Tooth Wear–Erosion page 3-DoctorSpiller.com

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The five major causes of pathologic, non carious tooth wear:n

  • Abrasion:
    • Bruxism
    • Toothpaste Abuse
  • Erosion
    • Regurgitation
    • Soda Swishing (Coke Swishing, Pepsi Swishing, etc.)
    • Fruit Mulling

Erosion page 3–Fruit Mulling

Erosion of tooth structure means the dissolving of hard tooth structures, both enamel and dentin, due to frequent exposure of the teeth to acidic solutions.  There are three major forms of erosive processes in the mouth.  These are Regurgitation of stomach contents into the mouth, Soda Swishing, and Fruit Mulling.  There are other unusual habits that can cause tooth erosion, but they are very patient specific and, taken as separate entities, are fairly rare.

Fruit mulling

Fruit mulling is the habit of “chewing” fruit pulp for prolonged periods before swallowing it.  This habit causes loss of tooth structure due to a combination of erosion from the acidity of the fruit itself, as well as a modified form of abrasion from the constant rubbing together of the teeth over the fruit pulp during the mulling process.

fruit-mulling2

The type of patient who mulls fruit

  • Fruit mullers are generally very health conscious.
  • They are frequently vegetarians.
    • Note: It doesn’t seem fair to deem someone who is health conscious to have a habit harmful to their health, but this is a major diagnostic point when assessing this type of tooth wear!
  • They eat a high proportion of fruit in their diet, and tend to mull (chew) the fruit pulp for a prolonged period before swallowing it in order to savor the taste and feel of the fruit.
  • Due to their health consciousness, they rarely drink sodas or become bulimic.  Thus these habits are almost never seen in combination with fruit mulling.
  • Also due to their health consciousness, these patients are likely to be aggressive tooth brushers, so the patterns of tooth wear seen in fruit mullers are often combined with those seen in toothpaste abuse.

Recognizing a fruit mulling habit

  • The posterior teeth are worn to a greater extent than the anterior teeth.
  • Maxillary and mandibular teeth are worn equally.
    • This is in opposition to soda swishing in which the lower posteriors are worn more than the maxillary teeth.
  • Cupping and cratering are always present and are a major factor in helping to diagnose this disorder.
    • With fruit mulling, the enamel edges surrounding the craters are worn smooth due to the abrasion of the fruit pulp (unless the edges are recently broken).  This is in opposition to soda swishing in which the enamel edges are more prone to be sharp, unless the habit is combined with toothpaste abuse.
  • Silver amalgams may be elevated above the level of the enamel surfaces in which they were placed (see the upper image).
    • This symptom is seen in all forms of erosion as a result of acidic erosion of the enamel surrounding the fillings.
  • Hand articulated plaster models show that wear on the posterior maxillary and mandibular teeth match up perfectly.
  • This habit never occurs in combination with regurgitation or soda swishing.
  • These patients will admit to their fruit mulling habit.

Fruit_Mulling_3

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