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Managing Dental Erosive Tooth Wear: Current Understanding and Future Directions

Course Number: 517

Fluoride and Erosive Tooth Wear

While dental erosion, like caries, is a mineral process, the erosion process follows a somewhat different pathway.47,60 There is little possibility of reversal, as erosive acids are able to overwhelm the protective pellicle layer and soften outer surfaces of the tooth; these softened surfaces can then be lost to abrasive forces, resulting in permanent and irreversible loss of tooth structure (Figure 12).

Diagram showing dental erosion.

Figure 12. Dental Erosion processes result in permanent loss of surface mineral structure.

It is well accepted that fluoride helps keep teeth strong. However, recent studies have demonstrated that all fluorides are not alike with their ability to help prevent dental erosion. While there would likely be a greater incidence of dental erosion in the absence of fluoride, the data suggest that most fluorides do not provide a high level of benefit against the increasing levels of challenge teeth are facing in today’s environment. In spite of the fact that almost 100% of the world’s toothpastes contain fluoride, the incidence and prevalence of dental erosion both appear to be on the rise. These data suggest many fluoride products may not be sufficiently effective to protect teeth against erosive acid challenges.

One of the currently used sources of fluoride, stannous fluoride (SnF2) (Figure 13), has been demonstrated in a broad range of studies to be unique in its ability to help prevent the initiation and progression of dental erosion. These include both laboratory61-64 and human in situ erosion clinical studies.65-70 Stannous-containing dentifrice demonstrated significantly better protection than sodium fluoride under erosive and erosive/tooth wear conditions71 and the use of these bioavailable SnF2 toothpastes, as part of a daily oral hygiene regimen, will provide patients with enamel erosion protection, combined with alleviation of dentin hypersensitivity pain when present, improving quality of life.72 Different from other sources of fluoride used, stannous fluoride deposits a retentive, acid resistant barrier layer onto exposed tooth surfaces that is protective against both the initiation and progression of dental erosion (Figure 14).73

Diagram showing stannous fluoride molecule.

Figure 13. Stannous fluoride (SnF2) is unique among the sources of fluoride routinely used for toothpaste formulations.

A recent meta-analysis showed that Sn-compounded fluoride, prevented enamel wear by erosion and erosion/abrasion compared to the non-fluoride group and monovalent fluoride group. There is no concentration of monovalent fluoride that could prevent erosion wear associated or not with abrasion.74 Along with a separate systematic review and meta-analysis both concluded that stannous fluoride showed a greater anti-erosive potential than non-stannous fluoride dentifrices and that as a treatment the use of stabilized stannous fluoride dentifrices to relieve dentin hypersensitivity and to prevent the initiation of dental erosion is favorable.75

Diagram showing enamel windows exposed to erosion cycling.

Figure 14. SnF2 helps prevent erosion by depositing an acid resistant barrier layer on exposed tooth surfaces, thus preventing the initiation and progression of irreversible damage.

Adapted from Faller; Cosmetics & Toiletries, 2012.76