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Albert suffered from obstructive sleep apnea and has been using a continuous positive airways pressure (CPAP) mask at night as part of the management of this condition.

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A clinical exam revealed a loss of tooth structure, with over closing as well as forward posturing of the mandible to gain occlusal contact between the anterior teeth. Testing of the saliva indicated an acidic resting salivary pH as well as when stimulated, and a slightly depressed salivary buffer capacity.

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A lifestyle analysis revealed that Albert had a high intake of both caffeine (400mg/day) and alcohol (5 standard drinks per day), but he drank little water. The diuretic effect of these two agents was substantial in his case, and added to the dehydrating influence of the CPAP therapy. Albert was recently diagnosed with insulin-dependant (Type 2) diabetes mellitus, which may have exerted an additional negative effect on his fluid balance.

The low flow, pH and buffer parameters contributed directly to his current complaint of tooth wear through softening of the remaining tooth structure.

Albert's dental management included lifestyle modifications, to increase water intake and reduce his consumption of caffeine and alcohol. He was then placed on a remineralisation program using GC Tooth Mousse Plus for 4 weeks, after which time his salivary parameters were re-checked and found to be normal. He then underwent rehabilitation of his occlusion.


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