Tooth erosion: the damage you don't notice

Tooth wear is one of the most underdiagnosed conditions in dentistry. Unlike a cavity, which progresses in one spot, wear affects multiple teeth simultaneously and progresses so gradually that neither the patient nor, in many cases, the dentist notices until the damage is significant.

Quick answer

Tooth wear results from the interaction of three mechanisms: erosion (acid), attrition (tooth-on-tooth grinding), and abrasion (mechanical wear from brushing or habits) ^[3]. The European consensus on severe tooth wear recommends early monitoring, prevention of further wear, and minimal-intervention restorative approaches when treatment is needed ^[1]. Acid reflux and dietary acids are major drivers, and the prevalence in risk groups is substantial ^[4].

The three types of wear, and why they interact

Shellis and Addy's work explained how erosion, attrition, and abrasion rarely act in isolation ^[3]. Erosive acids from diet or reflux soften the enamel surface, making it more vulnerable to mechanical wear from grinding and brushing. A patient who both grinds and drinks acidic beverages suffers accelerated wear that neither factor would cause alone. Understanding which mechanisms are at play determines the management strategy.

How we measure it

The Basic Erosive Wear Examination (BEWE) provides a standardised, simple scoring system for quantifying tooth wear in clinical practice ^[2]. It examines each sextant of the mouth and assigns a cumulative score that guides the urgency of intervention, from monitoring alone to active restorative treatment.

The acid reflux connection

Dallavilla and colleagues' systematic review of erosive tooth wear in risk groups found substantially elevated prevalence in patients with gastroesophageal reflux disease (GERD) ^[4]. Lechien and colleagues confirmed the association between laryngopharyngeal reflux and dental erosion ^[5]. Many patients with reflux-related erosion are unaware that their stomach acid is damaging their teeth, particularly the palatal surfaces of upper teeth, which are bathed in refluxed acid during sleep.

When and how to treat

The European consensus statement established clear guidelines: prevent further wear first, then restore only when function or aesthetics is compromised ^[1]. When restorative treatment is needed, the evidence supports direct composite resin as a conservative first-line approach. Vajani and colleagues' systematic review found that direct composite restorations for managing tooth wear have good short- to medium-term clinical outcomes ^[6].

The key principle is additive rather than subtractive: building up what has been lost with bonded material, rather than grinding down more tooth structure for a crown.

Frequently asked questions

What causes tooth erosion?

Dietary acids (citrus, vinegar, carbonated drinks), gastric acid from reflux, and some medications. The frequency of acid exposure matters more than the amount.

Can worn teeth grow back?

No. Lost enamel does not regenerate. But the damage can be arrested and the tooth rebuilt with conservative bonded restorations.

Is sparkling water bad for teeth?

Plain sparkling water has a mildly acidic pH but very low erosive potential. Flavoured or citrus-infused sparkling water is more erosive.

How do I protect my teeth from acid wear?

Avoid brushing immediately after acid exposure (wait 30 minutes). Use a fluoride rinse. If you have reflux, manage it medically. And if you grind, a night guard prevents the combination of erosion and attrition.

When should worn teeth be treated?

When the wear causes sensitivity, compromises function, or affects aesthetics. The earlier the intervention, the more conservative it can be.

When to see Dr. Khalid

If you have noticed your teeth getting shorter, thinner, or more sensitive, or if you have acid reflux, a comprehensive assessment with BEWE scoring can tell you where you stand and what, if anything, needs to be done.