Dental Erosion (Acid Erosion of Teeth)

What dental erosion is

Enamel is the hardest substance in the body, but it is made of minerals that dissolve in acid. Below a pH of about 5.5, enamel starts to lose minerals. Saliva normally neutralizes acid and helps repair small losses. Erosion happens when acid contact is so frequent or prolonged that saliva cannot keep up.

Erosion differs from other types of tooth wear:

These often combine. Acid-softened enamel wears away much faster when you grind or brush hard.

Causes of dental erosion

Acid from diet (extrinsic)

• Soft drinks, including diet and "sugar-free" sodas, which are acidic even without sugar
• Sports and energy drinks
• Fruit juices and citrus fruits, lemon water, and fruit teas
• Wine, especially white wine, and alcopops
• Vinegar and pickled foods, and apple cider vinegar drinks
• Sour candy and chewable vitamin C tablets
• Some medicines in liquid or chewable form, and occupational exposure to acid fumes

How you drink matters as much as what. Sipping a soda over an hour, swishing drinks around the mouth, or drinking acidic drinks at bedtime does more damage than finishing one with a meal.

Acid from the stomach (intrinsic)

• Gastroesophageal reflux disease (GERD): acid typically erodes the inner (tongue-side) surfaces of the upper back teeth. Some people have "silent" reflux without heartburn, and the dentist is the first to notice.
• Repeated vomiting: from bulimia nervosa, pregnancy sickness, alcohol use disorder or cyclical vomiting. It erodes the inner surfaces of the upper front teeth first.

Factors that reduce protection

• Dry mouth from medicines (antidepressants, antihistamines, diuretics), Sjögren's syndrome, radiotherapy or dehydration during exercise
• Thin enamel, which is common in children's baby teeth

Signs of tooth erosion

Early erosion is easy to miss. Signs include:

• Sensitivity to cold, hot, sweet or acidic foods as dentin becomes exposed
• Yellowing, because the thinning enamel shows more of the yellow dentin underneath
• Smooth, glassy, rounded surfaces with loss of natural surface texture
• Translucent, chipped or shortened edges of the front teeth
• Cupping: small craters on the chewing surfaces of back teeth
• Raised fillings, which look as if they stand above the surrounding tooth because the tooth around them has dissolved

Diagnosis

A dentist identifies erosion by its pattern and location, and often uses a scoring system such as the Basic Erosive Wear Examination (BEWE) to record severity and track it over time with photos or study models.

Your dentist will ask about diet, drinking habits, reflux symptoms, vomiting, medicines and dry mouth. If the pattern points to stomach acid and you have no known cause, they may suggest seeing your doctor to check for reflux or another condition.

Treatment

Stopping the erosion

• Find and reduce the acid source: cut down on acidic drinks, keep them to mealtimes, drink through a straw, and swallow rather than swish.
• Treat reflux: lifestyle changes and acid-reducing medicines as advised by your doctor.
• Get help for vomiting: treatment for an eating disorder or the cause of sickness protects the teeth more than any dental work.
• Boost saliva: sugar-free gum, water sips, and saliva substitutes for dry mouth.

Protecting what remains

• Fluoride toothpaste twice daily. Your dentist may recommend a high-fluoride prescription toothpaste or fluoride varnish.
• Stannous fluoride toothpastes form a protective layer and are among the better-studied options for erosion.
• Sensitivity toothpaste with potassium nitrate or stannous fluoride.
• A night guard if you also grind your teeth.

Repairing worn teeth

• Composite bonding to cover exposed dentin and rebuild edges
• Veneers or crowns for more advanced wear
• Full-mouth rehabilitation for severe, generalized erosion where teeth have lost a lot of height

Repairs last longer when the acid source has been controlled first.

Prevention

• Drink water or milk between meals instead of acidic drinks.
• Finish acidic foods or drinks with water or a piece of cheese to neutralize acid.
• Wait about 30 to 60 minutes after acid exposure or vomiting before brushing. Rinse with water or a fluoride mouthwash instead.
• Use a soft toothbrush and gentle technique.
• Have regular dental checkups so early wear is caught.

Frequently asked questions

Can tooth erosion be reversed?

No. Once enamel is lost it does not grow back, because enamel has no living cells. Very early softening can partly remineralize with fluoride and saliva. Erosion can be stopped, and lost tooth structure can be rebuilt with bonding, veneers or crowns.

What drinks cause the most dental erosion?

Soft drinks, sports and energy drinks, fruit juices, lemon water and wine are the most erosive. Diet sodas erode teeth as much as regular ones because the problem is acid, not sugar. Frequency matters most: sipping slowly through the day is far worse than drinking with a meal.

Should I brush my teeth after acidic drinks?

Not straight away. Acid temporarily softens enamel, and brushing immediately can wear it away faster. Rinse with water, then wait about 30 to 60 minutes before brushing. The same applies after vomiting or reflux.

Can acid reflux damage my teeth?

Yes. Stomach acid is far stronger than food acids. Reflux typically erodes the inner surfaces of the back teeth. Some people have reflux without heartburn, so erosion found by a dentist can be the first sign. Treating the reflux protects the teeth.

What does enamel erosion look like?

Eroded teeth look smoother, shinier and more rounded, often yellower because the dentin shows through. The biting edges of front teeth may look see-through or chipped, and back teeth may develop small craters. Fillings can appear raised above the tooth surface.