Dental erosion

The enemy is not always carbohydrates and cavities!  

CC: “My child’s teeth has yellow cavities”

Dx: dental erosion associated with gastroesophageal reflux disease (GERD)

Tx: monitor primary teeth, refer to PCP for GERD management 

🔑: Dental erosion is defined as loss of tooth structure (primarily enamel and dentin) caused by a chemical process that does not involve bacteria. This contrasts attrition (e.g. grinding), abrasion (e.g. aggressive brushing), abfraction, and caries. 

The typical distribution of erosion is of greater severity in the occlusal surfaces of the mandibular posteriors and palatal surfaces of the maxillary anteriors. 

Extrinsic factors include diet and beverages such as soda and acidic foods and can be corrected with appropriate patient education and diet modifications. Intrinsic factors include certain syndromes (e.g. Down syndrome and cerebral palsy), gastroesophageal reflux disease, and eating disorders (e.g. bulimia nervosa). This requires a referral to the appropriate physician. 

After a thorough review of the patient’s medical history and Q&A, it was concluded that the patient’s condition is associated with GERD. Keep in mind pediatric patients may have difficulty describing their symptoms. 

As you can see in the pictures, cupping is noted on the occlusal surfaces with increased severity noted on the right quadrant (evident from the fused cupping). Treatments include stainless steel crowns (to protect the teeth and restore vertical dimension of occlusion), composite restorations (to protect the teeth and restore aesthetics, may require bevel for retention), and no treatment (monitor if pulpal involvement is not suspected and affected teeth are near exfoliation). In this case, we opt for monitoring.