Enamel wear: Causes and mechanisms

Orange juice, wine, coke

What causes enamel wear?

Enamel demineralisation and remineralisation cycles

Enamel is equipped to respond to normal daily acid exposure. Brief periods of acid exposure trigger a demineralisation process that reduces the mineral density of the enamel surface, thereby weakening it.1,2Due to mineral-rich saliva, the enamel undergoes a natural process of remineralisation to restore its mineral density and the enamel is strengthened again.1,2Frequent exposure to acids, especially over long periods, can cause the remineralisation process to become overwhelmed, leaving enamel weakened. In this state, enamel is at risk of irreversible wear.1,2

  • Remineralisation and demineralisation process after 5-minute acid challenge

    Enamel remineralisation and demineralisation cycle after 5-minute acid challenge

    In vitro SEM images of enamel cross-sections show variations in mineral density3

    SEM, scanning electron microscope

  • Remineralisation and demineralisation process after 20-minute acid challenge

    Enamel remineralisation and demineralisation cycle after 20-minute acid challenge

    In vitro SEM images of enamel cross-sections show variations in mineral density3

    SEM, scanning electron microscope

Enamel wear factors

Enamel wear is a progressive condition

Enamel wear is most commonly caused by a combination of chemical agents and physical wear.

Dietary acidic exposure results in the loss of calcium ions from the enamel surface layer.4,5 This softens the tooth surface, leading to an increased susceptibility to mechanical abrasion such as tooth brushing.4,5

Attrition, abrasion, erosion and abfraction can all lead to enamel wear. Factors that increase the risk of enamel wear include:4–6

  • Frequent consumption of acidic foods and drinks
  • Dietary habits, such as swilling drinks or snacking
  • Gastric reflux or frequent vomiting
  • Tooth grinding (bruxism)
  • Acidic medication

Infographic adapted from Lussi et al. 20064

Patients’ enamel is at risk from the erosive effects of acidic food and drink

Modern diets bring increasing challenges to enamel7–9

Frequent intake of acidic or sugary foods reduces the mouth’s natural environment from a neutral pH of 7. This drop in pH becomes critical when it falls below a pH of about 5.5, leaving the teeth more at risk of enamel wear.13

  • Coke

    Soft drinks

    40% of people in the US drink soft drinks or fruit juice at least once daily (pH typically below 4)10

    Alcoholic drinks

    Great consumption of acidic soft drinks

    Alcoholic drinks are generally acidic and were increasingly consumed (both more often and in larger volumes) between 2001–2002 and 2012–2013 in the US11

    Smoothie

    Smoothies

    Many smoothies may have a pH below 5.512

  • Clock

    From 1981 to 2011, people of all ages increased the number of times they ate acidic food per day14

    Orange juice

    In 2012, fruit juice consumption in the US was highest in those aged 18–34 years12

Pronamel – helping protect your patients against enamel wear

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Impact on patient quality of life

Find out about the impact enamel wear has on patients’ daily lives.

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Diagnosis

Explore an overview of diagnosing enamel wear.

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Management

Explore an overview of enamel erosion management.

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Enamel wear

Find out more about enamel wear.

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The Sensodyne Pronamel range

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