Dental Erosion: Acid Wear and How to Reduce It
Dental erosion is tooth surface lost to acid from food, drink, medicines or the stomach, and lost tissue does not return. For anyone worried about erosion, this page covers its causes, what wear patterns can and cannot show, the evidence on brushing after acid, reducing acid contact, restoration, and when to see a dentist or GP.
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Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
Dr Ibraheem Ijaz, principal dentist and a General Dental Practitioner (GDC 301711), reviewed this page. He holds a BDS, BSc (Hons), MSc (Leeds), PG Dip Implant Dentistry and PG Cert Restorative and Aesthetic Dentistry.
What is dental erosion?
Dental erosion is the loss of tooth surface caused by acid, without the plaque bacteria involved in tooth decay. It is one cause of tooth wear, a usually slow condition that UK guidance says normally has several causes.
Each acid attack softens enamel for a while and removes some minerals, and problems start when attacks happen too often, the Oral Health Foundation explains. As enamel wears away, the softer dentine beneath is exposed; our guide to enamel, dentine and pulp describes these layers. UK guidance, Delivering Better Oral Health (DBOH), says lost tooth tissue does not come back, and that wear may happen in episodes.
Which foods and drinks cause dental erosion?
Acidic drinks are generally accepted as the most common unhealthy drinks for dental erosion, UK guidance (DBOH) says.
DBOH's list of extrinsic acid sources to explore with people at high risk, based on expert opinion and low-quality evidence, includes fizzy drinks other than unflavoured sparkling water, wine, smoothies, energy and sports drinks, fruit teas, drinks containing citric acid such as orange or lemon juice, vinegar-based foods and acidic sweets.
DBOH says there is no clear-cut critical pH for erosion, because a drink's calcium and other minerals may lessen its effect. A review adds that citric acid may also pull calcium from the tooth surface. Our page on diet and tooth decay covers decay, a separate process.
Which medical causes can lead to dental erosion?
Intrinsic acid, from the stomach, can cause dental erosion, and UK guidance lists gastro-oesophageal reflux, rumination, vomiting and eating disorders as sources. Where stomach acid may be involved, seek medical advice and support, as UK guidance advises for reflux and eating disorders.
For reflux disease, a 2012 review concluded that mainly case-control and observational studies show a clear though variable link with erosion, while relatively few were controlled trials. It also reported a large study that found no significant link.
Can the wear pattern show what caused the erosion?
The pattern of dental erosion may suggest a possible source of acid, but it is a clue for a dentist, not a diagnosis.
Erosion begins as a loss of shine and flattening; with continued acid exposure, hollows form on smooth surfaces and cupping or grooving on biting surfaces, a 2014 review describes. In a study of Swiss adults described in another review, erosive food and drink were strongly associated with erosion on the outer and biting surfaces. A third review calls erosion on the palate side of the teeth a typical sign of stomach acid. A 2020 tooth wear classification lists more transparent front tooth edges among signs of acid wear, but says such signs lack solid evidence.
The signs overlap: a 2008 review warns that a matching defect does not prove acid exposure, and that cupping and grooving may also come from abrasion.
If you notice sensitivity, changes in how your teeth look, or think you may have dental erosion, the Oral Health Foundation advises speaking to your dental team, who can help identify the cause and advise how to protect your teeth. For a possible medical cause such as reflux, UK guidance advises seeking medical advice.
To ask about dental erosion, book online or call 0114 288 2121.
Does brushing straight after acid make erosion worse?
Brushing soon after acid may add to wear, so the Oral Health Foundation advises waiting at least one hour after eating or drinking before brushing. It says brushing softened enamel can remove tiny amounts of enamel and speed up long-term wear.
The evidence is mixed. In a study in which 8 volunteers wore enamel samples in their mouths, softened enamel resisted brushing better over time but still wore more than unbrushed softened enamel at 60 minutes; the authors concluded at least 60 minutes should pass. A laboratory study found up to 4 hours in human saliva did not reharden eroded enamel or reduce wear, though protein-free artificial saliva protected it, and said the advice to delay brushing should be reconsidered.
