What causes dental erosion (and why healthy diets often make it worse)
Erosion is not decay and it is not caused by bacteria. It is acid dissolving enamel directly, and some of the biggest culprits are the things people take up when they decide to get healthy.
Here is an uncomfortable pattern we see fairly often.
Somebody decides to get healthier. They cut out soft drink and start on lemon water in the morning. They swap snacks for fruit, dress salads with vinegar, drink sparkling water through the day and take a sports drink to the gym.
Two years later their teeth are visibly thinner at the edges and sensitive to cold.
Nothing they did was unreasonable. They just ran into a problem that is not decay and does not behave like it.
Erosion is not decay
Decay is a bacterial process. Bacteria eat sugar, produce acid in one specific spot, and a hole forms.
Erosion needs no bacteria and no sugar. It is acid from food and drink dissolving enamel directly, across whole surfaces at once. You can have perfect brushing, no cavities in your life, and significant erosion.
That is why it slips past people. It does not produce the thing everybody is watching for.
What causes it
Anything acidic, and a lot of things are more acidic than they taste.
- Citrus and lemon water. The most common one we see, precisely because it is a health habit.
- Fruit juice, including the ones with no added sugar. The acid is in the fruit.
- Soft drinks, including diet versions. Removing the sugar does not remove the acid.
- Sports drinks, which are usually acidic and are sipped over a long session.
- Wine, particularly white.
- Sparkling water. Mildly acidic. Much better than soft drink, worse than still water, and worth knowing about if you drink a lot of it.
- Vinegar dressings, pickles and kombucha.
There are also causes that have nothing to do with diet. Reflux brings stomach acid into the mouth, often overnight without waking you, and stomach acid is far stronger than anything you drink. Frequent vomiting does the same. If either applies to you, that is worth raising with your GP as well as with us, and it is a completely normal thing to mention.
Sipping is the real problem
This is the part that matters most, and it is the same principle that governs sugar.
Your saliva neutralises acid and puts minerals back into enamel, but it takes time. Drink a glass of juice in five minutes and you get one acid episode that your mouth then recovers from. Sip the same glass over an hour and your teeth spend the whole hour in acid with no chance to recover.
The dose barely changes. The damage changes enormously.
The same applies to a water bottle with lemon in it on your desk, refilled through the day. That is one of the most erosive habits going, and it looks like the healthiest thing in the room.
The signs
Erosion is gradual, so people usually notice the consequences before the cause.
- Teeth looking more yellow. Enamel is fairly translucent, and the layer underneath is darker. As enamel thins, more of that shows through. The teeth are not staining, they are getting thinner.
- Front teeth going see-through at the edges, sometimes with small chips, because the edge is the thinnest part.
- Cupped hollows in the biting surfaces of the back teeth.
- Fillings that seem to be standing proud. They are not rising. The tooth around them is wearing down.
- Sensitivity to cold that has crept up over a year or two.
- Teeth looking generally shorter or more rounded than they used to.
What to do about it
You do not have to give up everything on that list. Five adjustments do most of the work.
Drink it, do not sip it. Acidic drinks with a meal, finished in a reasonable time, rather than nursed for an hour.
Use a straw for anything acidic, so it largely bypasses the front teeth.
Follow with plain water. A simple rinse helps a lot.
Do not brush for about an hour afterwards. This one is counterintuitive and it matters. Acid temporarily softens the surface of enamel, and brushing it in that state scrubs some of it off. You are wearing away exactly the surface you are trying to protect. Rinse at the time, brush later.
Finish with something neutral or alkaline. Cheese, milk or plain yoghurt help bring the mouth back to normal. Sugar-free gum works too, by prompting saliva.
Beyond that, a soft brush and a gentle hand, because erosion plus hard brushing is a fast combination.
What can be done if it has already happened
Enamel does not grow back. There is no way around that.
Early softening can be re-hardened with fluoride and better habits, and we may recommend a high-fluoride toothpaste for a while. Where enamel has genuinely been lost, the shape can be rebuilt with bonding, onlays or crowns, depending on how much is gone.
But rebuilding is repair, not reversal, and it does nothing about the cause. If the lemon water stays, the new work erodes too.
The bottom line
Erosion is the dental problem that punishes people for habits they took up in good faith.
It is easy to catch early, because we can compare your teeth against how they looked last visit. It is much harder to fix once the edges have gone.
If your teeth have become more sensitive, or look shorter or yellower than they did a few years ago, mention it. A full check-up and clean is a fixed $249, with your health fund claimed on the spot.
Read more: Is chocolate bad for your teeth?
Oral health FAQ
What is the difference between erosion and decay?
Decay is caused by bacteria turning sugar into acid in one spot, which makes a hole. Erosion is acid from food or drink dissolving enamel across whole surfaces at once. Decay makes a cavity, erosion thins the tooth generally, and you can have either without the other.
Is sparkling water bad for teeth?
It is mildly acidic, so it is more erosive than still water and much less so than soft drink or juice. If you drink a lot of it, having it with meals rather than sipping it all day is the sensible adjustment. Flavoured sparkling waters, especially citrus ones, tend to be more acidic than plain.
How do I know if I have erosion?
Teeth that look yellower, because the darker layer underneath shows through as enamel thins. Front teeth whose edges have become see-through or slightly chipped. Back teeth with cupped hollows in the biting surfaces. And sensitivity to cold that has crept up gradually.
Can eroded enamel be repaired?
It does not grow back, because enamel has no blood supply and no cells to rebuild it. Early softening can be hardened up with fluoride, and where enamel is genuinely lost, bonding, onlays or crowns rebuild the shape. The real aim is stopping the cause before it gets that far.
Should I stop drinking lemon water?
You do not have to. Drink it in one sitting rather than over an hour, use a straw so it bypasses the front teeth, follow it with plain water, and do not brush for about an hour afterwards. Those four changes remove most of the risk without removing the drink.
