Tooth Enamel Erosion and Prevention
The strongest and hardest tissue in the human body is tooth enamel. Two percent of enamel is comprised of organic material—protein, lipids and citrate. The other 98 percent consist of water and the minerals calcium hydroxylapatite and calcium fluorapatite (1). Enamel completely envelops other components of the tooth structure, including the dentin, cementum and dental pulp. Enamel protects teeth against the daily wear of biting and chewing. It enables the teeth to withstand hot and cold temperatures, acid and other chemicals which have an erosive effect on teeth. (1, 2, 3). Tooth enamel ranges in thickness from 2.5 to 3.0 millimeters. It appears white, but actually has a semi-translucent color. The enamel receives it white appearance from the dentin underneath. Coffee, tea, wine, and cigarette smoking discolors are some of the main reasons for discolored tooth enamel (3).
Causes of Tooth Enamel Erosion
Enamel has a high mineral content, which makes it vulnerable to “demineralization” from ingested foods, which contain starch and sugar.
Candy, soft drink, fruit juices, and other sweets leave a large amount of sugar coatings on the oral cavity. Sugar may constitute the single largest contributor to enamel erosion. Bacteria flourish on sugar and generate lactic acid, which eats into the enamel. The ingestion of sugar causes a decrease in the mouth’s pH level. During this time, teeth have more vulnerability and demineralization of the enamel occurs. Studies have found that consuming sugar in small amounts, in multiple intervals throughout the day, causes more damage than the intake of a large amount of sugar in one sitting. Some other factors include acid reflux disease (GERD), low salvia volume and high acidic foods.
In late 2009, the Journal of Dentistry published a study that concluded exposure to certain alkaline degreasers, employed in food and car care manufacturing processes, may damage tooth enamel. According to researcher Jörgen Norén, "This type of damage markedly increases the risk of cavaties and other dental damage (1).”
Patients with dry mouth because of medication or some other health condition also have a higher risk of tooth enamel erosion. The acids tend to remain around longer due to a decreased amount of saliva, which normally neutralizes these acids. Saliva also helps re-mineralize the mouth and strengthens tooth enamel.
Bruxism or teeth grinding wears away tooth enamel. The repetitive clenching and constant friction can also cause tooth fractures.
Mouthwash Research has demonstrated most mouthwash products have acidity content comparable to household vinegar. One study recommends, “low pH mouthrinses should not be considered for long-term or continuous use and never as pre-brushing rinses. In view of the plaque inhibitory efficacy of ASC, short-to medium-term applications similar to those of chlorhexidine would be envisaged (4, 5).”
TheraBreath’s mouthwash formula attacks the anaerobic bacteria known to lead to unsightly gums, halitosis and taste complaints. It does not contain acid or other harmful ingredients like saccharin, alcohol, sodium lauryl sulfate or benzalkonium chloride.
Symptoms of Enamel Erosion
Sensitivity of the teeth to sweets or hot and cold food, which may sometimes cause pain, are signs of early stage enamel erosion. Irregular, uneven edges on the teeth are also signs. Discolored, yellow teeth or smooth shiny surfaces point to enamel erosion, as do dents or rounded cups on the biting surfaces. Loss of enamel makes teeth more vulnerable to cavities and tooth decay. Eroded enamel becomes extremely sensitive and painful after the erosion has reached the later stages. Once the decay penetrates the hard enamel shell, it passes through to the tooth’s main body. Small cavities may not present a problem, however as the cavity expands and penetrates the tooth, it affects the nerve fiber. This could lead to an infection or abscess.
Treatment and Prevention of Enamel Erosion
Dental professionals should continually advise patients to brush their teeth after eating or drinking. Patients should use fluoride toothpaste a soft bristle brush and brush gently. Ingestion of milk or cheese after a meal helps neutralize acids and prevent enamel erosion. In addition, “Habitual use of xylitol, a sugar alcohol of the pentitol type, can be associated with significant reduction in cavities incidence and with tooth re-mineralization” (14).
The Oxygenating TheraBreath Chewing Gum is a natural product that contains xylitol and is free of aspartame and saccharin. It helps remove particles and stimulates saliva Dental professionals should encourage patients to floss their teeth instead of using a toothpick, as the toothpick can cause damage to the enamel. Some teeth-whitening products may also contain abrasives, which damage tooth enamel. Patients who work in the food or automobile industry should be encouraged to wear protective equipment when appropriate in order to prevent exposure to substances with high pH values (1).
