Sites of dental erosion are saliva-dependent

Acid demineralization of teeth causes occlusal erosion and attrition and associated non-carious cervical lesions at sites relatively unprotected by saliva. Associations of occlusal pathology and cervical lesions were looked for in 450 patients with toothwear, and 174 subjects with cervical lesions were identified. Associations of occlusal attrition, or erosion, or no wear, with cervical lesions at 72 buccal and lingual sites were recorded from epoxy resin replicas of the subjects' dentitions (3241 teeth). Criteria used to discriminate occlusal erosion from attrition; and shallow from grooved and wedge-shaped cervical lesions were delineated by scanning electron microscopy (SEM). In the absence of occlusal pathology, cervical lesions were very rare (<1%). In the presence of occlusal pathology, cervical lesions were present in 27.71% of buccal sites as opposed to 2.61% of lingual sites. The commonest site of cervical lesions was the facial of maxillary incisors (36% of sites). The least common site was the lingual aspect of mandibular molars (1.7% of sites). These differences may reflect the normal protective role of serous saliva and salivary pellicle in a site-specific manner, on the lingual surfaces of mandibular teeth particularly, and do not support abfraction as the prime aetiology of cervical lesions.