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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Money-Saving Advice on Dental Visits

Dental Revelations Blog-3892

Are you seeing your dentist for a check-up too often?

Here we go again. I am annoyed about something that is waiting to burst out. I have written about integrity of the dentists in one of my previous posts and today I am going to touch the same subject.

This post is about dentist check-up frequency patients should have.

Many dental practices very commonly advise people on their websites and in the surgeries to see dentist every three to six months and they justify this by prevention of bigger dental problems.

A revelation:

Recommending the same check-up interval to all the patients is not up to the standards of modern dentistry. It is merely (once again) about maximising the profit of the practice.

Check-up intervals should be decided after carefully evaluating the current status of the oral health, general health and oral hygiene routines. I will list the guidelines that are practiced in one of the leading countries.

Managing Decay

24 to 36 Months Interval in Check-Ups

This concerns the patients who have

  • no treatment requiring decay
  • no early decay that needs to be stopped or reversed
  • not had any decay for many years

It is important to check the patient’s eating habits to make sure that they are not harmful to the teeth and encourage patient to change them if needed.

6 to 12 Months Interval in Check-Ups

This concerns the patients who have

  • one or more early decay or advanced decay

It is important to make a plan together with a patient to stop the decaying. This might include visits to the hygienist.

Exceptions

Certain groups of people might need to see dentist more often than advised above. These are:

  • children and youngsters
  • people with illnesses and medications that reduce saliva flow
  • users of intoxicants
  • immigrants of certain countries
  • people with dental phobia
  • people with big life events (pregnancy, divorce, military service, retirement)
  • people of low education
  • smokers
  • people with illnesses or injuries that cause disability that prevent good oral hygiene
  • people with harmful eating habits and/or poor oral hygiene
  • people who use fluoride toothpaste less than twice a day
  • mouth breathers
  • people who are undergoing orthodontic treatment
  • people with dentures
  • people with erosion on teeth
  • patients who have had teeth extracted/root canal treated due to decay in the past 3 years

Managing Gum Disease

3 to 12 Months Intervals in Maintenance Visits

After a comprehensive therapy for the gum disease the patient needs to see periodontist/hygienist regularly for the maintenance visits. The interval of the maintenance visits is based on many risk factors like

  • severity of the bone loss
  • smoking status
  • overall health (diabetes)
  • genetics
  • age related (medications, illnesses)
  • gender (male)
  • low socioeconomic status
  • poor oral hygiene
  • condition of the teeth (restorations – especially subgingival crown margins, removable dentures)
  • furcations
  • anatomic abnormalities
  • residual pockets

The more advanced gums disease the shorter the maintenance interval. The more risk factors the shorter maintenance interval.

Conclusion

To recommend all the patients the same 3-monthly check ups is simply madness and it stinks of foul play.

Dear patients,

please be advised that you most definitely do not need to see a dentist every three months unless you fall into one of those risk factor categories above. But even in these cases a top-notch oral hygiene habits can make wonders and extend the check-up interval from three months to six.

Also if you do want to see a dentist every three months there is no harm done. Apart from you needing to pay unnecessarily for a treatment you don’t need.

Yours sincerely,

Dental Revelations Blog

Times change. So does the dentistry. Sticking to the old ways – “it has always been done like this” – is simply not what modern dental practice should do.

More on the subject click the links below.

NHS

Daily Mail

NICE – National Institute for Health and Care Excellence

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