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Frequently asked questions

Acid Erosion: Causes

Acid Erosion: Effects

Acid Erosion: Those Affected

Acid Erosion: Prevention

Acid Erosion: 21st Century

Why is GSK talking about acid erosion?

GlaxoSmithKline Consumer Healthcare is committed to improving oral health and well-being through unique and successful industry-professional partnerships, working with dental professionals in the front line of care in dental practice; with dental scientists in creating greater understanding of oral care needs and to develop new products; and with dental educators in developing the practitioners and leaders of tomorrow.

GlaxoSmithKline Consumer Healthcare recognises that acid erosion is an issue for oral health and, as such, is working to create better awareness and understanding amongst professionals and the public.

Are GSK planning to launch a product to combat acid erosion?

Scientists and dental professionals at GlaxoSmithKline Consumer Healthcare are working to create better awareness and understanding of acid erosion as an issue for oral health in the 21st Century - and to develop a product that will help people protect their teeth from the harmful effects of acidic food and drinks.

Acid Erosion: Causes

What is acid erosion?

It is a form of toothwear that is caused by acid softening of the surface of the tooth's enamel.

When tooth enamel (the tooth's hard surface) is exposed to acids (from food, drinks or the stomach), it temporarily softens and loses some of its mineral content. Saliva will help neutralise acidity, restore the mouth's natural balance and slowly harden the tooth enamel. However, because the tooth's recovery process is slow, if the acid attack happens frequently, the tooth does not have a chance to repair.

Over time, this acidic softening - particularly when combined with abrasion (a general wearing of the surface by constant rubbing), for example, from toothpaste during toothbrushing - can cause significant wear, resulting in reduced thickness of enamel which can lead to a change in the texture, shape and appearance of teeth, which may also mean they become sensitive.

What is the difference between decay and erosion?

When foods containing sugars or starches are eaten, the bacteria in the mouth (in plaque) convert these products to acids that can lead to dissolving of the tooth enamel. Over time, this can cause the enamel to break down and a cavity to form, which may require filling by a dentist.

Whilst decay is a localised process (ie. it does not effect all of the teeth at one time), erosion occurs across the whole tooth surface that has been exposed to acid. It does not involve bacteria or dietary sugars, but is the result of direct action of acids (either from food, drinks or the stomach) on tooth enamel surface.

Over time, this acidic softening can result in significant wear, leading to reduced thickness of enamel and a change in texture, shape and appearance of teeth, which may also lead them to become sensitive.

What causes acid erosion?

Frequent consumption of foods and drinks with a high acid content can cause enamel erosion.

When tooth enamel is exposed to acids (from food, drinks or the stomach), it temporarily softens and loses some of its mineral content. Saliva will help neutralise acidity, restore the mouth's natural balance and slowly harden the tooth enamel. However, because the tooth's recovery process is slow, if the acid attack happens frequently, the tooth does not have a chance to repair.

Some fruit teas, wine and various fruits can be highly acidic and therefore potentially damaging to the teeth. Acidic foods should not and cannot easily be avoided, but care needs to be taken as to the frequency and manner of consumption.

It is not just what is consumed that causes acid erosion, but also the way that acidic items are held within the mouth. Holding or retaining acidic food or drinks in the mouth prolongs the acid exposure on the teeth, therefore increasing the risk of erosion. Swilling an acidic drink, for example, can increase the acidic drink's contact with the tooth or teeth, again increasing the risk of erosion.

What foods are deemed acidic?

pH is a measure of how acidic or alkaline a substance is. The pH scale ranges from 1 to 14, with 1 being very acidic, 7 neutral and 14 very alkaline. Tooth enamel can dissolve with a pH of approximately 5.5 or below and dentine (the substance located between the enamel surface and the underlying root) can dissolve at approximately pH 6.5 or below.

Some fruit teas, wine and various fruits can be highly acidic and therefore potentially damaging to the teeth. This is not to say however that acidic food and drinks should be avoided.

Is it responsible to warn people against eating healthy foods?

Acidic foods should certainly not be avoided altogether. Fruit, for example, is an essential part of a healthy, balanced diet and a good source of many vitamins.

