München, 11 September 2009 – Erosive defects of the hard tooth structures result from the chronic action of acids of non-bacterial origin on the surface of the tooth. These acids come either from acidic foods (exogenous) or from the stomach (endogenous), e.g. in the case of reflux diseases. While exogenous acid attacks can be partially reduced by dietary changes, the teeth are largely unprotected against attacks by endogenous acids.
To date, the prevention of erosive tooth damage essentially consists of the early and proper recognition (bearing differential diagnoses in mind) of the early stages of erosion, as well as information and individual patient counseling. In the case of erosion defects of an exogenous origin, the further progression of the loss of hard tooth structures can generally be prevented only by modifying dietary habits. The first signs of erosive destruction are difficult for the patient to recognise. ”Rounding“ of incisor edges and fissures as well as increasing translucency of the incisor edges are the results of initial enamel loss. Later on there are indentations and surface loss with involvement of the dentin. Histologically, the surface defects can be described as having a typical etching pattern and locally reduced microhardness. They are thus clearly different from beginning caries which occurs in the case of demineralisation under a pseudo-intact coating. Further stages of acid-related erosion are mineral loss in the area of the peritubular dentin and finally the expansion of the dentin tubules with degradation of the intertubular dentin. This defect structure can no longer be regenerated.
In contrast to caries, causal and symptomatic measures in the case of erosion defects generally stop further damage, such that invasive treatments are only necessary if there are already esthetic or functional impairment.
Symptomatic measures to prevent loss of hard tooth structures are based on the deposit of low-soluble, generally mineral deposits on the surface of the tooth. This generally occurs through the use of a dental rinse, which contains the substances to be deposited in a soluble form. The effectiveness of the oral hygiene products is thus very crucially determined by the polyvalent metal ions used, such as tin or titanium and by the type of fluoride compound.
Prof. Dr. Carolina Ganss and her team at the Polyclinic for Dental Maintenance and Preventive Dentistry at the Justus-Liebig University in Giessen were able to demonstrate that the combination of stannous chloride and amine fluoride, formulated in a dental rinse (elmex EROSION PROTECTION), is highly effective in protecting against acid-related erosions. In contrast to formulations containing titanium, this protective effect also remains unchanged in the case of heavy acid exposure.
The authors propose a plausible mode of action of these erosion inhibitors, with which an amorphous, stannous deposit is first deposited on the surface of the tooth which, under exposure to erosive acids, eventually leads to the deposit of low-soluble, stannous mineral substance in the top layer of the surface of the tooth. For the in-situ study, enamel samples were treated with citric acid several times per day for several minutes. In comparison to placebo samples, it could be demonstrated that the loss of enamel substance after once-daily rinsing with a stannous chloride and amine fluoride solution was reduced by 67% (vs. 19% for sodium fluoride). In analogous experiments, dentin loss was also able to be significantly reduced by 47%.
Thus the new elmex EROSION PROTECTION dental rinse, with its active ingredient combination of stannous chloride and amine fluoride, effectively protects against acid-related tooth erosions.
Literature:
Ganss C, Schlüter N. Prevention and treatment of acid-related loss of hard tooth structures (erosions). IAPD (internal report) 2009.
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