Tooth Erosion: Prevention and Treatment Kevin HK Yip, Roger J Smales, John A Kaidonis
INDEX
×
Chapter Notes

Save Clear


Definitions, Appearances, Prevalence and EtiologyCHAPTER 1

Roger Smales,
John Kaidonis

ABSTRACT

The clinical terms of dental erosion, attrition and abrasion are not wear processes in their own right, but are used to describe the outcomes of several underlying mechanisms of tooth surface loss. Difficulties may be encountered in the diagnosis, and the measurement, of dental erosion (corrosion) as the condition usually coexists to varying extents with other forms of tooth wear. From limited evidence, the prevalence of erosion increases with age, and appears to be high in children and adolescents in several countries. Psychological and lifestyle behaviors are important factors in the onset and progression of tooth erosion.
 
INTRODUCTION
An increasing interest in erosion as a major cause of tooth surface loss is reflected by several more recent focused publications.13 Although tooth erosion has been reported in dental literature for over 100 years, only relatively recently its significance has been appreciated for the increased observation of clinical tooth wear, particularly in Western countries. Erosion is often overlooked or misdiagnosed as other forms of tooth wear, with which it frequently coexists. This has important implications for the treatment management of patients.
 
DEFINITIONS
In scientific terms, there are four fundamental frictional wear processes which occur when opposing contacting surfaces move relative to each other.4
Adhesive wear occurs when asperities (microscopic projections) on one surface become cold-welded to the other surface, resulting in the transfer of material from one surface to the other. This process usually involves metals.
Abrasive wear occurs when hard asperities on one surface plough into a softer surface. Two-body abrasive wear occurs when the particles are an integral part of the surface. However, 3-body wear occurs when fractured particles or the introduced foreign materials are present between the surfaces. Erosive wear occurs if the particles are carried to the surface by a high-velocity stream of gas or liquid.
Fatigue wear occurs when plastic deformation leads to subsurface micro-cracks with subsequent crack propagation to the surface and dislodgment of material.
Tribochemical wear occurs when a chemical reaction layer (Corrosion) on one surface is removed by the mechanical action of the opposing surface.
However, the foregoing terms are not used by clinicians to describe the wear of teeth and materials observed intraorally. Rather, the outcomes of several underlying events are described instead.42
zoom view
Fig. 1.1: Advanced erosion of the enamel and dentin resulting from the drinking of red wines every evening
Various clinical terms are often used interchangeably to describe the manifestations or forms of hard tooth surface loss, not all of which can be defined as tooth wear.46
Erosion or, more correctly, corrosion4,6 is described as tooth surface loss produced by chemical or electrolytic processes of non-bacterial origin, which usually involves acids.5 Frictional wear is not required to cause the surface loss of tooth substance (Fig. 1.1). However, frictional wear, even from the oral soft tissues, is invariably present.
Attrition is described as tooth surface loss produced by tooth-to-tooth frictional contact of opposing surfaces without an intervening foreign material, which occurs during swallowing, speech and tooth grinding.5 Attrition is actually a form of endogenous abrasion, and the dislodged tooth particles quickly convert the initial 2-body abrasion process to 3-body abrasion (Fig. 1.2).
Abrasion is described as tooth surface loss produced by foreign or exogenous material being forced over the tooth surfaces, which occurs during the chewing of foods, from toothbrushing and the use of interdental cleaning devices, and from occupational and acquired parafunctional habits such as fingernail biting5 (Fig. 1.3). A recent review of toothbrushes and toothpastes (dentifrices) concluded that negligible damage to dentin occurs with a toothbrush alone and that, under normal use, toothbrushing with toothpaste will cause limited wear of dentin in a lifetime's use.7
zoom view
Fig. 1.2: Severe generalized attrition from tooth grinding with abrasion of the exposed dentin. Extensive enamel flaking is present
zoom view
Fig. 1.3: Cervical abrasion in an unopposed premolar tooth resulting from incorrect toothbrushing and dentifrices.(Courtesy: JA Kaidonis, LC Richards, GC Townsend)
Abfraction is described as tooth surface loss produced by microstructural fracture of tooth substance in areas of stress concentration, usually affecting the facial cervical regions, which occurs as a result of occlusal forces.6
Resorption is described as the biological removal of hard tissues by vital specialized cells. Although there may 3be the loss of material from external tooth surfaces, the process is not regarded as tooth wear.5
Usually, more than one wear process is active in an individual at any time, although one may predominate.
Demastication describes the loss of tooth substance during mastication of the food bolus, which may involve several wear processes, but principally abrasion. Restorations and prostheses are also subject to various wear processes, which are described more frequently in scientific terms.
 
