Tooth Wear and Enamel Erosion: Causes, Signs and Treatment
This page is general information and does not replace an examination.
Tooth wear is the gradual loss of enamel and dentine. Erosion is its chemical form: acids from drinks, food, reflux or vomiting dissolve the tooth surface without bacteria being involved, and the loss is cumulative[1]. Mechanical wear between teeth (attrition) or from brushing and objects (abrasion) often adds to it; the three interact[10]. Some wear with age is normal; it becomes a problem when it is moderate to severe and causes signs or symptoms[3]. The first step is finding and controlling the cause; restorations are best delayed as long as possible and kept minimally invasive[2].
What is tooth wear?
Teeth lose a little hard tissue over a lifetime. This physiological wear is slow and normally causes no symptoms. Wear becomes pathological when it is moderate, severe or extreme and comes with signs or symptoms; its cause can be chemical, mechanical or both[3].
Erosive tooth wear is defined as a chemical-mechanical process that leads to a cumulative loss of hard dental tissue not caused by bacteria. It changes the natural surface shape and contour of the teeth[1]. That is the key difference from tooth decay, which is caused by bacteria.
It is common: a meta-analysis of 22 population studies estimated that 30.4% of children and adolescents aged 8 to 19 had erosive wear on their permanent teeth, with large differences between studies and regions[7].
Erosion, attrition and abrasion
| Form | What causes it | Typical pattern |
|---|---|---|
| Erosion (chemical) | Acids not produced by bacteria: acidic drinks and food, reflux, vomiting, some medicines and supplements, acidic vapours at work[1] | Smooth, silky-glazed surfaces; cupping and grooving on chewing surfaces[4] |
| Attrition (mechanical) | Wear between opposing teeth; the dentist checks for grinding or clenching[3][10] | Hard to separate from erosion in later stages[4] |
| Abrasion (mechanical) | Objects and habits, such as hard brushing; excessive oral hygiene is also listed among the predisposing factors for erosive wear[5][10] | Hard to separate from erosion in later stages[4] |
The three processes can act together, at the same time or one after another[10], and in later stages it is often hard to tell them apart during an examination[4].
Signs of enamel erosion and worn teeth
Erosion progresses slowly and many people do not notice it[4]. Typical signs of enamel erosion include a smooth, silky-glazed surface, an intact band of enamel along the gum line, and cupping and grooving on the chewing surfaces[4]. When wear advances, signs and symptoms can include[1][3]:
- teeth whose natural surface shape and contour have changed[1];
- sensitivity to cold, hot, sweet or sour (dentine hypersensitivity)[1];
- problems with appearance or function[1].
See-through or chipping edges. If the edges of your front teeth look see-through or chip easily, have them checked: the dentist assesses whether this is wear and what is causing it, rather than treating the look alone.
Sensitivity has other causes too, such as decay or receding gums; see sensitive teeth. Sudden severe pain, a broken tooth or swelling need prompt care.
Causes and risk factors
Erosion is multifactorial. Chemical, biological and behavioural factors interact, which is why some people show more erosion than others with the same diet[5].
- Drinks and food: low pH and high buffering capacity are major risk factors; calcium is a major protective factor[1]. Flavoured sparkling waters had a pH of 2.74–3.34 and an erosive potential similar to or greater than orange juice in laboratory tests[8]. Which everyday drinks and foods matter is covered in our guide to diet and teeth.
- Reflux and vomiting: stomach acid is a patient-related cause[1]. If you have heartburn, reflux or frequent vomiting, see your doctor; treating the cause protects the teeth.
- Medicines and supplements: some can contribute[1]; do not stop a medicine without asking your doctor.
- Saliva and lifestyle: saliva protects; exercise with dehydration and reduced saliva flow, excessive oral hygiene and chronic heavy alcohol use are predisposing factors[5].
- Work: exposure to acidic liquids or vapours[1].
- Grinding and clenching: mechanical wear adds to chemical softening[3][4]. Jaw-muscle pain that often comes with it is covered in TMJ and jaw pain.
