Prevention is better than cure

Dental erosion is an irreversible condition that affects a growing number of people, particularly children and adolescents. In a new PhD dissertation by Julie Marie Haabeth Brox she shows how early dental erosion develops, and here she explains why prevention, advocacy and dissemination of knowledge are a public health responsibility.

Julie Marie Haabeth Brox was recently awarded a PhD with the dissertation “Dental erosion: Onset, Progression, and Prevention Strategies in a Mouse Model” at the Institute of Oral Biology, Faculty of Dentistry, University of Oslo.

In her dissertation, Brox investigated how dental erosion develops, how quickly damage occurs, and how preventive strategies can reduce long-term consequences.

Part of her research was carried out in collaboration with NIOM, where advanced analytical methods were used to study changes in tooth structure at a microscopic level.

A growing public health challenge

Dental erosion is defined as an irreversible loss of hard dental tissue caused by chemical processes not involving bacteria. It is commonly linked to frequent consumption of acidic food and beverages such as soft drinks, juice and energy drinks. Brox explains:

“In Norway, between 38 and 59 per cent of adolescents aged 16–18 show signs of dental erosion. At the same time, consumption of energy drinks has increased markedly among young people. The condition can lead to pain, increased sensitivity, reduced chewing function and aesthetic challenges – and represents a significant cost to both individuals and the healthcare system.”

“For me, this is clearly a public health issue,” Brox says. “We do not have a good curative treatment for dental erosion. Once the damage is done, it is permanent. That means prevention is not just important – it is essential.”

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Three studies with one clear message

The dissertation consists of three experimental studies using an established mouse model, combined with detailed analyses of tooth surfaces using scanning electron microscopy.

The first study examined how quickly dental erosion develops. The results showed accelerated loss of enamel after only two weeks of exposure to acidic beverages.

“This tells us that erosion can start very early,” Brox explains. “If we want preventive measures to be effective, they have to be implemented at an early stage.”

The second study investigated the protective effect of different fluoride compounds. The findings demonstrated that metal fluorides provided better protection against erosion than traditional fluoride compounds. Microscopic analyses revealed that these compounds formed a protective coating on the tooth surface.

In the third study, two commercially available fluoride products were compared. A silver fluoride solution provided better protection against erosion than a standard fluoride varnish and also showed potential benefits in reducing dental hypersensitivity.

Research collaboration with NIOM

Parts of the experimental work were carried out at NIOM, where Brox collaborated with engineers and researchers and used advanced instrumentation, including scanning electron microscopy, to study changes in tooth structure in detail.

In addition to Amer Sehic and Qalbi Khan - her main supervisor – from the Institute of Oral Biology, Faculty of Dentistry, University of Oslo, two of her supervisors during the PhD project were Professor and Senior Scientist Aida Mulic and Scientist Amela Tulek from NIOM.

“The collaboration with NIOM gave me access to expertise and infrastructure that were crucial for this work,” Brox says. “It allowed us to visualise erosion processes and protective effects in a way that really strengthens the scientific conclusions.”

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Researchers have a great responsibility to communicate findings and results

For Brox, publishing scientific results is only part of the job. She believes researchers and health professionals have a responsibility to actively communicate their findings and contribute to preventive efforts.

“I think researchers need to play a more active role in advocacy and dissemination,” she says. “If we have solid knowledge about preventable harm, we have an obligation to make sure that knowledge reaches decision-makers, health professionals and the public.”

She points to measures such as clearer public information, preventive efforts in schools and stronger awareness of the risks associated with frequent consumption of acidic drinks.

“Prevention works,” Brox says.

“But it requires knowledge, early action and the willingness to use research as a basis for policy and practice.”

The results of Brox’s PhD project underline the importance of early detection and preventive strategies to reduce the long-term consequences of dental erosion. While further research is needed, the message is clear: once erosion occurs, the damage cannot be reversed.

As Brox puts it: prevention is better than cure, not just as a principle, but as a necessity for public oral health.