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Erosion is the process by which tooth mineral is irreversibly lost due to the action of acid. This is a direct pH effect that occurs when the intraoral pH drops below the critical pH of dental enamel (5.5). All acids, whether from intrinsic (such as that produced by gastric acid reflux) or extrinsic sources (e.g. dietary such as yoghurt, pickles, soft drinks - especially sports drinks), are capable of demineralizing tooth enamel if they produce a pH at the enamel surface that is lower than the critical pH. This results in erosion lesions. Some medications, especially those that are delivered by inhaler, have low pH and may contribute to erosion e.g. Albuterol (Ventolin - sulfuric acid is used to adjust the pH to between 3 and 5) and Cromolyn (Intal - pH of 5.5). Vitamin C supplements are often low pH due to the citric acid content and are particularly harmful of taken last thing before retiring. There have even been reports in the literature of swimmers' teeth being affected by the low pH of chlorinated pools.
Erosion is difficult to measure consistently (many different indices exist) and so it is hard to compare data from different studies (e.g involving adults, children, different countries, occupational exposures). In studies of 5 year old children in Ireland, 47% had erosion, and in a 1993 UK National Survey of Child Dental Health (17,061 children were examined) more than 50% of the 5 and 6 year olds had erosion, 25% of these with dentinal involvement. In the 11 year and older age group, almost 25% had erosion, 2% with dentinal involvement in the mixed dentition.
In a US study of 11-13 year olds 41% had erosion. In adults the situation is similar. In a Swiss study of subjects aged between 26 and 30 years, 7.7% had facial erosive lesions with dentin involvement and 29.9% had occlusal tooth loss into dentin. In the 46-50 year old group, 13.2% exhibited facial erosive lesions into dentin and 42.6% had occlusal erosion involving dentin.
Taken as a whole, studies suggest that the prevalence of dental erosion (of all causes) ranges from 5 to 50% in various populations and age groups.
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