Don’t you wish you could get more of your patients to brush after every meal? Well, based on our current understanding that may not be the best thing to wish for if they are eating or drinking acidic foods. Acid demineralizes tooth structure. We use this process everyday as the foundation of adhesive dentistry. This demineralized tooth structure is more susceptible to erosion and abrasion, both from parafunction and tooth brushing. A common example of this today is patients who suffer from gastric reflux, anorexia or bulimia.
The presence of gastric acid in the mouth causes a severe decalcification of the enamel called perimolysis. It is very common for these patients to begin aggressively brushing their teeth following a reflux or vomiting episode. This brushing will remove a significant amount of tooth structure, and can often be seen a disproportionate amount of erosion on the side opposite the patient’s dominant hand as seen in the photos.
This same phenomenon can be seen in patients who consume acidic foods or beverages and then follow this by brushing. Common foods that can cause this phenomenon are tomatoes, pickles and citrus fruits. Beverages like juices, coffee, tea, soda and wine can also be problematic. So what should our patients do if they want to cleanse their teeth and freshen their breath after eating a big plate of spaghetti and red sauce or if they suffer from reflux. The current recommendation is to refrain from brushing for thirty minutes to an hour. Patients can swish and rinse vigorously with water. They can also encourage the return of a normal salivary pH by swishing with a liquid antacid, chewing an antacid tablet, or eating a piece of cheese. Another recommendation is to add a teaspoon of baking soda to water and then swish. If the patient needs to they can brush their tongue and the soft tissues in their mouth.
There are classic signs in patients with wear that suggest the presence of acid versus attrition. Look for wear of tooth surfaces that are not in occlusion, restorations that are sticking up above the surrounding tooth structure and cupped areas of wear, with rough irregular edges. Lastly for our patients who show evidence of excessive acid we can recommend prescription strength toothpastes that contain a high percentage of fluoride, remineralizing agents like tricalcium phosphate and are less abrasive then OTC versions.
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