Diagnosis of dental erosion

Abstract

Dental erosion is an acid-mediated tissue loss without bacterial involvement. It occurs on occlusal and smooth surfaces and is a surface phenomenon. The diagnosis can therefore be easily made by visual inspection. In initial stages, the normal surface texture and lustre of enamel is lost. When the acid impacts continue, convex tooth structures flatten and distinct defects develop. On smooth surfaces, erosive lesions are mainly located coronal to the enamelcementum junction and are flat, dull, with an intact enamel rim at the gingival margin. On occlusal surfaces, cusps are flattened and cupped; restorations may stand proud of the surface. In advanced stages the occlusal morphology may completely disappear. Erosive lesions must be distinguished from attrition, abrasion and abfraction/wedge-shaped defects. For grading, the Basic Erosive Wear Examination (BEWE) is described which is also a guide to management. However, dental erosion is part of the physiological wear of the functioning dentition throughout lifetime. An adequate diagnosis must therefore differentiate between physiological and pathological stages of the condition integrating not only age, extent of tissue loss and progression rate but also the subjective sphere of the patient including pain, as well as functional and social impairment. The disease-illness-sickness triad is described as a concept for integrating the professional and subjective/social dimension of the condition.