Dental Erosion in Table Tennis Players: Causes, Signs, and How to Stop It

Dental erosion sits in a strange category among athlete health issues: common enough to be documented in multiple sports-medicine surveys, serious enough to eventually require expensive restorative work, and quiet enough that most players are entirely unaware of it until a dentist points at the characteristic flat, polished surfaces and says, matter-of-factly, that the enamel has been dissolving for some time. There is no dramatic onset. There is no injury to remember. There is just the accumulation, over months and years, of acid being applied to mineral — and the mineral slowly losing the contest.

For table tennis players, the risk is real and worth understanding. The combination of long training sessions, steady acidic-drink consumption, exercise-induced dry mouth, and jaw clenching on acid-softened enamel produces a compound exposure that many players carry without knowing. This guide explains how erosion works, why the table tennis exposure pattern matters, what dentists look for, and what genuinely prevents it.

The chemistry of erosion, simply stated

Tooth enamel is the hardest biological material the human body makes — a tightly crystalline matrix of calcium and phosphate, organised into hydroxyapatite rods. It is not, however, acid-resistant. When acid contacts enamel, hydrogen ions attack the calcium phosphate crystal structure, releasing calcium and phosphate into the oral fluid and dissolving the surface mineral. The process is reversible at low acid exposures: saliva delivers calcium and phosphate back to the enamel surface and, assisted by fluoride, rebuilds the crystal structure in what dentists call remineralisation. The problem arises when the acid challenge outpaces the remineralisation capacity — when the enamel loses more mineral than saliva and fluoride can replace.

The critical pH threshold is around 5.5. Above that, enamel dissolution is negligible and remineralisation can keep pace. Below it — and most sports drinks sit between pH 3.0 and 4.5 — enamel softens and mineral is released from the surface. The softened surface layer is then vulnerable: if an abrasive force (a toothbrush, a grinding jaw, even just the tongue) acts on it before remineralisation occurs, it carries mineral away that cannot be recovered. The window of softening after a single pH-3.5 exposure lasts around 20–30 minutes. Consume an acidic drink every ten minutes across a two-hour session and the enamel is effectively never in the remineralisation window at all.

Table tennis: the triple-exposure pattern

Not all sports carry the same erosion risk profile. Swimming pools expose athletes to chlorinated water, which can be erosive at high dose; cyclists drink acidic energy gels and ride for six hours; footballers drink sports drinks but sessions are shorter. Table tennis lands in its own specific risk category because three exposures tend to occur simultaneously and reinforce each other:

• Long sessions with sustained acidic-drink use. Serious training sessions regularly run two to four hours, with the conventional sports-nutrition advice to sip steadily throughout. This produces the extended, near-continuous acid exposure that is exactly the condition under which remineralisation cannot keep pace. The enamel spends most of the session in the softened, vulnerable state.
• Exercise-induced dry mouth. As session intensity rises, breathing switches increasingly to the oral route, and saliva evaporates faster than the parotid glands can replenish it. Saliva is the buffering system: it neutralises acid, and it is the delivery vehicle for the calcium and phosphate that drive remineralisation. Reduced saliva means reduced buffering and reduced remineralisation capacity, at exactly the time when acid exposure is highest. The mouth becomes a less defended environment.
• Jaw clenching on acid-softened enamel. As described separately in this section, table tennis players clench their jaws under the pressure of intense play. A jaw that clenches or grinds against a tooth with a softened, partially demineralised surface layer removes mineral much more efficiently than the same force applied to fully mineralised enamel. The acid primes the surface for mechanical damage; the clench then acts on a material that is already compromised.

Each of these exposures would individually produce measurable erosion risk over years. All three together, running in the same sessions for the same hours per week, produce an erosion exposure that is considerably greater than any simple sum of the parts.

How dentists measure and track it: the BEWE

The Basic Erosive Wear Examination (BEWE) is the standard clinical tool for quantifying and tracking dental erosion. It is straightforward: the dentist examines each sextant of the mouth and assigns the worst-affected tooth in that sextant a score from 0 to 3.

• Score 0: No erosion detected.
• Score 1: Initial surface change — a slight loss of enamel texture, no significant depth.
• Score 2: Hard tissue loss less than 50% of the tooth surface area — visible erosion, starting to affect the shape of the tooth.
• Score 3: Hard tissue loss affecting 50% or more of the surface — clinically significant erosion that changes the bite, produces sensitivity, or requires restorative intervention.

