I appreciate this opportunity to respond to Dr. John Rhicard’s comments regarding my article.
Now, I agree that "corrosion" is the more accurate description of the acid effect of wine on tooth structure. I used the term "erosion" in my article in accordance with a July 2004 JADA article, "Tooth Erosion Caused by Chewing Aspirin,"1 and previous authors’ usage of the term in their articles.2–8 However, these definitions have only just been clarified by Dr. Grippo and colleagues in an August 2004 JADA article.9 Those authors stated, "The term ‘erosion’ should be deleted from the dental lexicon and supplanted by ‘corrosion’ to denote chemical dissolution of teeth." Mea culpa, Dr. Rhicard; "corrosion" is the way to go.
I disagree with Dr. Rhicard’s thought that there was adequate saliva to dilute the wine residue and prevent corrosion. My article emphasized the fact that, for 34 years, the patient sipped wine after supper over a three-hour period, when an augmented salivary flow from a food stimulus was absent. The patient’s ability to buffer the acid wine with her normal but diminished resting salivary flow, which was sufficient to moisten the mucosa, was overwhelmed by the prolonged tooth-acid wine contact.
As specified in my article, the problem has been reported among such diverse groups as wine tasters, workers exposed to acidic fumes and those who misuse fruit juices, carbonated soft drinks, aspirin or vitamin C. Regardless of the cause, these patients will demonstrate a moist mucosa from a normal salivary production.
Although the figure legends did not mention buccal and lingual enamel loss, it existed, was evident clinically and was so stated in the text. Close scrutiny of the illustrations will reveal its presence on many teeth. Regarding Dr. Rhicard’s comment about a normal-appearing tooth no. 3, an unusual enamel loss (cupping) was evident clinically on this tooth. Its pattern was similar to that illustrated for tooth no. 14. I used poetic license and cropped the picture to highlight teeth nos. 4, 6 and 7.
Bruxing, as suggested by Dr. Rhicard, was definitely not a factor in my patient. The patient repeatedly denied its existence. The associated objective signs of bruxing include masseteric hypertrophy, faceted occlusal surfaces and bone alterations in the gonial angle area, and these were absent.10–13 The illustrations clearly substantiate the absence of facets with their sharply defined line angles and characteristic broad flat dental occlusal tables.
Instead, the cupping characteristic of corrosion is evident in Figure 2, and resulted from point contact with the cusps of the mandibular teeth. 6,7,14 Bruxing would not cause such a pattern; its dental surface effect is more extensive. With the mechanical action of bruxing, restorations tend to wear at the same rate as adjacent tooth structure.14 Not so in my patient, in whom chemical corrosion caused loss of tooth structure, resulting in an apparent elevation of amalgam, which is illustrated clearly in Figure 3.
I am unaware of any relation between postorthodontic care and bruxing, as stated by Dr. Rhicard. Is there a documented reference or is this anecdotal? Additionally, although alcoholics can be insomniacs, my patient did not suffer from a sleep disturbance. Again, I am not aware of any statistically significant report that relates sleep problems to bruxing.
Because terminology is now a legitimate issue of concern, Dr. Rhicard’s statement that "the patient shows classic abrasion and abfractive patterns of an aggressive, long-term bruxer" does not mesh with Grippo and colleagues’9 definition that "such a synergistic tooth-destructive effect may be observed cervically when toothbrushing abrasion exacerbates abfraction to produce wedge-shaped lesions." These lesions were not seen in my patient.
The term "attrition-abfraction" would seem to best describe the aggressive, long-term bruxer’s problem. My patient exemplified attrition-corrosion, which is the "loss of tooth substance due to action of a corrodent in areas in which tooth-to-tooth wear occur."9 Undoubtedly, wine corrosion assisted by toothbrush abrasion and abfraction were factors in the buccocervical enamel loss observed in my patient.
In summary, my chance to respond to Dr. Rhicard’s comments is appreciated. The interchange of thoughts can only serve to advance academic knowledge. We all benefit.
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