APPEARANCES
The most notable feature of dental erosion is the presence of smoothly glazed or silky and rounded tooth surfaces, which have lost all of their microanatomical detail (Fig. 1.4). Thinning of the enamel leads to increased incisal and proximal translucency, and yellowing of the teeth from the underlying dentin. Cervically, the enamel lesions are usually broad and shallow, often with poorly-defined margins (Fig. 1.5). Active erosion results in the removal of stains, and the acquired dental pellicle and plaque, giving a very clean appearance (Fig. 1.6). Saliva is required for the dental biofilms to reform before remineralization of the affected teeth can occur.
Exposure of the less-mineralized dentin results in a faster loss of material, with occlusal scooping or ‘cupping' of the cusp tips initially and ‘grooving' of the incisal edges being a common feature enhanced by abrasion from foods (Fig. 1.7). Unsupported enamel fractures away leaving jagged incisal edges.
zoom view
Fig. 1.4: Early enamel erosion of posterior teeth showing general rounding and loss of anatomical detail, with an increased yellowing appearance because of the thinned enamel
zoom view
Fig. 1.5: Early cervical enamel erosion of the central incisor showing a broad shallow lesion with poorly defined margins
zoom view
Fig. 1.6: Active erosion has resulted in very clean tooth surfaces and a minimally tarnished amalgam restoration
4
zoom view
Fig. 1.7: Progressive erosion results in occlusal scooping or cupping of the exposed softer dentin in posterior teeth, and grooving in anterior teeth.(Courtesy: JA Kaidonis, LC Richards, GC Townsend)
However, a narrow rim of sound enamel may be preserved adjacent to the gingival margins, possibly as the result of crevicular fluid exudates from healthy gingivae. The less soluble restorative materials present appear proud or raised above the surfaces of the affected teeth, and amalgam restorations appear non-tarnished810 (Fig. 1.8).
On exposed root surfaces, erosion may simulate the softened leathery, but intact, dentin observed with incipient root surface caries.11 The erosive lesions are often very sensitive and dark, and are usually located on the facial and palatal surfaces of the maxillary posterior teeth and occasionally on anterior teeth. The lesions occur in elderly people who suffer from repeated episodes of gastric reflux, leading to periodic cycles of demineralization and remineralization of exposed root surfaces. A very low unstimulated salivary pH is usually present (JM McIntyre, 1994). These softened darkened lesions are very susceptible to toothbrush/dentifrice abrasion.
zoom view
Fig. 1.8: Resin-based composite restorations are more acid resistant than the teeth, resulting in a proud or raised appearance. The teeth are pristine clean, following the acid removal of all stains and oral biofilms
Extensive erosion will result in an unsightly appearance with shortened teeth, reduced masticatory function, and tooth sensitivity when the process is rapid. However, extensive lesions can be present without causing undue sensitivity from the exposed dentin. Occasionally, the dental pulps may become exposed and non-vital, particularly in primary teeth. Although tooth wear, apart from erosion, is a normal ongoing physiological process, the wear should be regarded as pathological when it results in psychological and health problems or appears to be excessive for the person's age.
While the initial tooth sites affected by erosion often reflect the sources and manner of delivery of the acids,12 progressive tooth erosion involving various modifying factors usually blurs such distinctions as the various patterns coalesce. Modifying factors may include salivary flow rates and patterns, orofacial muscle activity, acquired dental pellicle thickness and tooth extraction sites. In long-standing instances of intrinsic erosion, lesions involving the incisal edges as well as the cervical regions of the lingual surfaces of mandibular anterior teeth may be present, which is usually not a feature of extrinsic erosion.13 Further information may be found in Chapters 6 and 7 on tooth sites which may be affected preferentially by the different sources of acids.
It can be difficult to detect signs of tooth erosion when other forms of tooth wear are also present, which is the usual clinical situation. However, being suspicious of the possibility that erosion may be present, and knowing what signs to look for, will result in its detection in many instances.
5
zoom view
Fig. 1.9: The diestone cast shows flat enamel facets with welldefined margins resulting from attrition
The classical appearances of attrition and abrasion differ from that of erosion.
Attrition results in flat matching facets, with wellcircumscribed borders, on opposing teeth that interdigitate and wear at the same rates (Fig. 1.9). During active tooth grinding the contacting enamel surfaces appear shiny and show numerous microscopic fine parallel striations, which are aligned in one direction and confined within the area of the facets. When active erosion is also present, then the enamel surfaces may appear dull. Extensive occlusal attrition is found with tooth grinding or bruxism, usually associated with hypertrophy of the muscles of mastication and with stress reactive hyperplasia of root cementum and alveolar bone. Heavy stresses cause enamel flaking or chipping, and may even result in fracture of tooth crowns (see Fig. 1.2).
Abrasion from food results in worn occlusal areas without delineated borders. There is a general rounding or 'blunted' effect on the teeth, and the tooth surfaces show numerous microscopic pits and haphazardly orientated scratches. Where cusps or incisal edges are reduced in height, then the exposed dentin may appear scooped out (Fig. 1.10). Abrasion also may result in wedge-shaped cervical lesions with well-defined margins, which are usually found on exposed facial root surfaces. These lesions are often associated with the use of abrasive toothbrushes/dentifrices, and their severity appears related to the method and frequency of brushing. Occlusal forces also have been implicated by some researchers in the etiology of cervical lesions.6 Abrasion of other tooth surfaces caused by various oral hygiene aids and by objects used with different occupations and habits is seen less frequently. Abrasive lesions are generally insensitive because any exposed dentinal tubules are covered with a smear layer as a result of mechanical burnishing. However, when active erosion is also present, then the affected teeth may become very sensitive.
zoom view
Fig. 1.10: Abrasion results in a more rounded and less well-defined occlusal appearance. The shallower scooped dentin lesions are deepest towards the buccal aspect in the mandibular posterior teeth. Multidirectional occlusal grooves of varying depths are present in the teeth, in the skeletal mandible
One study of occlusal scooping or ‘cupping' in dentin reported a significantly smaller mean depth to breadth ratio for abrasive wear (0.15) than for erosive wear (0.33), in dental casts obtained from two different population samples.14 The erosion lesions were relatively deeper, with the deepest parts usually positioned centrally. The shallower abrasive lesions showed maximum depths towards the buccal aspect of the 6lesions in posterior mandibular teeth, and towards the palatal aspect of the lesions in posterior maxillary teeth.
 
