DENTAL HARD TISSUE DESTRUCTION 117 



the application of acid solutions, had been thoroughly cleaned were 

 much more susceptible to the acid action than teeth which were not 

 first cleaned, but had retained some organic films on the surfaces. 



General Constitution 



In addition to the more obvious suspicion of oral environmental 

 factors, there has appeared in the literature considerable specu- 

 lation regarding other potential etiological influences on dental 

 erosion. These range from general systemic conditions to local pe- 

 culiarities within the mouth and teeth themselves. 



A number of descriptive terms have been used to characterize 

 the type of patient susceptible to erosion, such as the "neurasthenic" 

 patient, the "live-wire-type," the "better class," etc. The late Dr. 

 Bunting (cited by Hill, 1949) associated the development of these 

 lesions with nei'vous strain and thought the condition became ar- 

 rested with improvement in general health. Before the turn of the 

 century dental erosion was related to a general systemic condition 

 which was classified as "gouty diathesis" ( Darby, 1892 ) ; the dental 

 erosion patients were described as "neurasthenic" (Kirk, 1887). 

 Others have seen a tendency to alcoholism among their dental ero- 

 sion patients, but whether or not this might have been merely 

 secondary to a more basic nervous condition may perhaps have been 

 hard to tell in such cases. Yet it would be unwise to discard the 

 potential significance of such long-standing clinical impressions. 

 In an effort to bring the sequence of events within the framework 

 of some logical relationship to the oral environment, one may per- 

 haps consider four possible chain reactions that could bridge the 

 dental and general state of health: (1) an indirect systemic effect 

 on salivary secretion; (2) formation of oral debris of endogenous 

 origin similar to what may be found in general fever conditions; 

 (3) changes in the nature and habits of eating, drinking, and oral 

 hygiene; (4) a relationship to masticatory function which could 

 alter both the oral environment and the teeth themselves. 



Clinical Management 



At present the rationale for management of dental erosion can be 

 discussed only on highly theoretical and tentative grounds. For this 



