Relationship between enamel erosion and liquid flow rate.

The association of severe erosion with certain habits of consuming soft drinks prompted a study of erosion in relation to fluid flow. In the main experiments, citric acid solution (pH 3.2) was directed at polished enamel surfaces at flow rates of 26, 67 or 126 ml min(-1) through outlets of diameters 1.0, 2.6 or 5.0 mm for up to 20 min. Erosion depth increased with time of exposure and total volume of solution, with increasing flow rate and with decreasing outlet diameter. Scanning electron microscopy of acid-treated surfaces and of the subsurface enamel indicated that the clearance of dissolution products, rather than the mechanical dislodgement of partly dissolved crystal bundles, was the main process involved. For an exposure time of 20 min, erosion increased with (liquid velocity)(1/4). In a secondary experiment, it was found that the erosive potential of a low-erosive drink did not increase with increasing liquid velocity. The rapid increase in the rate of erosion caused by citric acid at low liquid velocities shows that reproducible stirring is essential for precision and intercomparison of in vitro studies. It also accounts for the rapid erosion seen when erosive drinks are consumed from a straw placed labial to the anterior teeth, or are "swished" between the teeth.