Localised palatal tooth surface loss and its treatment with porcelain laminates

Localised tooth surface loss and subsequent caries in a young patient due to an unusual dietary habit is reported. The treatment and management of such conditions is discussed. Tooth surface loss is a condition seen with increasing frequency, often associated with the retention of the natural dentition into older age. In these older patients, abrasion and attrition tend to predominate as the causative factors but, in younger patients, acid erosion is frequently implicated. The acid involved may be dietary, in the form of carbonated beverages, fruit juices, vinegar or excessive intake of citrus fruits. If not derived from the diet, gastric acid may be the source if the patient has gastric reflux, perhaps associated with an ulcer or, in cases of anorexia nervosa or bulimia, where the patient deliberately induces vomiting and bathes the teeth in acid. There is a preponderance of female patients in the latter categories, although not exclusively so. Sometimes patients develop habits where an acidic substance is held in contact with certain teeth and the erosive process is more localised. This is illustrated in the case quoted by Reuter where grapefruit was held against the palatal surfaces of the upper anterior teeth resulting in enamel loss affecting that area. In all these cases of erosion the affected tooth surface was reported as being hard and shiny, lacking any of the features normally associated with dental caries.(ABSTRACT TRUNCATED AT 250 WORDS)