Dental Erosion and Orthodontics UK

What is dental erosion and how is it different from decay?

Dental erosion is the irreversible loss of tooth structure caused by chemical dissolution from acid that does not involve bacteria. This distinguishes it from dental caries, which is a bacterial process. Erosion affects smooth surfaces of teeth — often the palatal surfaces of upper front teeth and the occlusal surfaces of back teeth — thinning the enamel and, in advanced cases, exposing the underlying dentine. Affected teeth often appear flattened, cupped, or glassy, and may be shorter than normal. Mild erosion is extremely common and in many people causes no symptoms or treatment need; moderate to severe erosion requires management before and during orthodontic treatment.

What are the common causes of dental erosion in the UK?

Dietary acid is the most frequent cause. High consumption of carbonated soft drinks, fruit juices, sports drinks, and acidic foods contributes significantly. The frequency of acid exposure matters more than the total amount — sipping fizzy drinks throughout the day is more erosive than drinking the same volume with a meal. Gastro-oesophageal reflux disease (GORD) is a significant medical cause; stomach acid that refluxes into the mouth is highly erosive and typically produces characteristic palatal erosion on the upper front teeth. Eating disorders involving purging produce a similar pattern. Xerostomia (dry mouth) from medication or systemic disease increases erosion risk by reducing saliva's protective buffering.

How does dental erosion affect orthodontic treatment?

Bracket bonding may be compromised because acid-etching enamel before bonding works by creating microporosities in the surface; severely eroded enamel is already thinned and structurally altered, and bonds may be less reliable. Sensitivity during treatment is more common because the protective enamel layer is reduced. Where erosion has shortened or reshaped the teeth significantly, this affects finishing goals and the aesthetic result. For patients using clear aligners, advanced erosion affecting tooth shape can alter aligner fit and tracking, particularly if attachment placement is planned in worn areas.

How should dental erosion be managed before starting orthodontics?

The first step is addressing the underlying cause. For dietary erosion, a detailed dietary analysis and behavioural advice is given — reducing frequency of acidic intake, using a straw for soft drinks, and not brushing immediately after acid exposure. For GORD, medical management by a GP or gastroenterologist should be optimised before treatment starts. For eating disorders, the patient must be under appropriate clinical care and erosion should be stable before commencing orthodontics. Remineralisation products — high-fluoride toothpaste, fluoride varnish applied by the dentist, and CPP-ACP products — help stabilise eroded surfaces before and during treatment.

What modifications are made when erosion is present during treatment?

When erosion is present but treatment proceeds, several modifications are considered. A stronger adhesive system or a primer specifically suited to compromised enamel may be used to improve bracket retention. Monitoring appointments may be more frequent. Sensitivity management may include desensitising toothpaste containing potassium nitrate or stannous fluoride, in-surgery fluoride varnish at each review appointment, and dietary advice throughout treatment. For aligner patients, erosion affecting aligner fit requires more frequent tracking checks.

How does erosion affect planning after orthodontic treatment?

Where dental erosion has caused significant tooth shape change — shortened incisors, cupped back teeth, or altered smile proportions — orthodontics addresses the alignment but cannot restore the lost tooth structure. Post-treatment planning should include the restorative dentist or a prosthodontist from the outset. Common restorative options include composite bonding to restore incisal edge length, porcelain veneers for more severe aesthetic defects once erosion is controlled, and onlays or crowns for heavily eroded back teeth. The orthodontic phase creates the ideal space and position for these restorations.

Useful related pages

This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.