Restorative & Materials · patient case question
Erosion confined to the lingual surfaces of the maxillary teeth is most suggestive of:
Patient case: Wear, erosion and a burning mouth
demo: 31-year-old female
chief: Sensitive front teeth that look increasingly thin, and occasional pain that comes and goes.
history: She drinks four cans of soda daily and has a history she is reluctant to discuss regarding eating patterns. She is otherwise well.
meds: None.
findings: Marked erosion of the lingual surfaces of the maxillary teeth with intact buccal surfaces. Smooth, shiny, saucer-shaped cervical lesions on the buccal aspects of several premolars. Parotid regions appear full bilaterally.
Show answer and explanation
Correct answer: D. Intrinsic acid exposure from regurgitation
- A. Attrition from parafunction produces flat, matched wear facets on occluding surfaces, not smooth loss of the palatal enamel.
- B. Dietary acid tends to affect labial and occlusal surfaces first, following the path the drink takes through the mouth.
- C. Abrasion from brushing affects buccal and cervical surfaces, precisely where the brush reaches, not the palatal surfaces.
- D. Correct. This pattern, called perimylolysis, follows repeated exposure to gastric acid, whether from self-induced vomiting or from gastro-oesophageal reflux. The tongue directs the refluxate against the palatal surfaces of the upper teeth while shielding the lower ones, which is why the distribution is so distinctive. Approach the conversation with care and coordinate with medical and psychological support.
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