Читать книгу The Impact of Nutrition and Diet on Oral Health - Группа авторов - Страница 20

Introduction and Prevalence

In recent years, dental erosion has evolved as a major threat to tooth integrity. It entails a gradual loss of tooth substance, due to repeated acidic insults on the enamel and dentine over time, and it is therefore often recognised late in the process. Dental erosion can be regarded as a common condition, with prevalence rates of between 4 and 82% in the adult population, with evidence suggesting that the incidence is increasing [12].

The condition is seen in both the primary and permanent dentition, and it is a growing concern that dental erosion is now being detected and established at even younger ages. Among pre-school children, erosion was found on 6–50% of the deciduous teeth, while, in adolescents, 9–17 years of age, the prevalence ranged between 11 and 100% [12].

To a large extent, the increase in disease activity can be attributed to various dietary changes, especially the significant increase in the amount and frequency of acidic foods and soft drink consumption in populations throughout the world [13]. Early erosive wear in permanent teeth may compromise the entire dentition and cause considerable pain, and it may result in an increasing need for further comprehensive restorations, affecting the quality of life of the individual throughout his or her life.

Aetiology and Pathogenesis

There are 2 causes of erosive tooth wear. The first is extrinsic factors, where the choices of diet/drinks and intake habits, beverages consumed during sporting activities, occupational factors or acidic medicines are examples of elements that may contribute to tooth mineral degradation [14, 15]. The individual’s choice of a healthier lifestyle often includes a diet with large amounts of fruit, vegetables and herbal teas, where the pH can be low, thus adding to the increase in erosion [16].

Intrinsic factors are the other cause, and gastro-oesophageal reflux disease and eating disorders also risk causing the chemical demineralisation of the enamel and dentine as a result of contact with the acidic contents of the stomach [17–19], while unhealthy lifestyles, such as alcoholism or the use of illegal designer drugs like ecstacy, have also been associated with an increase in the development of dental erosion [20]. Any accompanying form of excessive tooth wear, like attrition due to bruxism, adds considerably to the rate of hard-tissue loss [21].

The erosive damage to the dental hard tissues occurs after exposure to acidic substances and does not include the effects of bacteria or their products. The process involves an initial softening of the tooth surface, which is followed by a permanent loss of tooth substance. The degree of saturation of Ca²⁺, PO₄^3–, OH^– and F^– ions in the fluid that exists in the vicinity of the hydroxyapatite crystals, together with the critical pH for equilibrium and the erosive potential/chelating ability of the acid, are some factors that influence whether the minerals will dissolve or form deposits on the enamel surfaces [22]. To counteract the erosive processes, a satisfactory saliva secretion rate, composition and buffering capacity together with the formation of a protective dental biofilm shield, are considered to be influential protective biological parameters [23, 24].

Future

In the future, studies aiming to bring about the remineralisation of the affected dental tissues are needed. Increased awareness in the public and dental communities, early detection, change of behaviours associated with erosive tooth wear, applied preventive measures and continued targeted research are other plausible avenues to limit the expansion of dental erosion.