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
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
- Ask about acidic drinks, sipping habits, sports products, occupational exposure and acidic medicines.
- Screen sensitively for reflux, vomiting and eating disorders and refer medically when indicated.
- Assess salivary symptoms, timing of brushing, abrasive products, bruxism and dietary patterns.
- Dry and inspect all surfaces; record severity with a consistent index such as BEWE where appropriate.
- Create photographs, study scans or indices that allow longitudinal comparison.
- Assess sensitivity, pulp status, vertical dimension and functional or aesthetic impact in advanced cases.
Pattern and action table
| Finding | Possible contributor | Clinical response |
|---|---|---|
| Palatal maxillary erosion | Intrinsic gastric acid may contribute | Explore reflux or vomiting history sensitively |
| Labial or occlusal cupping | Dietary acid with mechanical wear | Review frequency and timing of exposures |
| Local cervical notch | Mixed abrasion, erosion and stress factors | Avoid single-cause assumptions |
| Increasing wear score or sensitivity | Active progression | Intensify cause control and reassess |
| Stable mild wear | Controlled condition | Monitor with preventive support |
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.
Related DentalReach reading
- soft-drink formulation and erosion
- bonding in non-carious cervical lesions
- toothpaste for dentine sensitivity
Frequently asked questions
Is erosive tooth wear the same as caries?
No. Erosion is non-bacterial chemical-mechanical surface loss; caries is a biofilm-mediated disease.
Should patients brush immediately after an acidic drink?
Generally advise rinsing and avoiding brushing immediately around an acid challenge while addressing the exposure itself.
Does every worn tooth need restoration?
No. Stable mild wear may be monitored; restoration depends on progression, symptoms, structure, function and aesthetics.