Tooth enamel degradation
Tooth erosion, breakdown of tooth enamel
The term tooth enamel degradation is understood in dentistry to mean the process of wear and tear or dissolution of the outermost tooth layer.
Tooth enamel (lat. Enamelum; Substantia adamantinea) belongs from an anatomical point of view, just like the dentine (Dentine), to the hard tooth substance of a tooth. Tooth enamel is the outermost layer that covers the surface of every tooth in the area of the tooth crown. Tooth enamel is the hardest substance in the human body and surrounds dentin. It contains large amounts of: calcium, phosphorus, magnesium, sodium, proteins and water.
The main component of tooth enamel consists of phosphate-containing compounds that are attacked by the action of acids and can dissolve. In contrast to dentin, tooth enamel is not connected to nerve fibers or blood vessels. As a result, harmful influences can spread for a long time before they are even noticed by the patient.
Carious defects that are limited to areas of the tooth enamel generally do not cause any symptoms. In other words, a painful caries attack on a tooth indicates that it is penetrating into the deeper dentin layer.
However, not all patients experience pain when the enamel-dentine boundary breaks through. Many sufferers only notice caries when the defect is already in the tooth pulp (pulp) and the effects on tooth preservation are devastating.
What is a tooth enamel defect?
A tooth enamel defect is an injury to the top layer of the tooth that has left the dentin just below the enamel undamaged. This defect can result from mechanical or chemical irritation.
In most cases it is caused by tooth decay. If the caries only affects the enamel layer, one speaks of an initial caries or an initial caries. At this stage, the tooth decay is still reversible and can be made inactive at this stage through good oral hygiene and regular fluoridation.
This means that the caries does exist, but does not enlarge towards the dentin and pulp. It is made practically harmless. At this stage, filling therapy is not yet necessary. This damage to the enamel can often be seen in the grooves of the molars or in their pits as black spots. It is important to clean this area well and fluoridate it preventively. If this is not the case, the inactive caries can revert to an active form and show a tendency to spread.
Once the tooth decay has reached the dentin, the dentin, it must be treated with a filling therapy, otherwise it will spread to the nerve chamber, the pulp and permanently damage the tooth. Then one no longer speaks of a tooth enamel defect, but of an enamel-dentine lesion.
But there are also tooth enamel defects that are not caused by tooth decay. For example, if you regularly brush your teeth with too much pressure and a toothpaste that is abrasive, you will damage your teeth. With each brushing, more enamel is broken down or removed, which can no longer be reproduced. The result is an enamel defect, which is typically found in the area of the tooth neck. One then speaks of Wedge-shaped defect.
Furthermore, tooth enamel defects can be caused by acid exposure from food or by grinding teeth.
Tooth enamel flakes off and becomes cracked
Tooth enamel is the hardest substance in our body, even harder than bones. Nevertheless, acids are able to dissolve the enamel layer or to damage it in such a way that small cracks appear in the enamel and it becomes porous. Frequent consumption of acidic foods can damage the tooth enamel in such a way that it becomes much thinner and more fragile and more easily forms microcracks and breaks off. This phenomenon is called erosion.
This condition mostly occurs in patients with an eating disorder. In bulimia, vomiting occurs after eating. The gastric fluid has a very low pH value and is a strong acid that repeatedly comes into contact with the front teeth when vomiting. This will damage the enamel and make it thinner, making it easier to break. If those affected brush their teeth immediately after vomiting, they brush off the roughened enamel as it were.
Furthermore, after a blow or fall, trauma and a fracture can occur in the tooth, which can break off the enamel more easily, since there is already a break inside the tooth.
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Another very common cause of tooth enamel flaking can be clenching and grinding. The excessive force exerted by the teeth can cause tooth enamel to yield and crack. This phenomenon of crunching occurs preferentially at night when the body shuts down and the person tries to process everyday events.
Tooth enamel becomes transparent - is this enamel degradation?
Erosion is the name given to the condition in which the tooth enamel appears transparent because it becomes thinner and thinner as acids dissolve it. This problem is common in patients with genetically more susceptible enamel who also consume a lot of acidic foods.
When consuming acidic foods, care should be taken that the teeth are not brushed immediately afterwards, as they are attacked by the acid and so more enamel can be removed. If the person concerned waits about 20-30 minutes, the acids in the mouth are buffered by the saliva and the pH value in the oral cavity has been neutralized so that the acids do not have any harmful effect on the enamel.
Causes of tooth enamel breakdown
The causes of tooth enamel degradation can be of various origins, because thermal and mechanical as well as chemical influences can affect the outermost layer of the tooth.
On the one hand, mechanical wear and tear (for example from nightly grinding), on the other hand, frequent vomiting (for example in the course of bulimia) can lead to tooth enamel degradation.
