After reading Dr. Louis Mandel’s January JADA article, "Dental Erosion Due to Wine Consumption," I feel compelled to comment. First, the use of the term "erosion" in the title and article is misleading. Erosion is the loss of solid matter due to the mechanical action of fluids. A more accurate term for this kind of process is "corrosion" from extrinsic sources, which distinguishes it from caries, which is corrosion from intrinsic (plaque) sources.
Also, given the fact that the "mucosa appeared normally moist," a sufficient salivary flow was present to substantially dilute what little wine residue that may have remained on the patient’s teeth. The amalgam restorations in the photos appear untouched, but a corrosive bath of pH 3 to 3.8 should have attacked the metal.
The wear patterns visible show extreme loss of occlusal enamel, but only Figure 2 (maxillary left side) shows some of the facial surfaces, which appear to be less involved. Wouldn’t it be that a corrosive liquid would damage the facial and lingual surfaces more readily than the occlusal surfaces? Figure 1 (maxillary right side) shows the mesial of tooth no. 3, and it looks undamaged. In conclusion, though the wine consumption is twice the American Heart Association’s recommended daily amount, it doesn’t explain the obvious damage.
The patient shows classic abrasion and abfractive patterns of an aggressive, long-term bruxer. She has a disturbed sleep pattern (excessive EtOH, or alcohol, consumption), and she is a postorthodontic patient, which usually leads to bruxing. Although the author stated that "the patient was not a bruxer," I would be surprised to find that centric occlusion coincides with centric relation, that she had no centric prematurities, that there were no abfractions, that she had no working and balancing contacts and that there was no facial recession. The photos show gingival festooning and rolled, raised margins. The author noted that "irregular enamel loss was most advanced on the occlusal aspects of the premolars and molars, where masticatory contact was pronounced."
In short, the available information points to bruxing as a primary cause, with the acidic wine as a possible secondary factor. This would only be an interesting diagnostic difference of opinion if the patient didn’t require major restorative services. Any restorations placed on those posterior teeth without first addressing the bruxism are in harm’s way, and will fail prematurely.
