Erosion, Abrasion and Attrition – These terms refer to destruction of tooth tissue, which has not been caused by dental decay: erosion is the process by which acid, e.g. fruit acid, softens the outer layer of a tooth. Abrasion is loss of tooth structure as a result of rubbing, e.g. with a toothbrush and toothpaste, and attrition is the wearing away of the biting surface of teeth as a result of grinding or chewing abrasive foods.

Erosion
Healthier living has led to a great increase in the consumption of fruit. Many fruits contain large quantities of natural acids; some fruits are particularly acidic, e.g. lemons and grapefruit. Other sources of acid include yoghurt, chewable vitamin C tablets, and fizzy drinks. A less common but quite destructive cause of acid erosion is stomach acid. Pregnant women suffering from severe morning sickness, or people suffering from hiatus hernia may show signs of dental erosion. These sorts of acids can dissolve the outer layer of teeth, and leave a soft surface, which is easily worn away (see below). Enamel is much harder than dentine (the middle part of a tooth), and is relatively resistant to erosion; however once the outer enamel layer has been perforated, dentine can be quickly worn away, causing “cup shaped” cavities or grooves.

Remineralization
Saliva contains a high concentration of minerals which will become deposited in softened enamel and dentine, and which are capable of hardening it again. This process happens in much the same way that the minerals in tap water form deposits inside a kettle, and takes about 1 hour. Therefore if the softened outer layer of a tooth exposed to acid is bathed in saliva for not less than 1 hour before using a toothbrush, the softened layer will become hard again, and be more resistant to abrasion.

Abrasion
Abrasion usually works hand in hand with erosion. A toothbrush and toothpaste will very quickly remove a softened layer of tooth; in just the same way as sandpaper will cut into soft plaster. That is why it is better not to use too much toothpaste on a toothbrush, and to brush teeth gently (but thoroughly). If an acidic substance such as orange juice has come into contact with the teeth it is better to wait at least an hour before using a toothbrush so as to allow the softened outer layer of the tooth to remineralize; this means that it may be better to brush your teeth before breakfast, rather than after.

Attrition
It is very unusual to see attrition in isolation, however in combination with erosion and abrasion quite severe damage to teeth may result. Fibrous foods (which are an extremely important constituent of a healthy diet) can be quite abrasive, e.g., if "All Bran" is eaten along with orange juice, which softens the tooth surface, the biting surface of the teeth may be rapidly worn away. It is also common for people who clench and grind their teeth to wear down the biting surfaces of their teeth.

In many cases these problems can be easily dealt with by correcting tooth brushing habits and avoiding the very frequent consumption of excessively acidic substances such as lemons. Sometimes it is necessary to look more deeply into the diet in order to identify the exact causative factors; after all, fruit and fibre are healthy foods, and have a very important role in any balanced diet.

If the problem has progressed to the extent that much of the tooth has been worn away, treatment may become necessary, so as to prevent further damage to the tooth, reduce sensitivity, and avoid damage to the dental nerve. There are many restorative techniques available, most of which use innovative white materials and adhesive technology:

Bonding
This procedure is carried out when a groove has been cut into the neck of the tooth as it approaches the gum. A tooth-colored adhesive filling material is bonded to the surface of the tooth, filling in the cavity and protecting the tooth surface from further damage. These new adhesive materials are very kind to the tissues, and have great potential for improving the appearance of the tooth.

Veneers
Where extensive damage has occurred, and much of the tooth surface has been destroyed these tooth-like restorations will strengthen and protect the tooth, as well as restoring the appearance. (For more information on this cosmetic technique see Veneers).

Crowns
If more than one surface of the tooth has been badly damaged then a crown may be necessary. There are many different types available, and recent advances in dental technology have greatly improved both the physical properties and the appearance of these restorations.