Pits and Erosive Tooth Lesions: What Does It Mean?

Through: Jeffrey W. Horowitz, DMD, FAGD, D-ABDSM, D-ASBA

During your time as a dentist, have you ever come across pitting and erosive tooth lesions?

Here’s a case study about my experience with it.

Pits and Erosive Tooth Lesions: Case Study

Patient information:

  • 69-year-old white man presents for dental examination related to tooth wear and minor orthodontic relapse
  • Medical history positive for hypertension, GERD and hypothyroidism
  • Dental/Perio exam negative other than amalgam leakage #7, posterior erosive pitting lesions and loss of lingual enamel 8.9
  • Archform is normal, but a deep bite exists
  • Soft tissue examination positive for oropharyngeal inflammation/oedema

Etiology of tooth structure loss

Dental erosion occurs when acids wear away the enamel on the teeth. Here are some common causes of dental erosion and pitting:

1. Battle of Attrition:

tooth to tooth

2. Wear

Extrinsic etiology; toothbrush, the particle size of toothpaste, abrasive diet, etc.

3. Abfraction

Of physical forces, bending, fracture

4. Erosion

Chemical Structural Degradation

5. Contagious


Many lesions are multifactorial, but which came first?

Non-carious “pitted” or “cupped” lesions on the occlusal and lingual surfaces; Think acid insult from intrinsic source (reflux/bulimia. Undiagnosed apnea is a common source of reflux and exhaustion.

If the structural loss on the occlusal surface does not match the opposing tooth structure (the models do not fit), rule out exhaustion.

Most facial lesions are multifactorial. True abfractions are most commonly seen in functional preterm infants, but exposed dentin is now more susceptible to both erosion (extrinsic and intrinsic sources), wear and potential caries.

Differential diagnosis

Wear: The patient has anterior prematurities, lingually 8.9, but posterior lesions are too well defined to suggest tooth-to-tooth wear. Models do not match.

Wear: Lesions are not likely to be too isolated to be caused by an extrinsic force.

abfraction: None noticed

Erosion: Most likely. No facial lesions indicating intrinsic origin versus diet were noted.

Infection (caries): None noted except #7 amalgam

Pits and Erosive Tooth Lesions: Summary

The patient was confirmed to have sleep apnea after a home sleep study diagnosed by a board-certified sleep physician.

Primary diagnosis: Acid erosion (intrinsic origin) secondary to OSA Primary erosion 8.9 with hyperocclusion secondary to orthodontic treatment accelerating structural degradation.

GERD and Oral pH Controlled by OSA Treating with Oral Appliance and OTC Prilosec.

Anterior occlusion (Hyperocclusion at 8.9) & crowding were corrected with clear aligner therapy.

Recommendation for Ultra Soft toothbrush and low abrasive toothpaste (RDA < 40).

No treatment of lesions because the patient had a low caries risk. Will monitor.

Next one: Scalloped Tongue, What Does It Mean?

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