What Is Enamel Erosion?
Enamel is the hard, translucent outer layer that covers the visible part of each tooth. It serves as the primary defence against physical wear, temperature changes, and chemical exposure. Although enamel is the hardest substance in the human body, it is not indestructible — and it is particularly vulnerable to acid.
When acids come into contact with the tooth surface, they soften and gradually dissolve the mineral crystals that make up enamel. Over time, this process — known as erosion — causes the enamel to become thinner and less effective as a protective barrier. As the enamel wears away, the softer, more sensitive dentine layer beneath becomes increasingly exposed.
It is worth distinguishing erosion from other forms of tooth wear. Abrasion refers to mechanical wear from brushing or external objects, while attrition describes wear caused by tooth-to-tooth contact during grinding or clenching. Tooth decay, by contrast, is caused by bacteria that produce acid in localised areas, typically resulting in cavities. Erosion is a chemical process driven by direct acid exposure across broader tooth surfaces.
Common Causes of Acid Wear
Acid wear can result from a range of dietary, medical, and lifestyle factors. The level of risk varies between individuals depending on the frequency and duration of acid exposure, saliva composition, and oral care habits.
Frequent Acidic Foods and Drinks
Regular consumption of citrus fruits, fruit juices, carbonated drinks, wine, and vinegar-based foods exposes enamel to repeated acid contact, gradually softening and dissolving its mineral structure.
Acid Reflux and Gastric Acid
Gastro-oesophageal reflux disease (GORD) and frequent vomiting bring strong stomach acids into contact with tooth surfaces, particularly the inner surfaces of the upper teeth, accelerating enamel loss.
Dry Mouth (Reduced Saliva Flow)
Saliva plays a key role in neutralising acids and remineralising enamel. Reduced saliva flow — whether from medication, medical conditions, or dehydration — diminishes this protective effect.
Brushing Immediately After Acid Exposure
Enamel is temporarily softened after contact with acidic substances. Brushing during this window can accelerate mineral removal. Waiting at least 30 minutes before brushing allows saliva to begin neutralising the acid.
Occupational and Lifestyle Factors
Certain occupations involving acid exposure, competitive swimmers exposed to pool chemicals, and individuals who frequently consume sports drinks may face a higher risk of acid-related enamel wear.
Early Signs of Enamel Erosion
In its early stages, enamel erosion may not cause obvious symptoms. However, the following changes can indicate that acid wear is beginning to affect your teeth:
Increased Tooth Sensitivity
As enamel thins, the underlying dentine becomes less protected, leading to heightened sensitivity to hot, cold, sweet, or acidic foods and drinks.
Smooth, Shiny Tooth Surfaces
Eroded enamel may appear unusually smooth or glassy, particularly on the biting surfaces and along the edges of the front teeth.
Yellowing Appearance
As the white enamel layer becomes thinner, the naturally yellow dentine beneath becomes more visible, giving teeth a warmer or more discoloured appearance.
Minor Changes in Tooth Shape
Subtle rounding of tooth edges, slight indentations on biting surfaces, or a change in how the teeth fit together may be early indicators of acid wear.
Advanced Signs and Symptoms
As erosion progresses beyond the early stages, more noticeable changes may develop. These tend to occur gradually and may include:
- Noticeable thinning of enamel, particularly on biting surfaces and tooth edges
- Increased and more persistent sensitivity to temperature and dietary triggers
- Small cracks, chips, or roughening of tooth surfaces
- Shortened, flattened, or translucent-looking teeth
- Increased risk of tooth fracture under normal biting forces
The presence of these signs does not necessarily indicate severe damage, but professional assessment is advisable to determine the extent of erosion and whether intervention is appropriate.
Why Professional Assessment Is Important
Enamel erosion often progresses gradually, and the early stages may not cause pain or obvious discomfort. By the time symptoms become noticeable, a significant amount of enamel may have already been lost. Regular dental assessments allow your dentist to identify erosion patterns early, before more extensive damage occurs.
During assessment, your dentist can evaluate the severity of any wear, identify contributing factors such as diet or acid reflux, and recommend appropriate preventive or restorative measures. Dental imaging may be used where appropriate to assess structural changes that are not visible to the eye.
Early intervention — even when limited to preventive advice and monitoring — may help reduce the risk of further enamel loss and the need for more extensive treatment in the future.
