Chapter 3- Tooth surface loss not caused by decay.

There are 3 types of wear on teeth- Erosion, Abrasion and Attrition.

There is another called Abfraction but that’s a bit more esoteric so we won’t worry about that for now.


pH is a measure of acidity from 1-14 [remember your chemistry lessons].

Big numbers alkali, little numbers acid. pH 7 neutral in the middle.

Anything with a pH of less than 5.5 will dissolve the enamel off your teeth.

These things are- fruit juice, fizzy drinks, citrus fruits consumed in large quantities, wine [sadly], smoothies, yogurt, vinegar, salad dressing and vomit if you are sick a lot.

Saliva has a buffering action, it will buffer it back to neutral, but it takes 40 minutes to an hour to do so.

When you drink a glass of fruit juice say, it softens the outside layer of your enamel. If you brush your teeth straight away, you will brush off that soft layer. It may only be microscopic, but after 20 years it adds up to a lot of enamel. Once it’s gone, it’s gone forever- never to return!

So if you eat or drink anything acidic you need to leave at least an hour before you brush your teeth. To allow your saliva to neutralise the acid and for your enamel to re harden.

Much easier not to have anything acidic for breakfast as you need to wait an hour before you brush your teeth, or brush them before breakfast or when you get to the office.

Sipping from cans.

If you drink a can of drink straight from the can, all of the acid in that can [diet or otherwise, may have fewer calories but it is just as acidic] goes straight out of the ring pull hole onto your 2 front teeth. You will see people sometimes with a big ‘sippers V’ triangular notch dissolved out from between their two front teeth.

When you take a sip, the pH in your mouth drops and your mouth becomes more acidic. Your saliva starts to neutralise it, 5 mins later you take another sip, your pH drops again, your saliva starts to neutralise it. If it takes an hour for you to drink that can of drink that means your teeth have been bathed in acid for an hour and then a further hour, gradually increasing in pH while your saliva neutralises the acid.

Don’t drink straight from a can, put it in a glass, drink from a wide bore straw, don’t swish it around your mouth and better still- don’t drink it at all!

If you are thirsty, drink water. All other drinks should be an occasional treat, not used to quench your thirst. Drink 8 glasses of water a day to stay healthy- to cool you down when you are hot, to give you enough circulating blood volume, to make enough saliva to lubricate your mouth, tears to clean your eyes, to make sure the cells in your body are turgid [full], to get rid of toxins in your urine, to make sure food passes through you easily, to stop your skin being dry and 101 other reasons.

Free Sugar.

There are lots of different types of sugar; glucose, sucrose, maltose, lactose, fructose. They all have different cariogenic rates [rot rates]. Sucrose is the worst [refined sugar in cakes, sweets, biscuits etc] . This is because the refining process changes the sugar from natural sugar to ‘free sugar’ which more readily attacks your teeth. Juice which has been pasteurized ie heated up to destroy the bacteria [so it can be transported in a refrigerated ship or lorry from far away, to your supermarket] contains ‘free sugar’ as the process of pasteurizing converts the fructose in the fruit to free sugar.

If you must drink juice- ‘the more bits the better’, make your own, drink it with a meal but not breakfast, drink it through a straw,  wash your mouth out with water afterwards. Better still don’t drink it at all!

Better to eat whole fruit, you need the roughage to reduce your risk of bowel cancer and the fructose in the fruit is locked in the cells not free.


Milk has a nearly neutral pH of 6.8, so it helps to reverse the acid attack. It also contains Caesin a protein which forms a protective layer on your teeth this helps with the Calcium and Phosphate metabolism of your enamel.

Medical conditions.

Some people have medical conditions or eating disorders which means they either regurgitate their stomach contents or vomit on a regular basis.

Stomach acid has a pH of 2. It is very acidic and will have the same erosive effect on teeth.

Some conditions are- Bulimia, Reflux oesophagitis, Hiatus hernia, Stomach ulcers and side effects of some chemotherapy drugs. If you have any of the above conditions it is vital that you seek your dentists help to avoid eroding and destroying your teeth.


Abrasion is scrubbing your teeth from side to side. If you do this you will wear groves in the side of your teeth which weakens them and makes them sensitive. These are called ‘abrasion cavities’. If you do have a tendency to scrub from side to side and you really can’t get out of the habit you may be better with a round headed electric toothbrush. You don’t need to do the round and round bit it does it all for you! [see no 6].  If you have really big groves speak to your dentist about having adhesive restorations placed [no drilling] to strengthen your teeth and stop sensitivity. Or you may just need a desensitising toothpaste if they are not too deep, read the back of the box to make sure it contains the right dose of fluoride [1350-1500 ppm] as well as a desensitiser.

I often find that abrasion often occurs in patients who are fastidious cleaners but have never been taught the correct method and so do themselves a lot of damage unwittingly. There is no substitute for professional instruction, it is a sound investment because once you have been taught the correct method and you master it, you are set up for the rest of your life.


Attrition is tooth surface loss on the biting surfaces, usually due to grinding or clenching. If you also soften the enamel with acid erosion the effect will be even worse. Attrition will lead to restoration failure, sensitivity and a host of other problems.

Go and see your dentist you need help!

This is only a quick overview, nonbacterial tooth surface loss is a very complicated subject with many factors and quite often a combination of more than one type. It needs to be properly assessed by a professional.

Go and see your dentist! Timely advice should be sort before it’s too late.

Prevention is better, simpler, cheaper and less painful than cure!

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