PREVALENCE
Although the prevalence of dental erosion appears to be increasing, particularly from studies of younger people in several countries, this may be partly due to a greater awareness of the condition by dentists following an increased number of published case reports and other articles in recent years. From the following limited evidence, the prevalence of tooth erosion in selected primary and permanent teeth appears to be high in most of the populations sampled.
A national survey of United Kingdom children reported palatal enamel erosion of the maxillary incisors in 37 percent of 14-year-olds, and dentin exposure in 2 percent of 13 to 15-year-olds.15 A similar United Kingdom national survey involving the maxillary primary incisors reported palatal enamel erosion in 19 percent and dentin or pulp exposure in 8 percent of 1.5 to 4.5-year-olds.16 Other United Kingdom studies have confirmed the frequent occurrence of enamel erosion in children.17 A study involving the maxillary primary incisors of Saudi 2 to 5-year-olds reported enamel erosion in 18.8 percent and involvement of the dentin and/or pulp in 12.5 percent of all children.18 Dental caries was associated frequently with the tooth erosion, which was related to the consumption of vitamin C supplements, carbonated drinks, and fruit syrup supplied from feeding bottles.19 Pronounced maxillary incisor tooth erosion also was observed in 34 percent of 5 to 6-year-old boys, and in 26 percent of 12 to 14-year-old boys, in one other Saudi study,20 which also employed the same previously-used assessment method.15 In a study from India, approximately 33 percent of 5 to 6-year olds were reported to have appreciable tooth wear and dental erosion.21 By contrast, a Chinese survey of maxillary primary incisors only found enamel erosion in 4.9 percent and dentin or pulp exposure in 0.9 percent of 3 to 5-year-olds.22 A comparative survey of 11 to 13-year-olds from the United Kingdom and the United States found enamel erosion in 37 percent and 41 percent of the subjects, respectively.23 A large Netherlands study found superficial enamel erosion in 30 percent, and deep enamel erosion in a further 11 percent, of 15 to 16-year-olds.24
In a random sample of 19- to 25-year-old Saudi male military inductees, 28 percent of the maxillary anterior teeth were reported to show pronounced dental erosion into dentin and/or pulp.25 The erosion correlated strongly with a high consumption of cola-type drinks.26 A Swiss study of dentin erosion reported one or more facial lesions in 7.7 percent of young adults and in 13.2 percent of middle-aged adults. Percentages for one or more occlusal lesions were 29.9 percent and 42.6 percent, respectively.27 A controlled study of Finnish adolescent and adult dental patients found that 5 percent had evidence of tooth erosion.28 Not unexpectedly, high percentages of people with vomiting in anorexia and bulimia nervosa and in chronic alcoholism, and of people whose work exposes them to acid fumes and acidic wines are reported to have tooth erosion.29,30 Summary findings from several other published prevalence studies of erosion in children have been tabulated in a recent review.31
 
