Erosive Tooth Wear: Assessment and Prevention Clinical Guide

Erosive tooth wear is cumulative chemical-mechanical loss of dental hard tissue not caused by bacteria. Effective care depends on recognising the pattern early, identifying intrinsic and extrinsic acids, controlling mechanical cofactors and monitoring progression before extensive restorative treatment.

Contents

1. Diagnosis
2. Assessment
3. Pattern table
4. Management
5. FAQs
6. References

Differentiate the wear processes

Tooth wear is often multifactorial. Erosion softens surfaces through intrinsic or extrinsic acid; attrition involves tooth-to-tooth contact; abrasion results from external mechanical action. Cervical lesions should not automatically be labelled “abfraction,” because the evidence for a single occlusal mechanism is uncertain. Record distribution, severity, symptoms, restorations and the patient’s age.

Structured clinical assessment

1. Ask about acidic drinks, sipping habits, sports products, occupational exposure and acidic medicines.
2. Screen sensitively for reflux, vomiting and eating disorders and refer medically when indicated.
3. Assess salivary symptoms, timing of brushing, abrasive products, bruxism and dietary patterns.
4. Dry and inspect all surfaces; record severity with a consistent index such as BEWE where appropriate.
5. Create photographs, study scans or indices that allow longitudinal comparison.
6. Assess sensitivity, pulp status, vertical dimension and functional or aesthetic impact in advanced cases.

Pattern and action table

Cause control before restoration

Reduce the frequency and contact time of acids, avoid holding or swishing acidic drinks, and advise rinsing rather than immediate brushing after an acid challenge. Use a soft brush and suitable low-abrasivity fluoride dentifrice. Manage sensitivity and salivary risk, coordinate care for intrinsic acid sources and monitor change. Restore only when structure, function, comfort or aesthetics justify intervention, using a minimally invasive plan where feasible.