Chapter 9: Acidic Beverages and Foods Associated with Dental Erosion and Erosive Tooth Wear.

Dental erosion is the partial demineralisation of the tooth surface caused by repeated exposure to acids. The loss of surface tissue, which results from simultaneous and/or subsequent exposure to mechanical forces is known as erosive tooth wear (ETW). Excessive consumption of acidic beverages and foods has been the main focus of research into erosion. Enamel dissolution is significantly associated with chemical parameters: pH, buffer capacity, titratable acidity, viscosity, as well as calcium, phosphate and fluoride concentrations in the beverages and foods. Some of these parameters are used to calculate the degree of saturation of a given substance, which represents its driving force to demineralise dental hard tissues. Undersaturated substances with low pH and high titratable acidity and high buffer capacity have greater erosive potential, while substances with high concentrations of Ca2+ and phosphate cause less demineralisation. Other physical parameters also modulate the demineralisation processes. Swishing drinks in the mouth tends to cause more erosion, since the Nernst layer is continuously renewed and does not reach saturation. Recent systematic reviews confirm that frequent consumption of carbonated/soft drinks are the main dietary factor associated with ETW. Vitamin C and frequent consumption of natural fruit juices and acidic snacks or sweets are also significantly associated with more ETW; whereas higher consumption of milk and yoghurt is a protecting factor. Patients presenting with ETW should have their dietary habits assessed by recording their complete dietary intake in a diet record sheet. Dentists should assess the erosive potential of the different beverages and foods, as well as the frequency of ingestion, then elaborate specific preventive measures and dietary interventions individually tailored to each patient.
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