How to protect your teeth
Where tooth wear is present, UK prevention guidance advises[9]:
- reduce how often you have acidic food or drinks;
- keep acidic food and drinks to mealtimes and look for alternatives between meals;
- avoid ways of drinking that promote wear, such as swilling and swishing.
An individual preventive programme can also include dietary advice based on a food diary, a fluoride routine, stimulation of saliva flow and non-destructive brushing habits; fluoride gel and fluoride mouthrinse in addition to fluoride toothpaste can help minimise abrasion of softened tooth substance[4]. Your dentist tells you which of these suits your situation.
How a dentist assesses wear
The European consensus calls for screening for early signs and evaluating all causes[1]. A common tool is the Basic Erosive Wear Examination (BEWE): the most severely affected surface in each of the six sextants of the mouth is scored on a four-level scale, and the total is matched to a risk level that guides management[6]. The dentist also asks about diet, reflux, medicines, grinding and brushing habits, because the cause decides the plan[5].
Monitoring over time shows how fast the wear is progressing, which is part of deciding whether and when to restore[2].
Treatment options
Management decisions depend mainly on how severe the wear is, what effects it has and what the patient wishes. Restorative treatment is typically best delayed as long as possible. When it is needed and agreed, a conservative, minimally invasive approach with adhesive materials is recommended, together with prevention[2]. Restorations aim to relieve pain and sensitivity or to restore appearance and function, and should only be used alongside preventive measures[1].
| Option | When it is used | What to know |
|---|---|---|
| Prevention and monitoring | Mild wear, or wear that is not progressing[2] | Cause control, diet and brushing advice, fluoride; regular check-ups to monitor the rate of wear |
| Fluoride or desensitising varnish | Sensitivity on worn or exposed surfaces | Applied in the clinic; a paid treatment |
| Composite bonding | Small to moderate loss, sensitive exposed dentine, worn edges[2] | Adhesive and minimally invasive, the approach the European consensus recommends[2] |
| Veneers or crowns | Larger loss of tooth structure, or teeth already heavily restored | More invasive; used only together with prevention[1] |
| Night guard | Grinding or clenching | A hard guard made in the clinic |
Tooth wear at our clinic: options and prices
Dr. Ali Cem Ulubey and Dr. Surur Ulubey examine and treat patients themselves; there are no rotating dentists. We do not reshape healthy enamel for cosmetic reasons; a chipped edge is polished or repaired with a small composite, as the case requires.
| Treatment | Price |
|---|---|
| Consultation and panoramic X-ray | No separate fee |
| Fluoride or desensitising varnish | Confirmed in your written quote |
| Composite filling | €60 per tooth |
| Aesthetic front-tooth composite filling | €120 per tooth |
| Composite veneer | €120 per tooth |
| E.max laminate veneer | €250 per tooth |
| Zirconia crown (Amann Girrbach) | €185 per tooth |
| E.max crown | €250 per tooth |
| Night guard (on its own) | €80 |
Prices are indicative; your final written quote follows the examination and X-rays and is valid for 30 days. Unless the treatment plan changes, the written price does not change.
A hard night guard is made in the clinic and can be ready within 2–3 hours when it is urgent. Our crown and bridge guarantees exclude fracture due to bruxism (teeth grinding), and patients who grind their teeth must wear the night guard we provide; the 5-year guarantee on E.max veneers likewise excludes bruxism without a night guard. All guarantees are conditional on attending recommended check-ups.
More on the options: composite bonding, veneers in Antalya and zirconia crowns. All fees are on our dental treatment prices page.
Frequently asked questions
Can enamel grow back?
No. Erosive tooth wear is a cumulative loss of hard tissue, and lost enamel does not regrow. Prevention aims to slow or stop further loss: fewer and shorter acid exposures, a fluoride routine and gentle brushing. Where tissue is missing and causes sensitivity or problems with appearance or chewing, it can be replaced with composite or, in larger cases, veneers or crowns.
Is some tooth wear normal?
Yes. Teeth wear slowly over a lifetime, and this physiological wear normally causes no symptoms. Wear is considered a problem when it is moderate, severe or extreme and comes with signs or symptoms such as sensitivity, changed tooth shape or chewing problems. A dentist can grade it and monitor whether it is progressing.
