Tooth erosion: causes, symptoms and ways to protect tooth enamel

Tooth erosion is one of the problems I see most often being overlooked. It doesn’t hurt at first, there’s no clear moment when it ‘appears’, and patients usually only realise something is wrong when they experience sensitivity or notice that their teeth look different.

In short, erosion is the gradual loss of enamel caused by acids. Once lost, enamel does not regenerate, which is precisely why it is worth understanding what causes it. Identifying the cause is just as important as the treatment, and prevention often makes the difference between a problem that is kept under control and one that gets worse. 

Tooth erosion is the progressive loss of hard tooth tissue caused by the chemical action of acids that do not originate from bacterial activity. Initially, the enamel is affected, and in advanced stages, the dentine may also be exposed.

Unlike dental caries, erosion is not caused by acids produced by bacteria in dental plaque. The acids involved may come from food or from the stomach, for example in the case of gastro-oesophageal reflux.

There is no single mechanism underlying dental wear, and all three types can occur simultaneously in the same person:

Precisely because these mechanisms can occur together, an accurate diagnosis requires a thorough examination.

As well as limiting frequent exposure to acids, a varied diet helps to maintain oral health. Find out which foods for healthy teeth and gums can be included in a balanced diet.

“Tooth enamel isn’t bothered by an orange eaten at mealtimes. It is bothered by acidic juice sipped in small sips throughout the day.” 
— Dr. Dan Straja, DENT ESTET

Gastro-oesophageal reflux and stomach acids

Stomach acid is very strong, and when it reaches the mouth, the enamel suffers. This can happen in cases of gastro-oesophageal reflux or repeated episodes of vomiting. If you suspect a medical cause, it is important that it is identified and treated, because otherwise simply protecting your teeth will not solve the problem. 

Saliva plays a protective role: it neutralises acids and helps restore balance in the mouth. When saliva flow decreases and a dry mouth sensation occurs, this protection weakens, and acids remain in contact with the teeth for longer. Hydration matters, and the frequency of exposure to acids becomes even more significant when there is little saliva.

The symptoms may be subtle. It is worth keeping an eye out for:

• sensitivity to cold, heat or acidic foods;
• thinner enamel;
• increased transparency at the edges of the teeth;
• changes in tooth colour (the dentine, which is more yellowish, becomes more visible);
• smoother or glossier surfaces;
• thinner or irregular tooth margins;
• changes in tooth shape, in advanced stages.

Sensitivity to cold, hot or acidic foods can have several causes, not just enamel erosion. Find out more about tooth sensitivity, the factors that contribute to it and treatment options.

Early-stage erosion

The damage is superficial, and the symptoms are subtle or absent altogether. This is precisely why early detection is so valuable: at this stage, we can intervene before important structural elements are lost.

Erosion in advanced stages

Enamel loss is more significant, the dentine becomes exposed, and sensitivity increases. Functional changes (chewing, sensitivity to any stimulus) and aesthetic changes (the shape and colour of the teeth) may occur. 

Limit frequent exposure to acids

Cut down on acidic drinks and snacks, avoid holding acidic drinks in your mouth and, where possible, consume them with meals. You don’t have to give them up altogether, but you should consume them more carefully.

Adjust your brushing technique

Avoid aggressive brushing; choose a suitable toothbrush and appropriate toothpaste. Do not brush immediately after exposure to acids, as the enamel is softer and more vulnerable at that time. A wait of around 30–60 minutes is usually recommended. Follow your dentist’s advice on oral hygiene.

Gentle brushing, using a fluoride toothpaste and cleaning your teeth properly are also important for preventing other oral problems. Discover the recommendations for a proper oral hygiene routine, tailored to your daily needs.

The role of fluoride and products for enamel protection

Fluoride products can help protect the tooth surface and promote the remineralisation of superficially demineralised areas. However, remineralisation does not mean the regeneration of enamel already lost through erosion.

Depending on the extent of the damage, your dentist may recommend fluoride toothpastes, desensitising products or professional treatments to reduce sensitivity and limit the progression of erosion.

Rinse your mouth with water after consuming acidic foods and drinks

It’s a simple but useful step: water helps to dilute the acids and reduce the time they remain on your teeth.

“Erosion doesn’t show up overnight, but it becomes apparent over time. A check-up every six months helps us catch it whilst we can still stop it, not just repair it.” 
— Dr. Dan Straja

Preventative measures and monitoring

The first step is to identify and address the cause. This is followed by changes to dietary habits, adjustments to oral hygiene and regular monitoring. In many early-stage cases, this is sufficient.

Managing tooth sensitivity

Sensitivity can be reduced using desensitising products and professional treatments, which protect the exposed surfaces.

Restorative treatments

When there is significant loss of tooth structure, the following may be required:

• composite restorations;
• veneers, where indicated;
• crowns or other restorations, when there is significant loss of tooth structure.

Treatment planning is tailored to each individual, as every case has its own extent and specific objectives. 

Regular check-ups enable the early detection of changes in tooth enamel, the provision of personalised advice on oral hygiene, and the monitoring of risk factors. The aim is to prevent the condition from progressing to more advanced stages, when treatment becomes more complex.

Book an appointment if:

• your tooth sensitivity persists;
• you notice changes in colour or transparency;
• the edges of your teeth are becoming thinner;
• there are visible signs of wear;
• you have gastro-oesophageal reflux or repeated episodes of heartburn;
• the shape of your teeth is gradually changing.

Tooth erosion is a progressive condition. Repeated exposure to acids must be reduced, and oral hygiene adjusted accordingly. The cause must be identified before choosing a treatment, and regular check-ups help to monitor the enamel.

If you have sensitivity that won’t go away or have noticed changes to your teeth, book an appointment. We’ll work out together what’s going on and how we can protect your enamel.