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18 October 2019

Working towards eradicating Erosive Tooth Wear

How King’s academics are changing practice and informing patients, dentists and the public about this preventable condition.

Teeth with erosive tooth wear
Teeth with erosive tooth wear

Erosive Tooth Wear hit the spotlight in the national and international media last year when a study by King’s Clinical Lecturer Dr Saoirse O’Toole revealed why some people suffer from tooth erosion and others don’t. It crucially uncovered that it wasn’t just about what people eat, but how they eat, that increases their chances of developing the condition.

Making headlines around the world, the research highlighted the damage caused by certain types of food, in particular acidic food and drinks, and that having them between meals carried the greatest risk. Those who consumed acidic drinks twice a day between meals, such as soft drinks, water with a slice of lemon or hot fruit flavoured teas, were more than 11 times more likely to have moderate or severe tooth erosion.  This figure was halved when drinks were consumed with meals.

But what is Erosive Tooth Wear?

Erosive Tooth Wear is the third most common oral condition – King’s research found it affects up to 30% of European adults. It is the premature wearing of teeth due to the softening of the dental enamel from dietary or gastric acids, combined with wear and tear. It occurs when the outer layer (enamel) of the tooth slowly dissolves. This can lead to changes in the shape or appearance of teeth, and they can become sensitive when eating or drinking cold food and drinks. At its worst, the tooth structure can gradually wear away.

Enamel covers the outside of the tooth and is the first barrier to protect the pulp.  While it is possible for acidic damage in the enamel to be repaired in the right conditions, severe Erosive Tooth Wear reduces quality of life and can mean complex and costly procedures, costing up to £30,000 per patient.

Erosive Tooth Wear is mostly aggravated by the types of food we eat and how we eat them. As a preventable condition, researchers have found that some people have habits which increase both the duration and the force that the acids are in contact with teeth, such as holding drinks in their mouth, or sipping them over long periods of time.

Medical conditions and Erosive Tooth Wear

As well as dietary erosion, academics at King’s also found that many medical conditions can result in the erosion of tooth enamel, and these can have serious and even possibly fatal consequences if left undiagnosed or untreated. Indeed, dentists can play a key role in the detection of health conditions including anorexia nervosa, bulimia and Gastro-Oesophageal Reflux Disease (GORD).  The published research show that regurgitated or vomited stomach contents are highly acidic and repeated contact with tooth enamel results in erosive tooth wear.

Building the Foundations

Erosive Tooth Wear can cause major problems for both individuals and communities. Often the causes and treatment options are poorly understood. To help break down these barriers and ensure research from King’s is translated into better health, King’s Professor Bartlett, Head of Prosthodontics and Professor Nigel Pitt, Academic Lead for Impact worked with leading academics from across Europe, to establish the Erosive Tooth Wear Foundation in 2018, a registered UK charity.

The foundation’s website provides key information on the condition, as well as e-Learning modules with validated CPD (Continuing Professional Development) programmes, videos and research papers. It provides information on the underlying science, the scale of the problem and how to best prevent, and where appropriate, manage the problem. Using a range of education tools, the Foundation team are working to spread information widely across patients and the public.

Erosive Tooth Wear Foundation
Erosive Tooth Wear Foundation

Campaign to drive routine screening

To help drive awareness, academics at King’s, leaders of the Erosive Tooth Wear Foundation and GSK launched a unified campaign in July 2019.

As part of this campaign, leading experts called on the dental profession to use the basic erosive tooth wear examination (BEWE) alongside the basic gum disease examination (BPE) as part of every oral assessment, to ensure early identification and prevention. 

As it follows the same approach as the gum disease examination, the idea is that the erosive tooth wear check can be conducted at the same time, requiring little additional clinical time.

A series of artworks and live experiments were used at the launch to showcase key causes of erosive tooth wear and how the dental profession can better serve patients by utilising this examination during patient consultations. 

The launch of the campaign was a success. There was widespread coverage in the dental press and social media saw high engagements within relevant communities, including almost over 500,000 from those in the dental profession. No mean feat considering there are approximately 51,000 dental professionals in the UK.

Demonstrations at the Erosive Tooth Wear meeting
Demonstrations at the Erosive Tooth Wear meeting

The future

As a result of increasing the public and professional awareness of the condition, the Erosive Tooth Wear examination has now been incorporated into three international dental software programmes for clinical records and within dental schools in the UK. 75% teach the examination as part of their routine clinical care for undergraduates.

But there is still work to be done. The team from King’s are calling for the basic Erosive Tooth Wear examination to be incorporated into every clinical examination performed in the UK.  This they say, would reduce the potential for patients to develop severe levels of the condition and remove it as one of the most common oral health conditions in the country. 


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