As a leading healthcare company, GlaxoSmithKline Consumer Healthcare, is working to make people aware of the issue of acid erosion to ensure that they take small steps to minimise the risk.

For example, it is best not to regularly brush teeth immediately after consuming acidic food or drinks as this is when tooth enamel is softened and as a consequence, more vulnerable to wear - it is best to wait at least 1 hour and some experts believe even longer.

Can acid erosion be caused by anything other than diet?

Diet, and the way that acidic food and drinks are consumed, is the most likely cause of acid erosion. However it can also result from stomach acids in the mouth, for example, as a consequence of bulimia (vomiting) or indigestion (regurgitation / gastric reflux).

There are also instances - as a result of occupational or industrial exposure - where acid erosion has been brought about, for example, by prolonged inhalation of acidic fumes.

Acid Erosion: Effects

How does acid erosion affect teeth?

The wear caused by acid erosion can lead to reduced thickness of enamel and a change in texture, shape and appearance of teeth, which may also cause teeth to become sensitive.

The early signs that acid erosion may be present can include:

  • Sensitivity
    As dentine becomes exposed through loss of enamel, an occasional slight twinge may be felt when consuming hot, cold or sweet foods and drinks
  • Discolouration
    Teeth can have a slight yellow appearance as enamel becomes thinner, the darker dentine shows through
  • Rounded Teeth
    A rounded 'sandblasted' look on the surface and edges of the teeth

The later stages of acid erosion can include:

  • Transparency
    Front teeth may appear slightly transparent near their biting edges
  • Advanced Discolouration
    Teeth may show a darker yellow appearance due to the exposed dentine showing through
  • Cracks
    Small cracks and roughness may be present at the edges of the teeth
  • Severe Sensitivity
    As dentine continues to become exposed over time, patients can suffer from a severe case of sensitive teeth
  • Cupping
    Small dents may appear on the chewing surface of the teeth - at this stage any fillings may appear to rise up

What is the link between acid erosion and sensitivity?

As tooth enamel is worn away, the underlying dentine may be exposed. This is a softer part of the tooth and as it becomes exposed, teeth may be more sensitive. As nerve endings in the teeth are activated, a slight twinge can be felt when consuming hot, cold or sweet foods and drinks.

What are the long term consequences of acid erosion?

People typically do not become aware of erosion until it has reached an advanced stage. To detect it in its early stages will often require a detailed dental examination.

The later stages of acid erosion can include:

  • Transparency
    Front teeth may appear slightly transparent near their biting edges
  • Advanced Discolouration
    Teeth may show a darker yellow appearance due to the exposed dentine showing through
  • Cracks
    Small cracks and roughness may be present at the edges of the teeth
  • Severe Sensitivity
    As dentine continues to become exposed over time, patients can suffer from a severe case of sensitive teeth
  • Cupping
    Small dents may appear on the chewing surface of the teeth - at this stage any fillings may appear to rise up

In the long-term the effects of acid erosion may require dental treatment in order to protect the tooth and the dentine underneath. A dentist may decide to place a bonded filling, a veneer or a crown to restore the tooth to its former colour and shape. In extreme cases, the damage caused by acid erosion may result in extraction of the tooth.

How quickly can the effects of acid erosion occur?

There have been extreme instances where enamel has been stripped from teeth in a period of six-months, but this is extreme.

There are many factors however which contribute to the progression of acid erosion, most notably the frequency and concentration of the acids in contact with the teeth and the volume and defence of an individual's saliva. Everyone's lifestyles, consumption habits and teeth are different and all can affect the rate at which acid erosion affects teeth.

How does acid erosion affect the appearance of teeth?

The effects of acid erosion can lead to a general wearing away of the tooth's surface and edges, which can make the teeth look older (for example, yellowing, rounding and cracking of the teeth in later stages).

There are many factors which contribute to the progression of acid erosion, most notably the frequency and concentration of the acids in contact with the teeth and the volume and defence of an individual's saliva. Everyone's lifestyles, consumption, brushing habits and teeth are different and all can affect the rate at which acid erosion affects teeth.

