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Tooth wear is a commonly reported finding globally; however, many patients are unaware of having tooth wear. Identifying early signs of erosion, abrasion or attrition and determining the risk factors contributing to a patient's tooth wear may help to prevent further loss of enamel and dentine in the future. Appropriate prevention should be instigated, or appropriate referral made to other health professionals, when conditions such as gastroesophageal reflux or eating disorders are suspected. This paper presents the epidemiology and aetiological factors for tooth wear, as well as identifying the common clinical presentations of tooth wear. Patient perspectives on tooth wear and preventive techniques that can be utilised are also discussed.Key pointsThis paper summarises the clinical presentation of erosion, attrition and abrasion.Prevalence of tooth wear and aetiological factors are discussed in detail.Strategies for prevention of tooth wear are described.

Objective To investigate the prevalence of tooth wear (TW) and identify associated risk factors among undergraduate students using intraoral scanning (IOS) technology. Methods A cross-sectional study was conducted on 504 first- to third-year undergraduate students from various medical and health-related disciplines, selected by multistage stratified random sampling at Kunming Medical University. Participants underwent digital dental scans (TRIOS 5, 3Shape) and completed a validated questionnaire covering demographics, dietary habits, and medical history. Tooth wear was assessed by calibrated examiners (kappa > 0.79) using the Basic Erosive Wear Examination (BEWE) index on digital models. Statistical analyses included chi-square tests and multiple linear regression (SPSS 27.0), with significance set at p  < 0.05. Results The study included students with a mean age of 20.58 (± 2.07) years. The overall TW prevalence (BEWE ≥ 2) was 68.1%. In terms of severity, the majority of participants were classified as low risk (BEWE total scores 3–8: 82.9%). Severe wear (BEWE = 3) was most frequently observed in mandibular incisors (2.18–2.58%). Males exhibited significantly higher BEWE scores than females ( p  = 0.035). Factors statistically significantly associated with higher BEWE total scores included: frequent carbonated drink consumption ( b  = 1.044, 95% CI: 0.665–1.423), acidic fruit intake ( b  = 1.520, 95% CI: 1.031–2.008), bruxism ( b  = 0.973, 95% CI: 0.324–1.622), and gastroesophageal reflux ( b  = 0.741, 95% CI: 0.132–1.350). Conversely, coffee consumption ( b = -0.568, 95% CI: -0.991– -0.145) and gum chewing ( b  = − 0.396, 95% CI: -0.730– -0.063) were statistically significantly associated with lower wear scores. Conclusion Tooth wear is highly prevalent among undergraduates, with acidic diets, intrinsic factors (such as GERD), and parafunctional habits being significant factors associated with the condition. IOS technology facilitates detailed TW assessment for the early detection of wear patterns, supporting targeted preventive strategies in young populations. Clinical significance High tooth wear prevalence in young adults underscores the urgency of routine screening. Identifying associations with acidic diet and bruxism supports personalized prevention. Furthermore, intraoral scanning serves as a sensitive tool for early monitoring, enabling timely intervention to limit progression.

This study investigated UK general dental practitioners’ habits and attitudes toward screening, risk assessment, and diagnosis of periodontal diseases and tooth wear in adult patients during routine examinations. Two primary recruiters, UK-based final year post-graduate students enrolled on the MSc in Aesthetic Dentistry at King’s College London distributed a piloted, paper-based, 14-statement questionnaire via secondary recruiters to UK general dentists. The latter participants were based at local dental practices or attending post-graduate courses. The secondary recruiters circulated and collected the questionnaire from the participants on the same day of distribution. Responses were supplied in an anonymised manner, and returned to the primary recruiters, either physically or by the scanning of the responses. Data were analysed using descriptive statistics, Chi-squared, and Fisher’s exact tests (Stata v12; significance at p  < 0.05). Of 325 questionnaires distributed, 261 were satisfactorily completed, n = 261 (response rate: 80.3%). During an adult patient dental examination, high agreement was reported for periodontal risk assessment, probing, and diagnosis (≥ 88%). For the same appointment type, tooth wear risk assessments and clinical assessments were routinely performed by ≥ 81% of the sample, and 74% recorded tooth wear clinical diagnoses. While 98.5% used the Basic Periodontal Examination (BPE), only 29.8% regularly reported using a tooth wear index. The Basic Erosive Wear Examination (BEWE) was the most used (22.9%), but 4.3 times less frequently than the BPE. Satisfaction with undergraduate training with assessment and diagnosis was 2.9 times higher for periodontal assessment than for tooth wear. Significant differences were observed in the use of indices for periodontal disease versus tooth wear. The findings of this study support the need for clearer guidelines and a universally accepted tooth wear index in general practice, alongside improved satisfaction with UK undergraduate training in tooth wear assessment and diagnosis.

