evaluation/correction of occlusion, bonded restorations (to aid diagnosis: if comes out confirms), therapy to relieve parafunctional habits

Loss of tooth tissue by chemical dissolution

increasingly common - seen in 52-65% children, demineralisation begins if pH of saliva drops 5.5

Diet: acidic drinks (esp citric acid), juices, hot water lemon honey, holding/swishing in mouth, increased risk if brushing in under 1 hour of exposure. Medication: chewable aspirin, vit c tabs (erosion and attrition mainly molars). Drug use: crack cocaine and methamphetamines cause direct erosion, ecstasy leads to dehydration. Xerostomia: no/limited saliva, loss of buffering & natural cleansing (more likely to suck sweets). Environmental/Occupational: wine tasting, industrial (battery manufacturer). Perimolysis: decalcification of teeth by gastric acid, chronic vomiting/gastric reflux, chronic alcoholism, bulimia nervosa.

shiny amalgams, halo of enamel, sensitivity, teeth may look shiny, amalgams stand tall, thinning incisal edge (eventually fractures), broad shallow concavities, cupping of occlusal surfaces, can affect all surfaces dependant on aetiology.

depends on cause, dietary advice, no holding/swilling/retaining acid food/drink, no brushing for 60 mins after exposure to acid, drink through straw, avoid sports top bottles and sport drinks during exercise

rinse with water/alkaline solution after vomiting, sugar free gum, fluoride m/w, advice from gp, specialist t/p, restorations, treat sensitivity