Dental erosion and erosive tooth wear in childhood and adolescence: from diagnosis to prevention

BACKGROUND: Dental erosion and erosive tooth wear (ETW) are increasingly significant non-carious defects in industrialized countries. Reasons for an increased prevalence are mainly modern dietary habits, but an improved diagnostic awareness also contributes to an apparent increase in cases. Unlike caries, erosion involves acid-induced demineralization without bacterial involvement. When this is combined with mechanical wear, it results in ETW. Diagnosis commonly employs the Basic Erosive Wear Examination (BEWE), a standardized clinical index assessing lesion severity across sextants. ETIOLOGY AND SUSCEPTIBILITY FACTORS: Primary teeth might be more susceptible to ETW due to thinner and less mineralized enamel with lower microhardness, and dentine with a higher carbonate content and higher tubule density. Longer acid exposures increase their demineralization rates compared to permanent teeth. The salivary pellicle offers variable protection, with children's saliva showing distinct composition and efficacy. Key risk factors include frequent consumption of acidic beverages, certain medications, gastroesophageal reflux, and certain behavioral habits. Genetic, salivary, and lifestyle factors further modulate individual susceptibility. PREVENTION: Preventive strategies emphasize risk assessment, dietary modification, and chemical protection using different fluoride-based agents, which form acid-resistant surface layers reducing enamel and dentine solubility. Combinations with chitosan or other polymers may enhance protection. Novel approaches include bio-inspired and film-forming agents, pellicle modification with proteins (e.g., CaneCPI-5), and natural polyphenols that reinforce acid resistance and collagen stability. While laboratory and in situ studies support these strategies, long-term clinical validation remains limited. CONCLUSIONS: Comprehensive management of ETW should integrate early diagnosis, patient education, and multi-modal prevention, particularly targeting children and adolescents, where susceptibility and long-term consequences are greatest.