Dental Erosion Risk Factors in Bullet Points

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Eating fruits and berries frequently will put you at risk of dental erosion.

There has been so much discussion about dental erosion recently that I wanted to gather all the latest information in one post. I have been in dental profession for over 20 years and even I still learn new things about dental erosion. So read this post to see if you knew these things as well.

I will update this post every time I learn something new that will cause dental erosion. I would be grateful if you could collaborate by commenting this post in case I have missed some risk factors.

The Risk Factors

  • diet that does not contain dairy products
  • vegetarian diet even if dairy products are used
  • consumption of acidic beverages, especially when consumed between the meals (including all juices, sugar-free drinks, sparkling water, any drink with flavouring, alcohol and bubbles. As an example the pH of Coca-Cola is 2,5 = highly acidic)
  • vitamin supplements in a form of a drink (including fizzy tablets)
  • use of sport drinks
  • dehydration
  • dehydration + sport drinks = increased risk
  • drinking tea apart from green tea and black tea
  • consumption of erosive foods, increased risk if consuming erosive foods/drinks over 3 times per day (e.g. fruits, berries, vinegar, pickled food, herbal tea, cola, sparkling water, juice, flavoured water)
  • eating sour candy
  • frequent consumption of alcohol
  • use of smokeless tobacco
  • frequent use of salad dressings
  • gastro-esophagel reflux disease (GERD)
  • gastro-esophagel reflux disease combined with a use of a mouth guard (read this to find out how to protect your teeth if you use mouth guard)
  • eating disorder (anorexia, bulimia)
  • frequent vomiting (e.g. when pregnant)
  • eating fruits between the meals (when fruits are eaten as a part of a meal = no risk)
  • eating indian food frequently (indian spices, especially panipuri masala, are acidic)
  • swishing acidic drink in mouth before swallowing
  • sipping an acidic drink (e.g. herbal tea, cola, sparkling water, juice, flavoured water) over a long period of time
  • brushing teeth after eating
  • brushing teeth after drinking acidic drinks like wine, juice, sparkling water
  • dry mouth (saliva protects the teeth, neutralises the acids)
  • drinking herbal tea very hot (high temperature increases the erosive potential of a drink)
  • consumption of pickled foods
  • medication that dry the mouth as a side-effect (e.g. antihistamines, antidepressants)
  • use of oral moisturizers with pH below 6.7 (see a table pH levels of commonly used oral moisturizers and dry mouth treatment products here)
  • acidic mouthwashes e.g. Listerine Total Care rinse pH = 3.57
  • anti-tartar toothpastes that has chelating agents – chelators bind or trap other chemicals such as calcium = they effectively remove calcium also from teeth.
  • use of non-fluoride toothpaste
  • liquid breakfast (including smoothies). There’s no saliva in mouth in the morning = nothing to neutralise acids. Chewable breakfast would make the saliva flow again after sleeping.
  • certain illnesses that affect the saliva flow (e.g. Sjögren’s syndrome)
  • drinking fruit juices instead of eating the real fruit – fruit juice has been proven to cause erosion 10 times more than the same fruit chewed.
  • chewing gum with liquid center including sugar-free chewing gums (also xylitol). The liquid inside the chewing gum is acidic.
  • sugar-free candy, especially fruit-flavoured ones (they contain high levels of food acid, particularly citric and phosphoric acid)
  • dry mouth + sugar-free fruit-flavoured candy to stimulate saliva flow = increased risk of erosion
  • asthma medication, especially if brushing after corticosteroids (e.g. Flixotide evohaler)

Edit 27.1.2019

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5 thoughts on “Dental Erosion Risk Factors in Bullet Points

  1. I have a question. You mention GERD combined with a mouth guard. I presume it is mentioned separately because it is worse than GERD alone? I have frequent dry mouth at night since taking antibiotics, and I just started using a mouth guard recently at night (on bottom teeth). I noticed that when I remove the mouth guard in the morning, the inside is covered in saliva. Wouldn’t this saliva keep my teeth more protected than sleeping with dry mouth all night?

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    • Hello again! Yes, the teeth have better chances to fight against stomach acid if the saliva can reach all the teeth. That’s why it is worse if you have both GERD and mouth guard. It is unusual to have night guard on lower teeth but sometimes it is done so. Sometimes it is even done for both top and bottom.

      There are large salivary glands under tongue and it might be that saliva (that little amount there is at night) has better access under the night guard. Also as I wrote in my post GC Tooth Mousse Review and Advice for Use, the saliva can crawl on the surface of the tongue and get an access under the mouth guard (on top teeth). So lower teeth might be more protected when you have night guard on them. Not sure about that though. Also if you experience extreme dryness (wakes you up) I doubt it is saliva you find from the mouth guard. We also get gingival crevicular fluid (GCF) from the pockets between the gum and the tooth and it has protective value to the teeth.

      My mouth guard on top teeth is also moist but it is thicker substance than saliva. More like phlegm (could be the GCF). I doubt it can fight against stomach acid. That’s why I use Tooth Mousse regularly.

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      • Thank you. I didn’t know about the GCF. I used to have extreme dryness but it’s a little better now. I still don’t wear the guard regularly, because I’m not sure about the comfort or the help it provides. I read your article on mouth guards, and as one might guess I have some distrust of my dentist on the issue… How am I sure she’s offering the right treatment? How am I sure who will offer the right treatment?

        I don’t know if Tooth Mousse is readily available in Canada, but I can order it for 25$ on amazon. Does it seem like a normal price?

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      • If your dentist is a general dentist I would seek reassurance from a prosthodontist (specialist with couple of years of extra training on occlusion). Maybe just a consultation? Remember to take your mouth guard with you.

        The price is around that 25$ everywhere. Only in Ebay they sell it cheaper but somehow I don’t trust the genuineness of things sold there. It is rather small tube for that price but you only need a pea size amount per jaw.

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