How is tooth wear treated?
First by finding and controlling the cause, such as acidic drinks, reflux or grinding. European consensus advises delaying restorations as long as possible and, when they are needed, choosing minimally invasive adhesive options such as composite bonding together with prevention. Veneers or crowns are for larger loss, after the cause is under control.
Will I need veneers or crowns for worn teeth?
Not necessarily. Many people need only prevention and monitoring, and moderate loss is often restored with composite bonding. Veneers or crowns are considered when a lot of tooth structure is missing or teeth are already heavily restored. The examination, X-rays and your own wishes decide the plan, which you receive in writing.
Does a night guard stop tooth wear?
A night guard is made for grinding and clenching; it does not change the acid exposure that causes erosion. If you grind, we make a hard night guard in the clinic, which can be ready within 2–3 hours when urgent. For patients who grind, wearing it is also a condition of our crown, bridge and veneer guarantees.
Can acid reflux damage my teeth?
Yes. Reflux and vomiting are recognised causes of erosive tooth wear. If you have heartburn, reflux or frequent vomiting, see your doctor, because treating the cause protects your teeth. Tell your dentist too, so that the pattern of wear can be checked and a fluoride routine planned.
Sources
- Carvalho TS, Colon P, Ganss C, et al. Consensus report of the European Federation of Conservative Dentistry: erosive tooth wear — diagnosis and management. Clin Oral Investig. 2015;19(7):1557-1561. PMID 26121968. pubmed.ncbi.nlm.nih.gov/26121968
- Loomans B, Opdam N, Attin T, et al. Severe tooth wear: European consensus statement on management guidelines. J Adhes Dent. 2017;19(2):111-119. PMID 28439579. pubmed.ncbi.nlm.nih.gov/28439579
- Wetselaar P, Wetselaar-Glas MJM, Katzer LD, Ahlers MO. Diagnosing tooth wear, a new taxonomy based on the revised version of the Tooth Wear Evaluation System (TWES 2.0). J Oral Rehabil. 2020;47(6):703-712. PMID 32274827. pubmed.ncbi.nlm.nih.gov/32274827
- Lussi A, Hellwig E, Zero D, Jaeggi T. Erosive tooth wear: diagnosis, risk factors and prevention. Am J Dent. 2006;19(6):319-325. PMID 17212071. pubmed.ncbi.nlm.nih.gov/17212071
- Lussi A, Jaeggi T. Erosion — diagnosis and risk factors. Clin Oral Investig. 2008;12 Suppl 1:S5-S13. PMID 18228059. pubmed.ncbi.nlm.nih.gov/18228059
- Bartlett D, Ganss C, Lussi A. Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs. Clin Oral Investig. 2008;12 Suppl 1:S65-S68. PMID 18228057. pubmed.ncbi.nlm.nih.gov/18228057
- Salas MM, Nascimento GG, Huysmans MC, Demarco FF. Estimated prevalence of erosive tooth wear in permanent teeth of children and adolescents: an epidemiological systematic review and meta-regression analysis. J Dent. 2015;43(1):42-50. PMID 25446243. pubmed.ncbi.nlm.nih.gov/25446243
- Brown CJ, Smith G, Shaw L, Parry J, et al. The erosive potential of flavoured sparkling water drinks. Int J Paediatr Dent. 2007;17(2):86-91. PMID 17263857. pubmed.ncbi.nlm.nih.gov/17263857
- Office for Health Improvement and Disparities (UK). Delivering better oral health: an evidence-based toolkit for prevention. Chapter 10: Healthier eating (updated 10 September 2025; accessed 26 October 2026). www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-10-healthier-eating
- Litonjua LA, Andreana S, Bush PJ, Cohen RE. Tooth wear: attrition, erosion, and abrasion. Quintessence Int. 2003;34(6):435-446. PMID 12859088. pubmed.ncbi.nlm.nih.gov/12859088
This article is general patient information and does not replace a clinical examination or X-rays.
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