How Dentists Assess Enamel Erosion
A structured clinical assessment helps determine the extent of acid wear and guides the appropriate management approach. Your dentist may use several of the following methods:
Clinical Examination
A thorough visual and tactile inspection of all tooth surfaces to identify areas of enamel thinning, surface changes, and wear patterns consistent with acid erosion.
Assessment of Contributing Factors
Discussion of dietary habits, medical history, acid reflux symptoms, oral care routine, and lifestyle factors that may be contributing to acid exposure.
Severity Grading
Evaluation of the extent and depth of enamel loss to determine whether the erosion is in an early, moderate, or advanced stage, guiding the appropriate management approach.
Dental Imaging
X-rays or other imaging where clinically indicated to assess the extent of structural changes not visible during clinical examination and to check for any associated issues.
Bite and Occlusal Analysis
Assessment of how the teeth meet during biting and chewing to identify whether grinding or clenching may be contributing to the pattern of wear.
Professional Management and Treatment Options
The approach to managing enamel erosion depends on its severity, the areas affected, and the underlying contributing factors. Your dentist will discuss the most suitable options based on the clinical findings. Management may include:
Preventive Advice and Monitoring
For early-stage erosion, your dentist may recommend dietary modifications, changes to oral care habits, and regular monitoring to help reduce further acid exposure and track any progression.
Fluoride-Based Protective Strategies
Professional fluoride applications and prescribed high-fluoride toothpaste may help strengthen remaining enamel and reduce sensitivity by encouraging surface remineralisation.
Composite Bonding
Where erosion has altered tooth shape or exposed sensitive dentine, composite bonding may be used to restore worn surfaces, improve appearance, and provide a protective layer over vulnerable areas.
Protective Restorations
Depending on the extent and location of enamel loss, restorations such as onlays or veneers may be considered to protect weakened tooth structure and restore function.
Bite Assessment and Grinding Management
Where bruxism is contributing to the pattern of wear, a custom-made bite guard may be recommended to help protect enamel from further mechanical damage.
Crowns for Advanced Cases
In cases of significant structural compromise, a dental crown may be recommended to restore the tooth's shape, strength, and function, and to prevent further deterioration.
Treatment outcomes vary depending on individual circumstances. Wording such as “may help protect,” “may reduce progression,” and “aims to restore structure” reflects the realistic nature of clinical outcomes.
Professional Review for Enamel Erosion
A professional dental assessment helps determine the extent of enamel wear and whether preventive or restorative treatment is appropriate. Your dentist can identify early signs of erosion, assess contributing factors, and recommend a tailored management plan.
Depending on the findings, your dentist may recommend general dentistry and preventive care, composite bonding to restore worn surfaces, dental crowns for structurally compromised teeth, or an emergency dental assessment if discomfort is severe.
Assessment and treatment for enamel erosion are available at our London clinics. You can attend our South Kensington dental clinic or our City of London clinic near St Paul's for a professional dental review.
Can Enamel Grow Back?
Enamel does not regenerate once it has been significantly lost. Unlike bone, which can remodel and repair itself, mature enamel lacks living cells capable of producing new tissue. This is why prevention and early intervention are particularly important.
However, very early mineral changes — sometimes referred to as demineralisation — may be partially stabilised with appropriate care. Fluoride-based products, dietary adjustments, and improved oral hygiene can help encourage remineralisation of the enamel surface before structural loss becomes irreversible.
Professional monitoring helps track the progression of erosion over time, allowing your dentist to recommend intervention at the most appropriate stage. Where enamel has already been lost, restorative options such as composite bonding or crowns can help protect the remaining tooth structure.
Reducing the Risk of Acid Wear
While not every cause of enamel erosion can be prevented, the following strategies may help reduce acid exposure and protect your enamel:
- Limit the frequency of acidic foods and drinks, and consider consuming them during mealtimes rather than throughout the day
- Wait at least 30 minutes after consuming acidic foods or drinks before brushing your teeth
- Use a fluoride toothpaste and consider a remineralising or enamel-strengthening formulation as recommended by your dentist
- Drink water after consuming acidic beverages to help rinse acid from tooth surfaces
- If you experience acid reflux, seek appropriate medical management to reduce gastric acid reaching the mouth
- Attend regular dental check-ups so early signs of enamel erosion can be identified and monitored
