Objectives: Following initial studies on 150 patients (Holbrook et al NOF/CED 1999,abst no.1) a standardised procedure was adopted for examining patients with dental erosion referred for examination and investigation. Subsequently, 249 new patients were examined with the aim of determining the relationship of risk factors to erosion. Methods: Erosion was scored separately for anterior and posterior teeth by one clinician and was graded as severe if it extended into dentine and mild if it was confined to enamel. Data were collected on: consumption of acidic drinks, salivary flow rate, pH, and buffer capacity. Gastro-intestinal investigations included 24-h monitoring of oesophageal pH, oesophageal manometry and gastroscopy. The presence of pathological reflux, hiatus hernia and Helicobacter sp was determined. Results: Severe molar erosion (24 subjects) was significantly associated with at least one of the parameters indicating gastro-oesophageal reflux disease (OR 1.58; p<0.001). Erosion of anterior teeth (severe =72 subjects) was also significantly associated with reflux (OR 1.33; p<0.005). Consumption of >0.5L acidic drink per day indicated a dietary risk for erosion. No association of dietary risk factors and molar erosion was seen but the association was significant for incisor erosion (OR 3.17; p<0.001), especially when severe. Salivary parameters were less clearly associated with erosion except for a low salivary buffer capacity that was associated with severe erosion of the anterior teeth (chi-square=6.57; p<0.05). Conclusions: Tooth erosion is a multifactorial disease affecting anterior and posterior teeth but the known aetiological and protective factors interact in a complex manner, not yet fully understood, to produce the variable distribution and severity of erosion that is seen clinically.

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