Some other products designed to inhibit the erosion of tooth enamel include:
- Chlorhexidine was originally used in the United Kingdom in 1954 as a disinfectant and a topical antiseptic. During the 1970s researchers learned of Chlorhexidine’s ability to prevent plaque formation and work as an effective anti-plaque wash. Chlorhexidine varnishes reduce S. mutans, P. gingivalis and gingivitis, which produce significant health benefits.
- Chloride Varnish is a method of re-mineralizing the patient’s teeth with a concentrated fluoride therapy. The dental hygienist or dentist applies fluoride to the tooth structure for a few hours. Fluoride serves as a treatment for the prevention of cavities and dentine sensitivities experienced by some patients.
Other procedures for treating tooth enamel loss include bonding, which not only improves aesthetics, but also provides protection for the tooth. Extreme enamel loss may require covering the damaged tooth with a crown, which prevents further tooth decay (12).
Many patients simply do not understand what factors affect the loss of tooth enamel. Knowledgeable dental professionals can perform an exam to assess the patient’s status, communicate the findings of their evaluation and recommend a treatment protocol with an explanation of how it prevents further erosion. TheraBreath products, such as gum, toothpaste and mouthwash contain the ingredients scientifically proven to address the main causes of tooth enamel erosion.
1 Science Daily, “Exposure to Alkaline Substances Can Result In Damaged Teeth” https://www.sciencedaily.com/releases/2009/10/091027132424.htm. Science Daily, Oct 2009.
2 Wikipedia, “Tooth Enamel.” https://en.wikipedia.org/wiki/Tooth_enamel
3 Katherine Kam, “Tooth Enamel Erosion.” https://www.webmd.com/oral-health/healthy-teeth-10/tooth-enamel-protection. Web MD
4 George AM, Kalangi SK, Vasudevan M, Krishnaswamy NR. “Chlorhexidine varnishes effectively inhibit Porphyromonas gingivalis and Streptococcus mutans - an in vivo study.” https://www.ncbi.nlm.nih.gov/pubmed/21760672. J Indian Soc Periodontol. 2010 Jul;14(3):178-80.
5 Miriam Puig Silla, José María Montiel Company, José Manuel Almerich Silla. ““Use of chlorhexidine varnishes in preventing and treating periodontal disease.” https://www.medicinaoral.com/medoralfree01/v13i4/medoralv13i4p257.pdf. Med Oral Patol Oral Cir Bucal. 2008 Apr1;13(4):E257-60.
6 Pontefract H, Hughes J, Kemp K, Yates R, Newcombe RG, Addy M. “The erosive effects of some mouthrinses on enamel. A study in situ.” https://www.ncbi.nlm.nih.gov/pubmed/11314887. J Clin Periodontol. 2001 Apr;28(4):319-24.
7 Rytömaa I, Meurman JH, Franssila S, Torkko H. “Oral hygiene products may cause dental erosion.” https://www.ncbi.nlm.nih.gov/pubmed/2512575 Proc Finn Dent Soc. 1989;85(3):161-6
8 H.J. Sandham, L. Nadeau, H.I. Phillips. “The Effect of Chlorhexidine Varnish Treatment on Salivary Mutans Streptococcal Levels in Child Orthodontic Patients” https://jdr.sagepub.com/content/71/1/32 .Journal of Dental Research JDR January 1992 vol. 71 no. 1 32-
10 Mathews MS, Amaechi BT, Ramalingam K, Ccahuana-Vasquez RA, Chedjieu IP, Mackey AC, Karlinsey, “In situ remineralisation of eroded enamel lesions by NaF rinses.”
11 Ashwin Mathew George, Kalangi, Vasudevanand Krishnaswamy “Chlorhexidine varnishes effectively inhibit Porphyromonas gingivalis and Streptococcus mutans — an in vivo study.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100861/?tool=pubmedJ Indian Soc Periodontol. 2010 Jul-Sep; 14(3): 178–180. doi: 10.4103/0972-124X.75913
12 Web MD, “Tooth Enamel Erosion and Restoration.” https://www.webmd.com/oral-health/tooth-enamel-erosion-restoration?page=3
13 American Dental Association, “Dental Sealants” https://www.ada.org/sections/professionalResources/pdfs/patient_28.pdf.
14 Kauko K. Mäkinen, “Sugar Alcohols, Caries Incidence, and Remineralization of Caries Lesions: A Literature Review.” ttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836749/?tool=pmcentrez. Int J Dent. 2010
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