The six sextant scores are summed to produce a cumulative BEWE. A healthy adult with low acid exposure should score 0 across all sextants, giving a total of 0. A total BEWE of 3–8 warrants dietary counselling and enhanced fluoride use; 9–13 requires active preventive management with 3-monthly recalls; above 14, restorative treatment may be needed to prevent further structural compromise.

In surveys of athlete populations, BEWE scores significantly above those of age-matched controls are the norm rather than the exception. One systematic review of erosion in athletes found mean BEWE scores two to three times higher in regular sports-drink users than in matched non-athletes. The scores are skewed to the posterior teeth (where clenching adds to the acid damage) and to the upper anterior palatal surfaces (where acidic liquid pools briefly after each sip). The pattern is specific and recognisable.

What erosion looks like in practice

A few specific findings are worth knowing, because once you understand what you are looking at, the signs become visible in photographs, mirrors, and the feel of your own teeth:

• The biting surfaces of back teeth look flatter and smoother than they naturally should. The small cusps and ridges that define a healthy molar are worn level. The biting face has a polished, glassy appearance.
• The upper front teeth may show a broad, smooth, slightly concave dish on the palatal surface — the side facing the tongue. This is particularly associated with sustained acidic-liquid exposure because the upper front teeth contact the fluid on each sip.
• Teeth may look slightly shorter over time. When significant enamel is lost, the teeth can appear younger relatives of what they were — the visible crown is genuinely shorter because the biting edge has dissolved.
• Fillings may appear to "stand proud" — to sit slightly above the surrounding tooth surface, as if the restoration has risen. In fact, the enamel around the filling has dissolved; the restoration, which does not dissolve, is now elevated relative to its surroundings.
• Cold sensitivity: as enamel thins, the temperature-sensitive dentine beneath becomes closer to the surface, and exposure to cold food, drinks, or air begins to register as a sharp, brief pain. This is often the first symptom athletes actually notice — and by the time sensitivity sets in, several years of detectable erosion have usually already occurred.

Prevention: what the evidence supports

Prevention of dental erosion, once understood, is not complicated. It reduces to managing how long the enamel spends below pH 5.5 and ensuring the remineralisation system (saliva and fluoride) can work between acid exposures. The habits that accomplish this are the same ones that appear in sports dentistry guidelines across multiple countries:

1. Drink from a sports bottle or straw. This concentrates acidic liquid at the back of the throat rather than bathing the anterior and palatal surfaces of all teeth on each sip. The absolute acid dose entering the mouth is the same; the contact time with the teeth most vulnerable to erosion is significantly shorter.
2. Rinse with plain water after each sports drink. A 10-second rinse immediately after finishing a serving of isotonic or acidic drink dilutes residual acid and helps saliva return the oral pH to the safe zone faster. It is a negligible time cost and measurably reduces the length of the acid exposure window.
3. Do not brush within 30 minutes of acidic exposure. This is the counterintuitive one, but the mechanism is clear: enamel softened by acid is vulnerable to abrasion, and a toothbrush applied to a softened surface is an abrasive tool working against a compromised material. The 30-minute wait allows remineralisation to harden the surface again. Brushing before acidic exposure, or waiting until the window has closed, is the protective strategy.
4. Use a fluoride toothpaste, twice daily, consistently. Fluoride drives the formation of fluorapatite in remineralised enamel — a crystal structure harder and more acid-resistant than the original hydroxyapatite. It does not prevent erosion, but it reduces the rate at which each acid exposure damages the surface. Consistent twice-daily use over months and years produces a meaningfully more resilient enamel surface.
5. Alternate acidic drinks with plain water. One or two bottles of plain water per session is not a nutritional compromise for most training contexts; it is simply reducing the total acid load across the session. The carbohydrate that a sports drink provides is valuable when the session demands it — at one-hour-plus of high intensity, after the initial glycogen is depleted. It is not necessary for the warm-up, the cool-down, or the lower-intensity skill phases. Targeting sports drink to the periods when it matters nutritionally and using water at other times is a straightforward way to cut total acid exposure without any loss of performance benefit.
6. Ask for BEWE at every routine visit. A dentist who records and shares your BEWE score at each visit gives you a tracked longitudinal measurement that tells you whether the habits are working. Erosion that stays at BEWE 0–1 across five years is successfully managed. Erosion that progresses from BEWE 1 to BEWE 2 in two years signals that the current habits are not adequate and something needs to change. It is the simplest outcome metric available for this particular risk, and it is free at every routine appointment — you only have to ask.