MEASUREMENT
Assessments of the prevalence and severity of dental erosion, and of other manifestations of tooth wear, have been hampered by difficulties in diagnosis and measurement, and by the small number of reliable studies published.17,29 Despite numerous attempts and refinements over many years, problems have been encountered in devising simple, quantifiable clinical indices which are valid and reliable.29,32,33 The subjective indices often used in epidemiological surveys are unreliable for longitudinal studies, particularly for the extent of enamel loss, and for close monitoring of the progression of tooth wear in patients by dental practitioners. On the other hand, the expensive sophisticated methods which are 7available for measuring clinical tooth wear are impractical.3436
Cross-sectional surveys often only examine the labial and palatal surfaces of the maxillary incisors, and use a very coarse rating scale with few categories, in order to obtain high examiner agreements.34 Other subjective rating scales for assessing the extent of tooth wear have included the scoring of all teeth and all tooth surfaces, using an extended number of categories.33 Even with the assistance of reference photographs and models, achieving high examiner agreements may still be difficult for some rating categories. The process of scoring many tooth surfaces is tedious, and permanent records are usually not obtained to allow closer examinations and direct comparisons over time. The eye can detect far more subtle morphological changes than those recorded by rating scales.
In dental practices, the use of high-quality diestone casts poured from addition-cured silicone impressions is a more practical method for assessing gross changes in tooth morphology over time. Clinical photography is useful for detecting changes in tooth translucency and color caused by thinning of the enamel and from exposure of the underlying dentin. These records can be used for patient education, and may also be important for medicolegal reasons in some instances.
A more sensitive method for assessing the rate of tooth wear in dental practice is to use a No. 12 scalpel blade to scratch the surface of an affected tooth. Then take either a small flowable resin composite or an addition-cured silicone impression using a wooden tongue blade, which can be labeled with the patient's name and date (Fig. 1.11). Repeat the impressions over a 2- to 4-weeks period and observe, using magnification, the rate of disappearance of the ‘groove' in the impressions.37
From direct clinical observation, color photographs or dental casts, the amount of occlusal and incisal tooth surface wear for individual teeth can be scored from a set of charts38 (Fig. 1.12).
zoom view
Fig. 1.11: Addition-cured silicone impression taken of a horizontal groove placed on a tooth using a No. 12 scalpel blade. Disappearance of the ‘groove' in the serial impressions taken over several weeks denotes active erosion
zoom view
Fig. 1.12: Representative scores for varying degrees of occlusal wear at four tooth sites in the maxillary and mandibular arches. Interpolation between the illustrated stages may be used for approximate intermediate wear scores
8
Table 1.1   A table constructed for the maxillary first molar shows predicted tooth wear scores at different ages
Age (years)
Predicted wear scores
20
0
0
4
8
12
30
0
8
15
22
30
40
5
16
26
37
47
50
10
24
37
51
65
60
15
32
49
66
82
70
20
40
60
80
100
80
25
48
60
80
100
90
30
56
83
100
100
100
35
64
94
100
100
The tooth wear scores are based on ratios of the area of exposed dentin to total crown area. The scores are related to the age of the individual and can be used to project the likelihood of the extent of future tooth wear (Table 1.1). The severity of the wear can be compared against clinically low, moderate and high wear plots (Fig. 1.13). This assessment method has implications for identifying and treating potential tooth wear problems at an early age.
 