This in vitro study set out to assess the agreement of 3D-colored digital dental images in detecting occlusal caries and erosive tooth wear (ETW) in primary teeth, by comparing indirect digital assessments with conventional direct visual examinations. Extracted primary molars with varying degrees of caries severity and ETW were mounted on modeling wax, with the crowns exposed for the assessments. Then, two independent experiments were conducted. The first analyzed occlusal caries in 233 extracted primary molars using the International Caries Detection and Assessment System (ICDAS, scores 0–6), while the second evaluated ETW in 164 primary molars using the Basic Erosive Wear Examination (BEWE, scores 0–3). Direct visual examinations were performed under standardized lighting, dryness and magnification. For the indirect assessment, teeth were scanned using an intraoral scanner (TRIOS 4, 3Shape), and digital images were assessed via 3Shape Unite software. Agreement between methods was determined using kappa statistics and percent agreement. Substantial agreement was found for caries detection (Kappa = 0.64; 71% agreement) with the highest concordance at ICDAS scores 4–6 (> 90%) and the lowest at score 0 (36%). For ETW, substantial agreement was also observed Kappa = 0.58; 80% agreement), with highest concordance at BEWE score 2 (99%). The digital method tended to overestimate scores 0 and 1 and underestimate scores 2 and 3 in caries detection. 3D-colored digital images demonstrated substantial agreement with conventional visual methods for detecting both dental caries and ETW in primary teeth. These results highlight its promise as a practical and non-invasive adjunct in pediatric dental diagnostics, with potential to enhance early detection and support the integration of digital tools into routine and remote oral health care.

Objective This case-control study evaluated the association between inhaled anti-asthmatic therapy and tooth wear in children and adolescents, considering medication type, treatment duration, and delivery method. Materials and methods A total of 129 patients aged 3–7 years (primary dentition) and 10–17 years (permanent dentition) were included. The study group comprised 70 asthmatic children receiving inhaled corticosteroids (ICS) or combination ICS/long-acting beta-agonist (LABA) therapy. The control group included 59 healthy children. Clinical interviews and medical records provided data on asthma severity, dietary habits, oral hygiene, parafunctions, and GERD symptoms. Tooth wear was assessed using the Smith and Knight Tooth Wear Index (TWI). Statistical analysis included t-tests, Spearman correlations, and logistic regression. Results Asthmatic patients exhibited significantly more tooth wear than controls (p = 0.0025), particularly on buccal/labial surfaces and in permanent dentition. Wear correlated with combination therapy, high ICS doses, longer treatment duration, and use of dry powder inhalers (DPIs). GERD was more common in asthmatic patients (p = 0.0016) and linked to palatal/lingual wear. Sweetened beverage consumption also contributed to wear. Conclusions Inhaled asthma therapy—especially with DPIs and combination regimens—is associated with increased tooth wear. Emphasizing mouth rinsing after inhaler use and preventive dental care may reduce the risk in pediatric asthma patients. These findings underline the need for interdisciplinary collaboration between medical and dental professionals to minimize oral health risks in asthmatic children.

