Worn teeth: acid, grinding or brushing? How to tell the difference
Do You Know? For patients.
Tooth wear is the slow loss of enamel and the layer under it, without decay. It is becoming more common, including in younger adults. Finding the cause early matters, because each type is prevented differently.
The main types
Erosion (acid): smooth, shiny, cupped surfaces, often on the inside of upper front teeth or the chewing surfaces of back teeth. Acidic drinks, frequent sipping and stomach reflux are common causes.
Attrition (grinding): flat, sharp-edged facets where upper and lower teeth meet, sometimes with chipping. Often linked to night grinding or daytime clenching.
Abrasion (brushing): notches near the gum line, usually from hard brushing or abrasive toothpaste.
Most worn teeth show a mix of these, which is why a proper assessment helps.
What the research shows
A large review of 273 studies grouped tooth wear risk factors into diet and drinking habits, reflux and medical history, brushing habits, bruxism, stress and other behaviours.
Reflux and eating disorders can first show up as tooth erosion, so dentists are often the first to notice them.
Dentists use scoring systems such as BEWE or TWES 2.0 to record wear and track whether it is getting worse over time.
Signs to look out for
Teeth that look shorter, flatter or more see-through at the edges.
New sensitivity to cold, or fillings that seem to stand proud of the tooth.
Chipped front teeth, or a smile that looks older than it should.
What to do
Keep acidic drinks to mealtimes, use a straw, and rinse with water afterwards.
Wait about an hour after acid or reflux before brushing, and use a soft brush with fluoride toothpaste.
If you grind, a custom night guard protects the teeth.
Ask for photos or scans at your check-up so wear can be compared over time. Many cases only need monitoring; restoring teeth is for wear that is progressing or causing problems.
Related: Worn teeth: causes and treatment
This article is general information and not a substitute for an examination.
References
Dhaliwal G, Ouanounou A. Tooth surface loss: causes, management, and prevention. Quintessence Int. 2024;55(6):504-513. doi:10.3290/j.qi.b5223649
Oudkerk J, Grenade C, Davarpanah A, Vanheusden A, Vandenput S, Mainjot AK. Risk factors of tooth wear in permanent dentition: a scoping review. J Oral Rehabil. 2023;50(10):1110-1165. doi:10.1111/joor.13489
Lorens M, Tomaszewska I. Methods for assessing and measuring tooth wear: a comparison of the Basic Erosive Wear Examination, Tooth Wear Index and Tooth Wear Evaluation System version 2.0. J Oral Rehabil. 2026;53(2):568-578. doi:10.1111/joor.70104
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