ETIOLOGY
The acids responsible for the primary causes of tooth erosion originate from extrinsic (exogenous or external) and intrinsic (endogenous or internal) sources (Fig. 1.14).
zoom view
Fig. 1.13: A graph can be used to compare the current wear score for a particular tooth in a person against the predicted wear scores for low (scores < 30 by age 100), moderate (scores 30-90 by age 100), and high (scores > 90 by age 100) wear rates
zoom view
Fig. 1.14: Extensive, severe tooth wear caused by a combination of intrinsic and extrinsic acids, together with tooth grinding. Two maxillary incisors required root canal therapy because of exposed pulps
Both sources were found in one study of patients from dental practices to occur with approximately the same frequency.28 Considerable risks of erosion were found to be associated with citrus fruits eaten more than twice each day, vomiting, gastric symptoms, and the ingestion of apple vinegar. People may consume large amounts of acidic fruits and vegetables, and acidic fruit juices and other beverages as part of a healthier lifestyle, when dieting, when replacing lost fluids after undertaking strenuous activities, and when attempting to stimulate an increased flow of saliva. The erosive potential of the acids is influenced by the type of acid, the pH and the titratable acid content. Some acids such as citric acid in particular, and phosphoric acid, also can chelate calcium from the tooth surface. The very low pH of approximately 1.2 for gastric acid will lead to severe occlusal tooth surface loss under even low occlusal frictional loads.39
Extrinsic sources of acids broadly comprise acidic diets, medicaments and environments. Events causing intrinsic acidic gastric contents to enter the mouth broadly comprise recurrent vomiting, regurgitation from gastroesophageal reflux disease (GERD), and rumination. These events can be caused by anatomical defects, psychological problems, medical conditions, and side effects from medications/drugs, alcohol and spicy foods. Extrinsic and intrinsic causes of tooth erosion are described further in Chapters 5 to 7, and have been reviewed in depth in several publications.30,31,40439
zoom view
Fig. 1.15: The patient, also shown in Figure 1.1, said that she drank only one glass of red wine each evening with her meals
One of these articles contains tabulated summaries of the findings from many published studies which have investigated the erosive potential of beverages and foodstuffs.31
A suspicion of erosion following the examination of the teeth should prompt a thorough medical history of any symptoms associated with gastric reflux and with hyposalivation. Patients should be asked about the possible causes for the symptoms, keeping in mind that the answers may sometimes be evasive in instances of psychological eating disorders and drug or alcohol abuse44 (Fig. 1.15). Questions should also be directed at determining an extrinsic cause for the tooth erosion, which frequently involves the patient's diet. The diet should be monitored over several consecutive days, including the weekend, to confirm the frequency and amounts of spicy and acidic foods and beverages consumed, and any medications taken.44 Industrial, occupational and recreational causes may be responsible directly for the erosion in some instances.
Of increasing importance is the recognition of lifestyle habits, choices and economic conditions which may affect the onset and rate of progression of tooth erosion. The choosing and frequent consumption of erosive foods and drinks can be based on considerations of finance, health and body image. Many lifestyle behaviors affecting tooth erosion result from misguided beliefs, psychological stresses, peer pressures and intense brand name advertizing, as described in Chapter 3. Important cofactors which exacerbate the primary acidic causes include tooth grinding, abrasive diets, inappropriate tooth brushing/dentifrices, and hyposalivation.
 
CONCLUSION
People are at an increased risk for tooth erosion, often because of psychological pressures and conditioning which lead to inappropriate lifestyle behaviors. Recognition of the presence of tooth erosion has important implications for the dental and medical treatment management of patients.
 
