Tooth cupping describes a specific pattern of damage that occurs on the biting surfaces of teeth. This condition is a recognizable form of dental erosion often diagnosed during routine checkups. Recognizing this wear pattern is important because it signals an ongoing damaging process. Understanding how tooth cupping develops is the first step toward managing the risks it poses to long-term oral health and developing an effective strategy to stop the damage.
Identifying Tooth Cupping
Tooth cupping is characterized by concave, cup-shaped depressions that appear on the chewing surfaces of the back teeth or the biting edges of the front teeth. The unique appearance of the cup-shaped lesion is created by the differential hardness of the tooth layers.
The outer layer, enamel, is the hardest substance in the human body, while the underlying dentin is softer. When the tooth is exposed to acid, the enamel is dissolved, but once the acid reaches the softer dentin, the wear process accelerates. This faster degradation of the dentin leaves the surrounding, more resilient enamel standing higher, creating a ring around the depressed dentin—the characteristic “cupped” look. If left unaddressed, the enamel walls surrounding the cup will eventually collapse, leading to deeper and broader indentations.
The Primary Causes of Cupping
Cupping is a sign of dental erosion, which is the chemical dissolution of tooth tissue by non-bacterial acids. The causes of this acid exposure are generally divided into two main categories: extrinsic and intrinsic sources.
Extrinsic causes involve the frequent introduction of acids from outside the body, primarily through dietary choices. Common culprits include regular consumption of highly acidic beverages like soda, sports drinks, fruit juices, and wine. Even some acidic foods, such as citrus fruits, can contribute to erosion. The problem is compounded by a dry mouth, which reduces the natural, acid-neutralizing effect of saliva.
Intrinsic erosion is caused by acids from within the body, most notably stomach acid. This is commonly linked to chronic conditions like gastroesophageal reflux disease (GERD) or frequent vomiting associated with eating disorders. Stomach acid is potent and can cause significant damage to the enamel, particularly on the inner surfaces of the upper back teeth. Addressing the underlying medical condition is therefore a necessary part of managing this type of acid-related tooth cupping.
Addressing and Repairing Cupped Teeth
Ignoring tooth cupping can lead to serious consequences for oral health. As the dentin becomes exposed and the cups deepen, patients often experience significant tooth sensitivity to hot, cold, or sweet stimuli. In severe cases, continued loss of tooth structure can lead to pulp exposure, requiring procedures like root canals or even tooth loss. The weakened tooth structure also becomes more susceptible to cracks and fractures.
Treatment for cupped teeth is determined by the severity of the damage. For less severe cupping where the dentin is not deeply involved, dental bonding is often used, where a tooth-colored resin is applied to fill the concavity and protect the area from further wear. Teeth with extensive enamel loss may require more substantial restorative work, such as composite fillings, inlays, onlays, or full dental crowns to fully restore the tooth’s shape and function.
Treatment must also include preventing further damage by addressing the underlying cause of the erosion. If the cupping is due to dietary acids, reducing the consumption of acidic drinks and avoiding brushing immediately after consuming acidic foods is recommended. Brushing too soon after an acid attack can scrub away softened enamel, so waiting about 30 minutes allows saliva time to re-harden the surface.
For those with intrinsic acid exposure, managing conditions like GERD with medical intervention is a necessary step to stop the erosion. Dentists often recommend high-fluoride toothpastes or professional fluoride treatments to promote remineralization and strengthen the remaining enamel. Using a straw for acidic drinks to minimize contact and drinking plain water after meals to neutralize acids are effective preventive strategies.