When prevention is not enough: what treatment looks like

For players who are already showing BEWE scores of 2 or above — who have been competing and training for years without this information — the goal shifts from pure prevention to prevention-plus-monitoring, possibly with some restorative work. The approach depends on severity.

Mild erosion (BEWE 1–2, limited to a few surfaces) is typically managed with intensive prevention: fluoride varnish applications at the dental practice every three to four months, a prescription-strength fluoride toothpaste, dietary review, and perhaps a custom-fitted mouthguard for sleep bruxism if the mechanical component is significant. No drilling, no restorations — just arresting the progression and allowing remineralisation to make the surface as resistant as possible.

Moderate erosion (BEWE 2–3, affecting the biting surface dimension or producing sensitivity) may require composite resin build-ups on the most affected teeth to restore the lost structure and protect the exposed dentine. This is reversible and conservative — composite can be layered on and adjusted without removing tooth structure. Severe erosion, where significant vertical dimension has been lost, is a more significant restoration requiring crowns or full-arch treatment. This is expensive and time-intensive — several months of treatment, multiple appointments, real cost. It is exactly the outcome that routine monitoring and early habits are designed to prevent.

The simple version

Dental erosion in table tennis players is common, driven by well-understood chemistry, detectable before it produces symptoms, and highly preventable at essentially no cost or performance compromise. The habits are unglamorous — use a bottle, rinse with water, wait before brushing, use fluoride toothpaste, let your dentist track the BEWE — but they are effective, and the alternative is paying a very large restorative dentistry bill years from now for a process that could have been stopped much earlier.

Enamel, once lost, is gone. A career in table tennis does not require losing it.

Part of our series on how the demands of competitive table tennis show up in players' long-term health off the table.

Frequently asked questions

What is dental erosion and how is it different from cavities?

Dental erosion is the loss of tooth enamel caused by acid chemically dissolving the mineral surface of the tooth. No bacteria are involved — it is a direct acid-mineral reaction. Cavities (dental caries) are caused by bacteria that metabolise sugar and produce acid locally in a patch of plaque attached to the tooth. Erosion tends to produce a smooth, broad, polished-looking surface loss across whole tooth faces; cavities produce localised holes, usually brown or dark, in grooves and around fillings. An athlete who drinks acidic sports drinks has an erosion risk; an athlete who eats a lot of sugar and has poor plaque control has a caries risk — many athletes have both.

What are the signs of dental erosion?

Early erosion produces no symptoms at all, which is why most athletes are unaware of it until a dentist finds it. The signs a dentist looks for are: a smooth, glassy, slightly concave surface on the biting faces of back teeth; a broad, shallow concavity on the palatal (tongue-facing) surface of upper front teeth; teeth that appear slightly shorter than normal; and in later stages, new or worsening sensitivity to cold drinks, cold air, or sweet foods as the enamel thins toward the dentine. The patient-noticeable symptoms — sensitivity, food feel different, teeth look different — typically arrive years after the erosion has been established.

What is a BEWE score?

The Basic Erosive Wear Examination (BEWE) is a clinical scoring system dentists use to grade and track erosion. Each sextant of the mouth (six sections) gets a score from 0 (no erosion) to 3 (hard tissue loss affecting more than 50% of the tooth surface). The scores are summed to give a cumulative BEWE that guides treatment: a total score under 2 needs no active treatment; scores of 3–8 suggest monitoring and dietary counselling; scores of 9 and above indicate active management with preventive measures; very high scores warrant restoration to prevent further loss. Ask your dentist to record and share your BEWE score at each visit so you can track it over time.

Can you reverse dental erosion?

Once enamel has been lost to erosion, it cannot regenerate — enamel is not living tissue and the cells that made it no longer exist after teeth erupt. What can be reversed is the process: stopping the acid exposure stops further erosion. In mild cases, improved remineralisation through fluoride use can partially harden and protect the eroded surface. In significant cases, eroded teeth may need composite resin bonding or crowns to restore the lost structure. Prevention is therefore genuinely worth far more than treatment — fixing erosion is expensive and time-consuming; preventing it is cheap.

Do all athletes get dental erosion from sports drinks?

Not all athletes, but athletes as a group show measurably higher rates of erosion than the general population, and the effect is strongest in sports with long sessions and frequent acidic-drink use. Several large surveys find erosion prevalence of 30–75% in athlete populations, compared to 8–20% in age-matched general adults. The risk is real but manageable: the protective habits — using a bottle, rinsing with water, waiting before brushing, consistent fluoride toothpaste — genuinely reduce exposure, and athletes who adopt them early in their careers arrive at a very different enamel status twenty years later than those who do not.