REFERENCES
  1. ten Cate JM, Imfeld T (Eds). Etiology, mechanisms and implications of dental erosion. Workshop proceedings 1995. Eur J Oral Sci 1996; 104: 149–244.
  1. Addy M, Embery G, Edgar WM, Orchardson R (Eds). Tooth Wear and Sensitivity. Clinical Advances in Restorative Dentistry. Martin Dunitz,  London:  2000.
  1. Ibbetson R, Eder A (Eds). Tooth Surface Loss. British Dental Association,  London:  2002.
  1. Mair LH, Stolarski TA, Vowles RW, Lloyd CH. Wear: mechanisms, manifestations and measurement. Report of a workshop. J Dent 1996; 24: 141–148.
  1. Imfeld T.Dental erosion. Definition, classification and links. Eur J Oral Sci 1996; 104(Suppl): 151–155.
  1. Grippo JO, Simring M, Schreiner S.Attrition, abrasion, corrosion and abfraction revisited. J Am Dent Assoc 2004; 135: 1109–1118. (Erratum: 2004; 135: 1376).
  1. Hunter ML, Addy M, Pickles MJ, Joiner A. The role of toothpastes and toothbrushes in the aetiology of tooth wear. Int Dent J 2002; 52(Suppl 2): 399–405.
  1. Eccles JD, Jenkins WGS.Dental erosion and diet. J Dent 1974;2:153–159.
  1. Eccles JD.Tooth surface loss from abrasion, attrition and erosion. Dent Update 1982;9:373–381.
  1. Bartlett D, Smith GN. Definition, classification and clinical assessment of attrition, erosion and abrasion of enamel and dentine. In Addy M, Embery G, Edgar WM, Orchardson R (Eds): Tooth Wear and Sensitivity. Clinical Advances in Restorative Dentistry. Martin Dunitz,  London:  2000;87–92.10
  1. White I, McIntyre J, Logan R.Studies on dental erosion: an in vitro model of root surface erosion. Aust Dent J 2001;46:203–207.
  1. Jarvinen VK, Rytomaa II, Meurman JH.Location of dental erosion in a referred population. Caries Res 1992; 26: 391–396.
  1. Valena V, Young WG.Dental erosion patterns from intrinsic acid regurgitation and vomiting. Aust Dent J 2002;47:106–115.
  1. Bell EJ, Kaidonis J, Townsend G, Richards L.Comparison of exposed dentinal surfaces resulting from abrasion and erosion. Aust Dent J 1998;43:362–366.
  1. O'Brien M. Children's Dental Health in the United Kingdom 1993. Office of Population Censuses and Surveys, HMSO,  London:  1994.
  1. Hinds K, Gregory JR.National diet and nutrition survey: children aged 1½ to 4½ years. Vol 2: report of the dental survey. Office of Population Census and Surveys,  London:  1995.
  1. Nunn JH.Prevalence of dental erosion and the implications for oral health. Eur J Oral Sci 1996;104:156–161.
  1. Al-Malik MI, Holt RD, Bedi R.Erosion, caries and rampant caries in preschool children in Jeddah, Saudi Arabia. Community Dent Oral Epidemiol 2002;30:16–23.
  1. Al-Malik MI, Holt RD, Bedi R.The relationship between erosion, caries and rampant caries and dietary habits in preschool children in Saudi Arabia. Int J Paediatr Dent 2001;11:430–439.
  1. Al-Majed I, Maguire A, Murray JJ.Risk factors for dental erosion in 5-6-year old and 12-14-year old boys in Saudi Arabia. Community Dent Oral Epidemiol 2002;30:38–46.
  1. Deshpande SD, Hugar SM.Dental erosion in children: an increasing problem. J Indian Soc Pedod Prev Dent 2004; 22:118–127.
  1. Luo Y, Zeng XJ, Du MQ, Bedi R.The prevalence of dental erosion in preschool children in China. J Dent 2005; 33:115–121.
  1. Deery C, Wagner ML, Longbottom C, Simon R, Nugent ZJ.The prevalence of dental erosion in a United States and a United Kingdom sample of adolescents. Pediatr Dent 2000; 22:505–510.
