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The other areas of her dentition were unaffected and appeared clinically normal. Her general health was good, however she suffered from moderately severe asthma requiring daily use of a number of maintenance medicine. She had a moderate intake of caffeine (140mg/day) from cola soft drinks.

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Her daily water intake was low, and she avoided drinking any sizeable volumes of cold water, since this caused a stomach upset. Careful questioning revealed Emma had suffered for some years from gastro-oesophageal reflux, a condition frequently associated with asthma. She noticed that her reflux was less severe on days when she had no cola soft drinks.

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Emma's saliva test revealed a low resting flow rate and acidic pH, but normal stimulated parameters. The low pH was explained partly by a negative fluid balance (from diuretic effects of the caffeine) and by the hyposalivatory effects of her medications. She was advised to eliminate cola soft drinks, since caffeine stimulates gastric acid production and could exacerbate gastric reflux.

Emma was also advised to drink warm water slowly, to minimise the stimulation of gastric acid secretion caused by stomach distension. She was referred to her medical practitioner who considered the value of using a H-2 receptor antagonist medication to suppress gastric acid production. Emma was advised to apply Tooth Mousse directly onto the eroded palatal surfaces and rapidly obtained relief from sensitivity. After 2 weeks, the eroded dentine was covered with a thin layer of sealant for further protection.


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