Acid Erosion: Those Affected

How many people are affected by acid erosion?

Experts agree that nearly everybody with natural teeth will develop some signs of acid erosion. Many will show the mild, early signs of acid erosion, however increasingly significant numbers of people are showing advanced signs. In October 2005, 91% of UK dentists reported seeing cases of acid erosion on a weekly basis.1

The number of people showing signs of acid erosion is rising due to the number of people keeping their natural teeth for longer, combined with the acidity in the modern diet.

In the 20th Century, dental diseases, for example tooth decay and periodontal disease, were widespread. This greatly affected the life span of teeth and meant that the majority did not retain their teeth for life.

Improved oral hygiene and restorative treatments have extended the life span of teeth in the 21st Century. However, as teeth are lasting longer they are subject to the effects of wear, particularly from acids and tooth brushing over a longer time period.

Who is most likely to be affected by acid erosion?

Everyone with natural teeth should be considered at risk of acid erosion, which can affect all age groups and both sexes.

A wide range of foods that could be associated with the modern diet are highly acidic, such as some fruit teas, wine and various fruits. This is not to say however that acidic food and drinks should be avoided.

Can children have acid erosion?

Milk teeth are very much at risk from acid erosion because they are less mineralised and therefore the enamel is softer than adult teeth to begin with. Therefore great care should be taken with the acidic content of a child's diet.

Is it true that acid erosion is something that people should not worry about until they are older?

Everyone with natural teeth should be considered at risk of developing toothwear due to acid erosion.

The acids in foods and drinks can affect the teeth of all ages. A wide range of foods that are associated with the modern diet are highly acidic, such as some fruit teas, wine and various fruits and acid erosion can affect all age groups. This is not to say however that acidic food and drinks should be avoided.

Acid Erosion: Prevention

What can be done to prevent acid erosion?

To help protect your teeth against the effects of dietary acids, there are several steps that can be taken:

  • Avoid brushing teeth immediately after consuming acidic food or drinks as this is when the enamel is at its softest. It is best to brush teeth before meals or wait at least 1 hour after eating before brushing teeth
  • Drink acidic drinks quickly - don't swish them around or hold them for prolonged periods within your mouth. Or consider using a straw placed towards the back of the mouth
  • Brush teeth gently, but thoroughly, with a medium soft toothbrush
  • Select a toothpaste which is low in abrasion, non acidic and has maximum fluoride availability
  • Have regular dental check-ups and talk to a dental professional about any concerns

Can acid erosion be reversed?

Once the damage has been done it cannot be reversed. In the advanced stages of acid erosion there is likely to be a need for expensive and complicated dentistry to restore teeth to normal function. This is why understanding the problem and taking steps to minimise risk is so important.

Acid Erosion: 21st Century

Why is acid erosion only now becoming a problem?

In the 20th Century, dental diseases, for example tooth decay and periodontal disease, were widespread. This greatly affected the life span of teeth and meant that the majority did not retain their teeth for life.

Improved oral hygiene and restorative treatments have extended the life span of teeth in the 21st Century. However, as teeth are lasting longer they are subject to the effects of wear, particularly from acids and tooth brushing for prolonged time periods.

What is more, people's expectations have changed and today they expect to keep their teeth healthy and looking good for longer.

Did people suffer from acid erosion in the past?

Yes, but in the early 20th Century, dental diseases, for example tooth decay and periodontal disease (a disease affecting the gums and bone that support the teeth), were widespread. This greatly affected the life span of teeth and meant that the majority of people did not retain their teeth for life.

Improved oral hygiene and restorative treatments have extended the life span of teeth in the 21st Century. However, as teeth are lasting longer they are becoming subject to the effects of acid erosion.

How long have dentists known acid erosion is a problem?

Dentists learn about acid erosion resulting in toothwear at dental school; however in the past they will have encountered it less frequently. Now, as teeth are being retained for longer, dentists are increasingly seeing signs of acid erosion and are beginning to become aware of the problem it poses in the 21st Century. As such they are having to be increasingly vigilant to look out for early stages of the condition.

  1. British Dental Association Omnibus Survey, October - December 2005