The main cause of the breakdown of tooth enamel is still the frequent consumption of acidic foods and drinks. In this context, contrary to what was expected, not just artificial, but above all so-called natural acids represent a high risk for the development of tooth enamel degradation processes. An acid-induced tooth enamel degradation (technical term: Acid erosion) takes place every day while eating.
The role of food in the breakdown of tooth enamel
Fruit juices, carbonated soft drinks, wine and various types of fruit in particular have a particularly high proportion of natural acids.
For this reason, the assumption that the breakdown of tooth enamel is only a problem for those people who eat unhealthily must be strictly denied. Healthy foods in particular often attack tooth enamel, soften it and can thus lead to tooth enamel degradation.
The pH value is generally regarded as an indicator of the acidic properties of various foods and drinks.
Basically, pH values between 0 and 14 can be assumed. A value of around 7 is considered neutral, which means that the food has neither acidic nor basic properties on the tooth substance. A pH value below 7 indicates an acidic food, values above 7 indicate a basic (alkaline) Character.With the help of this knowledge, food and drinks that promote tooth enamel degradation can be distinguished from less harmful ones.
Group 1 (pH value from 2.5 to 3.5)
This group includes foods and beverages that have extremely acidic properties and, if consumed in excess, have a particularly high risk of promoting the development of tooth enamel degradation. In addition to apples, grapefruit and applesauce, honey, fruit jam and orange juice are also included in this group. Pineapples (with a pH of 3.2), strawberries and white grapes also have a comparatively low pH value.
If one or more of these foods are consumed frequently, it can be beneficial to strengthen the enamel by regularly using toothpaste or tablets containing fluoride.
Group 2 (pH 3.6 to 4.5)
Even those foods that belong to this group can sustainably soften and damage the tooth substance, especially the tooth enamel. In many cases the result is an irreversible breakdown of the tooth tissue. In addition to cherries (pH 4.0), Oranges (pH 3.6), Tomatoes (pH 4.1), cream cheese and fruit sorbet also belong to this food group.
Group 3 (pH 4.6 to 5.5)
Both maple syrup (pH 4.6) and pickles (pH 5.1), as well as cottage cheese (pH 4.8) belong to this food group. Since they with
Their pH value is relatively close to the neutral value of 7, they belong to the (comparatively) less harmful foods. Nevertheless, their excessive consumption attacks the tooth structure and can lead to tooth enamel degradation.
How can I rebuild tooth enamel?
The human body cannot reproduce tooth enamel. The enamel-forming cells perish after the one-time production of enamel during the child's development. This means that as soon as the tooth enamel has a defect, the tooth enamel is lost forever.
Toothpastes that promise to produce artificial tooth enamel that is cleaned up when you brush cannot keep their advertising promises. Because tooth enamel cannot be formed artificially either. Therefore it is not recommended.
The only way to repair the tooth enamel defect is with filling therapy. The lesion is cleaned, if necessary the causative caries is removed and a filling material is introduced. This material can be plastic, cement or amalgam.
In the case of a more extensive lesion in the enamel, it can also be replaced by a veneer or an inlay made of zirconium ceramic or gold. The size of the defect is decisive for the selection of the restorative material. The tooth is fully protected at the damaged area by the filling.
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Prevent tooth enamel degradation
In order to specifically prevent the breakdown of tooth enamel, it is generally necessary to fundamentally change one's own eating habits.
From a medical point of view, it does not make sense to completely avoid foods that contain natural acids (e.g. fruit), but reducing those foods that contain artificial acids can enormously promote the health of the tooth enamel.
For this reason, acidic beverages such as sports drinks, lemonades and soft drinks should only be consumed rarely or not at all. Drinks that have a high percentage of calcium and phosphate compounds in addition to the acid content are considered less harmful due to the neutralizing properties of these ingredients. If acidic foods and / or drinks cannot be avoided, at least the contact time between acid and tooth enamel should be kept as short as possible.
For this reason, the use of drinking straws can greatly reduce the risk of tooth enamel breakdown. In addition, care should be taken to ensure that a suitable form of oral hygiene is considered after consuming acidic food and drinks. For example, chewing special dental care chewing gum can neutralize the lowering of the pH value within the oral cavity caused by acidic foods and thus reduce the harmful effects.
Brushing your teeth, on the other hand, should not be done within an hour of consuming acidic foods. This is due to the fact that otherwise the tooth enamel attacked and softened by the acids can be removed directly with the brushes. Since a pronounced breakdown of tooth enamel can also be triggered by frequent vomiting or a so-called reflux disease, treatment of the underlying disease should be considered in such cases. In addition, after vomiting, the mouth should be rinsed thoroughly with pure water before the toothbrush is used.