  1. van Rijkom HM, Truin GJ, Frencken JE, Konig KG, van't HofMA, Bronkhorst EM,et al. Prevalence, distribution and background variables of smooth-bordered tooth wear in teenagers in the Hague, the Netherlands. Caries Res 2002; 36:147–154.
  1. Johansson AK, Johansson A, Birkhed D, Omar R, Baghdadi S.Dental erosion, soft-drink intake, and oral health in young Saudi men, and the development of a system for assessing erosive anterior tooth wear. Acta Odontol Scand 1996; 54:369–378.
  1. Johansson AK, Johansson A, Birkhed D, Omar R, Baghdadi S, Khan N,et al. Dental erosion associated with soft-drink consumption in young Saudi men. Acta Odontol Scand 1997; 55:390–397.
  1. Lussi A, Schaffner M, Hotz P, Suter P.Dental erosion in a population of Swiss adults. Community Dent Oral Epidemiol 1991; 19:286–290.
  1. Jarvinen VK, Rytomaa II, Heinonen OP. Risk factors in dental erosion. J Dent Res 1991; 70:942–947.
  1. Nunn JH. Prevalence and distribution of tooth wear. In Addy M, Embery G, Edgar WM, Orchardson R (Eds): Tooth Wear and Sensitivity. Clinical Advances in Restorative Dentistry. Martin Dunitz,  London:  2000;93–104.
  1. Zero DT, Lussi A. Etiology of enamel erosion: intrinsic and extrinsic factors. In Addy M, Embery G, Edgar WM, Orchardson R (Eds): Tooth Wear and Sensitivity. Clinical Advances in Restorative Dentistry. Martin Dunitz,  London:  2000;121–139.
  1. Mahoney EK, Kilpatrick NM.Dental erosion: Part 1. Aetiology and prevalence of dental erosion. NZ Dent J 2003; 99:33–41.
  1. Ekfeldt A. Incisal and occlusal tooth wear and wear of some prosthodontic materials. An epidemiological and clinical study. Swed Dent J 1989 65 (Suppl): 1–62.
  1. Lussi A. Dental erosion. Clinical diagnosis and case history taking. Eur J Oral Sci 1996; 104:191–198.
  1. Grenby TH.Methods of assessing erosion and erosive potential. Eur J Oral Sci 1996; 104:207–214.
  1. West NX, Jandt KD. Methodologies and instrumentation to measure tooth wear. In Addy M, Embery G, Edgar WM, Orchardson R (Eds): Tooth Wear and Sensitivity. Clinical Advances in Restorative Dentistry. Martin Dunitz,  London:  2000;105–119.
  1. Mitchell HL, Chadwick RG, Manton SL. Assessment of a procedure for detecting minute levels of tooth erosion. Med Biol Eng Comput 2003; 41: 464–469.
  1. Kaidonis JA, Richards LC, Townsend GC.Non-carious changes to tooth crowns. In Mount GJ, Hume WR (Eds): Preservation and Restoration of Tooth Structure. Knowledge Books and Software,  Brisbane:  2005;59.
  1. Richards LC, Kaidonis JA, Townsend GC.A model for the prediction of tooth wear in individuals. Aust Dent J 2003; 48: 259–262.
  1. Kaidonis JA, Richards LC, Townsend GC, Tansley GD.Wear of human enamel: a quantitative in vitro assessment. J Dent Res 1998;77:1983–1990.
  1. Scheutzel P.Etiology of enamel erosion—intrinsic factors. Eur J Oral Sci 1996; 104: 178–190.
  1. Zero DT.Etiology of dental erosion – extrinsic factors. Eur J Oral Sci 1996; 104: 162–177.
  1. Kelleher M, Bishop K. Tooth surface loss: an overview. In Ibbetson R and Eder A (Eds): Tooth Surface Loss. British Dental Association,  London:  2002;3–8.
  1. Milosevic A. Eating disorders and the dentist. In Ibbetson R and Eder A (Eds): Tooth Surface Loss. British Dental Association,  London:  2002;9–13.
  1. Watson ML, Burke FJT.Investigation and treatment of patients with teeth affected by tooth substance loss; A review. Dent Update 2000; 27: 175–183.