The role of the diet in tooth wear

Key Points

  • The frequency of dietary acid intake between meals, any habits which involve rinsing acidic drinks around the mouth and the time period the acid is in the mouth are factors to consider when you suspect dietary erosive tooth wear.

  • Ask about hidden dietary acids which the patient may not be aware about. Possibilities include fruit cordial, fruit teas or addition of lemon to water/tea.

  • Planning a suitable dietary substitution in advance with the patient, may make them more likely to change their behaviour rather than telling them simply to avoid the dietary acid.

Abstract

An acidic diet has been associated with erosive tooth wear. However, some people who consume dietary acids develop erosive tooth wear and some do not. This review paper provides an overview of the risk factors of dietary acid consumption which increase the likelihood of developing severe erosive tooth wear. Increased frequency of dietary acid consumption, particularly between meals appears to be the predominant risk factor. However, habitually drinking acidic drinks by sipping them slowly or swishing, rinsing or holding acidic drinks in the mouth before swallowing will also increase risk of progression. Consuming fruit over long time periods at a single sitting and dietary acids being served at increased temperatures have also been implicated. Additions of fruit or fruit flavourings to drinks and regular consumption of vinegars, pickles, acidic medications or acidic sugar-free sweets are potential hidden risk factors that should be discussed with patients at risk of erosive tooth wear progression. Behaviour change is difficult to achieve but specific, targeted behavioural interventions and offering alternatives may increase success.

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Figure 1: This patient rinsed acidic drinks around their mouth.
Figure 2: This patient sipped hot tea with lemon flavouring several times a day.

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O'Toole, S., Mullan, F. The role of the diet in tooth wear. Br Dent J 224, 379–383 (2018). https://doi.org/10.1038/sj.bdj.2018.127

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