Some erosive patterns are head scratchers. How does erosion occur in just one part of the mouth? With some bulimic patients, there is more wear on one side of the mouth because they turn their head to one side when they regurgitate. When there is no erosion on the palatal surfaces of the anterior teeth and heavy erosion on the occlusal and facial surfaces there are other causes of wear to be considered. One is “Coke swishing." This is actually the swishing of any highly acidic soft drink, including carbonated sports drinks and energy drinks. There are some individuals who simply don’t like the sensation of the bubbles when they swallow and they will swish the soft drink around their mouth prior to swallowing. If they hold the liquid on one side, the wear will be greater on that side. These individuals will also show erosive, satiny lesions on the facial surfaces of some teeth. Notice the wear in places where opposing teeth can’t touch. This patient “swished” 12 cans of Diet Coke every day. The key to this wear is not quantity, rather frequency of exposure, that is titratablilty of the low pH liquid. There is also the risk of high rates of caries if the liquid is not sugar free.