Identifying enamel erosion using intra-oral scanning

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Identifying and communicating enamel erosion to patients using intra-oral scanning

Dr Elaine Halley is a past president of the British Academy of Cosmetic Dentistry and an accredited member of the International College of Dentists. (Image: Elaine Halley)
Align Technology

Align Technology

Fri. 19. January 2024


Gastro-oesophageal reflux disease (GORD) and its potential effects on tooth enamel was the subject of a recent Align Technology webinar. It was presented by UK dentist Dr Elaine Halley and Dr Nick Boyle, a specialist surgeon who heads one of the UK’s largest and most experienced practices in the treatment of benign gastro-oesophageal disease. The webinar is available on demand.

The presentation offers dental practitioners detailed insights into the causes and symptoms of GORD, how it is diagnosed and treated and how intra-oral scanners and a digital workflow can help to identify and monitor tooth surface loss. In addition, it discussed the role of dentists in managing patients with signs and symptoms of tooth surface loss.

As Dr Halley is seeing patients in her practice with tooth erosion more and more frequently, she was eager to understand the correct workflows for treating them. She said: “Typically, we think of tooth surface loss in four groups. There is erosion or acid erosion, dissolution of the tooth structure; attrition, where teeth wear together or wear against an object; abrasion with toothbrush overuse; and abfraction, where we maybe have some occlusal stresses on the teeth and breakdown at the cervical margin.”

“When we notice surface loss, we need to ask ourselves a number of questions. Is the tooth surface loss across all of the teeth? Is it more on the front teeth? Is it just on certain surfaces of the back teeth? Is it on one arch or both arches? And is it appropriate for the age of the patient?” she continued.

She stressed that tooth surface loss can often be the result of more than one factor, including diet, tooth grinding, jaw clenching or medications, all of which need to be discussed with the patient.

Digital tools boost both condition tracking and patient communication

According to Dr Halley, digital tools such as the iTero intra-oral scanner can be instrumental in both identifying tooth loss and pinpointing where it is most prevalent. “Being able to scan every patient at regular intervals depending on their risk assessment from a diagnostic point of view, not just as an impressions replacement, allows us to demonstrate to the patient what’s going on in their mouth.”

“Using the iTero scanner, we can identify early tooth surface loss and use tools such as near-infra-red imaging technology for interproximal caries aid detection and TimeLapse functionality to overlay one scan with another to assess the amount of destruction of the tooth,” she said.

Dr Boyle stressed the value of information sharing in an age where medical practitioners tend “to work in silos”. He explained that research shows that between 10% and 20% of adults will suffer from reflux symptoms on a regular basis. About 3% of all primary care consultations will be for reflux-type symptoms, and at least half of those will be people going back at least for the second time. “It’s a chronic, persistent and difficult-to-treat problem,” he said.

The link between enamel decay and reflux

In the webinar, Dr Boyle offered a thorough explanation of GORD, which he emphasised does not include the word “acid” because reflux from the stomach into the oesophagus, lungs, mouth and throat can contain many substances, including powerful enzymes, such as pepsin and trypsin, bile and acid, all of which can damage both hard and soft tissue.

He added that, aside from physical causes of reflux—such as failure of the lower oesophageal sphincter—lifestyle choices, including drinking alcohol, eating processed foods and eating late at night, can exacerbate reflux. There are a range of treatments, he explained, including medical interventions to fix physical issues and prescription and over-the-counter medications. These factors make it important for differing medical expertise to be involved in diagnosis and treatment, he said.

In addition, he pointed to a study that reported a significant association between GORD and damage to tooth enamel. “On the basis of this study, there is a significantly increased chance that if you’ve got reflux, you’re going to have enamel tooth damage,” he said.

In terms of what dentists can do in everyday practice to identify patients whose teeth are at risk from reflux, Dr Boyle said that if they suspect someone has ongoing dental enamel problems as a result of reflux—including laryngopharyngeal reflux—they should refer them to their general practitioner to be evaluated.

Concluding the presentation, Dr Halley underlined how many areas of physical health are interrelated. “Intra-oral scanners can be a useful tool to highlight areas of concern in communications with medical partners and patients alike.”

The webinar, titled “Digital diagnostics, erosion and reflux”, can be watched here.

More information about the iTero digital scanner and Align Technology’s digital workflow can be found at

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