by tooth brush- …a destructive process of enamel and dentin color and surface texture (Fig. 1-4). ing, abfraction, and attrition, or occlusal by the chemical action of acids from various A Type 1 lesion is frequently observed and incisal wear due to mastication, sources that leads to tooth surface loss, with- in association with systemic, dietary, and and need to be differentiated from one out involvement of microbial organisms.31 environmental etiologies, and its location www.agd.org General Dentistry May/June 2014 47 Oral Medicine, Oral Diagnosis, Oral Pathology Distinguishing and diagnosing features of dental erosion is consistent with the causative etiolo- gies.16,20,31 Individuals who are vulnerable to this type of dental erosion are those with systemic conditions that propel gastric juice into the oral cavity either by GERD or purging, avid consumers of regular or diet soda for prolonged dura- tions, persons who consume excessive amounts of citrus fruits and/or juice on Fig. 5. Facial view showing white enamel spots associated with Fig. 6. Facial view of mandibular a daily basis, and individuals exposed to excessive daily intake of orange juice for 3 years.
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