Erosion

Question 1

What is erosive toothwear?

Answer 1

The combination of erosion plus abrasion/attrition

Question 2

If the patient shows strong signs of erosive toothwear but says that they don’t experience any reflux, what are THREE potential causes?

Answer 2

• Acidic diet (most common cause of erosive toothwear)
• Medications (e.g. asthma puffer)
• Sleep regurgitation

Question 3

What are FOUR reasons why is acid attack more dangerous during sleep?

Answer 3

Decreased:

• Salivary flow
• Primary peristalsis (swallowing)
• Secondary peristalsis (oesophageal)
• Heartburn (warning)

Question 4

Why is the mucosa in the oral cavity not as affected by acid attack vs. oesophageal mucosa?

Answer 4

Acid is rapidly diluted in the oral cavity.

Question 5

What are THREE oesophageal manifestations of GORD?

Answer 5

• Reflux oesophagitis (mucosal erosion)
• Barrett’s oesophagus
• Adenocarcinoma

Question 6

What happens in Barrett’s oesophagus and what’s so bad about it?

Answer 6

• Metaplasia (mimics intestinal mucosa e.g. goblet cells)
• May progress to dysplasia then adenocarcinoma (poor prognosis)
  NOTE: cancer risk is higher with obesity (16.5x)

Question 7

What is the first-line treatment for GORD related toothwear?

Answer 7

Remove the cause. (Prevention is key - remineralising agents only as adjunctive treatment)
- Controlling attrition/abrasion also important (e.g. nightguard, OHI)

Question 8

True or false: erosive toothwear can occur very rapidly, taking out large scoops of enamel at a time.

Answer 8

False, although it does occur rapidly, it occurs in very thin layers at a time (nanometres). This cycle repeats rapidly, leading to the scooped lesions.