UK guidance (DBOH) finds no strong evidence that brushing timing matters greatly. A review concludes that normal brushing's benefits far exceed possible side effects, though excessive brushing, especially of eroded teeth, might cause some harm.
After frequent vomiting, DBOH suggests rinsing with water and applying fluoride toothpaste with a finger, or a fluoride mouthwash, rather than brushing, and advises seeking medical advice and support for reflux or an eating disorder.
How can you reduce dental erosion?
Tackling the sources of acid matters more than toothpaste or brushing changes, professional consensus suggests, according to UK guidance (DBOH). Suggestions include:
- Limit acidic food and drinks to mealtimes, swallow drinks quickly rather than holding them in your mouth, finish meals with milk or cheese, and chew sugar-free gum (Oral Health Foundation).
- Between meals, choose plain water or unflavoured sparkling water, or tea or coffee without sugar (DBOH).
DBOH notes that few clinical studies have tested ways of preventing erosion, and that most of the evidence is of low certainty.
Do eroded teeth need restoring?
Restoring eroded teeth is not always needed, a 2018 British Dental Journal guide concluded, and a 2015 European consensus says it should only accompany prevention.
When eroded teeth do need rebuilding, this falls within repairing and rebuilding damaged teeth, which aims to keep natural teeth, and our page on full mouth rehabilitation covers rebuilding a worn bite.
When should you see a GP about a medical cause?
For a possible medical cause of dental erosion, the NHS advises:
- Heartburn or acid reflux: see a GP if lifestyle changes and pharmacy medicines are not helping your heartburn, you have heartburn most days, or you also have other symptoms, like food getting stuck in your throat, frequently being sick, or losing weight for no reason. If at any time you feel your symptoms are getting worse, contact a GP, go to 111.nhs.uk or call 111.
- Sickness in pregnancy: if you are being sick frequently and cannot keep food down, tell your midwife or doctor, or contact the hospital as soon as possible.
- Eating disorders: if you think you may have an eating disorder, see a GP as soon as you can. You can also talk in confidence to an adviser from the eating disorders charity Beat on 0808 801 0677.
Frequently asked questions
Do special toothpastes help with dental erosion?
They may play a supplementary role. UK guidance says laboratory and in situ studies suggest specialised toothpastes with fluoride, or fluoride plus a stannous ingredient, can help. A 2020 systematic review found stannous fluoride toothpaste showed greater anti-erosive potential in seven of eight studies, but judged most at high risk of bias.
Does drinking through a straw prevent erosion?
The evidence is unclear. UK guidance says a wide-bore straw may be considered, with weak evidence for aiming it at the back of the mouth, but finds insufficient evidence that straws reduce erosion. A review warns that a straw placed in front of the front teeth can be destructive.
Can medicines cause dental erosion?
Some may. UK guidance lists chewable vitamin C tablets, aspirin, asthma inhalers and some iron preparations among possible acid sources, and notes that medicines which reduce saliva may add to the risk. It suggests tablets that can be swallowed, non-acidic alternatives, and discussing options with a pharmacist or GP.
Can sport or exercise affect dental erosion?
It may add to the risk. UK guidance lists sports and energy drinks among acidic drinks, and intense sport among conditions that reduce saliva, which dilutes and buffers acid. A review names regular exercise with dehydration as a predisposing factor. The guidance suggests plain water instead of acidic drinks.
Should I stop eating fruit to protect my teeth from erosion?
Usually not. UK guidance says most people should not be advised to eat less fruit, or less often, because fruit benefits general health. Only where fruit is identified as a risk factor does it suggest avoiding grazing on acidic fruit and swapping some for vegetables, bananas or avocados, particularly between meals.
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Contact Deepcar Dental Care online or by phone; the practice is at 334 Manchester Road, Deepcar, Sheffield, S36 2RH. Its restorative treatments include tooth wear management and full mouth rehabilitation. Patients describe their visits in our patient reviews.
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Deepcar, Sheffield S36 2RH
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