Food processing wears down teeth, thus affecting tooth functionality and evolutionary success. Other than intrinsic silica phytoliths, extrinsic mineral dust/grit adhering to plants causes tooth wear in mammalian herbivores. Dental microwear texture analysis (DMTA) is widely applied to infer diet from microscopic dental wear traces. The relationship between external abrasives and dental microwear texture (DMT) formation remains elusive. Feeding experiments with sheep have shown negligible effects of dust-laden grass and browse, suggesting that intrinsic properties of plants are more important. Here, we explore the effect of clay- to sand-sized mineral abrasives (quartz, volcanic ash, loess, kaolin) on DMT in a controlled feeding experiment with guinea pigs. By adding 1, 4, 5, or 8% mineral abrasives to a pelleted base diet, we test for the effect of particle size, shape, and amount on DMT. Wear by fine-grained quartz (>5/<50 μm), loess, and kaolin is not significantly different from the abrasive-free control diet. Fine silt-sized quartz (∼5 μm) results in higher surface anisotropy and lower roughness (polishing effect). Coarse-grained volcanic ash leads to significantly higher complexity, while fine sands (130 to 166 μm) result in significantly higher roughness. Complexity and roughness values exceed those from feeding experiments with guinea pigs who received plants with different phytolith content. Our results highlight that large (>95-μm) external silicate abrasives lead to distinct microscopic wear with higher roughness and complexity than caused bymineral abrasive-free herbivorous diets. Hence, high loads of mineral dust and grit in natural diets might be identified by DMTA, also in the fossil record.

Although we are increasingly recognising the need to assess patients for accelerated rates of tooth wear progression, it is often difficult to do so within a feasible diagnostic window. This paper aims to provide evidence-based timelines which a diagnosing clinician can expect to assess tooth wear progression in study models, clinical indices, clinical photographs and visually with intraoral scans. It also discusses new technologies emerging for the quantitative assessment of tooth wear, timelines for diagnosis, and caveats in the 3D scan registration and analysis process.Key pointsReviews the aetiology of erosive tooth wear.Discusses new and old ways of monitoring erosive tooth wear progression.Highlights the timelines over which you can expect to see change using each of these methods.Gives an insight into the future of computer-aided diagnostics for tooth wear in dentistry.

Objective To evaluate short, mid and long-term clinical outcomes and patients’ satisfaction of minimally invasive full-mouth rehabilitation using different materials and techniques for patients with moderate to severe tooth wear. Furthermore, materials were analyzed to identify their influences on clinical results. Materials and methods Search was conducted in PubMed, Cochrane Central Register of Controlled Trial, Embase, Web of science and Scopus until December 19, 2024. Randomized clinical trials (RCT), cohort studies and case series with at least mean period of 3 years were included. The revised Cochrane risk of bias tool, Newcastle–Ottawa scale and Joanna Briggs Institute Critical Appraisal were used to evaluate the quality of RCT, cohort studies and case series. Meta-analysis and Poisson regression were conducted. Results Ten studies in this review included three case series, six cohort studies and one RCT with three low, six moderate risks and one some concerns. Annual failure rates (AFRs) and annual complication rates (ACRs) of direct composite restorations were 0–6.2% and 1.0%-4.2%, respectively. AFRs of indirect restorations were 0%-0.5%. Overall ACRs of indirect restorations fabricated by traditional indirect resin composites, polymer-infiltrated ceramic-network, resin nanoceramics and ceramics were at 1.6%-15.1%, 0.7%-4.8%, 0.5%-5.0% and 0.2%-1.1%, respectively. The estimated AFRs of direct composites, resin nanoceramics and ceramics were 0.64%, 0.13% and 0.04% respectively. Significantly lowest AFRs of ceramic was found after mid-term follow-up with incidence rate ratios of direct composites, resin nanoceramics and ceramics being 1: 0.68 ( P  = 0.60): 0.001 ( P  < 0.05). The estimated ACRs of the three materials were 2.16%, 2.14% and 0.62%. Overall AFRs of restorations using different techniques were 0%-0.5%. Overall ACRs of direct and indirect techniques were 1.1%-2.2% and 0.2%-4.8%, respectively. Overall ACRs of hybrid technique were 0.5% to 15.1%. Restoration fracture was the most predominant complication regardless of materials. High appreciation was expressed by patient reported outcomes measures. Conclusions Minimally invasive full-mouth rehabilitation for patients with moderate to severe tooth wear presented good clinical performance apart from traditional indirect resin composite used in posterior teeth. Clinical relevance Minimally invasive full-mouth rehabilitation should be strongly advocated for the patients with moderately and severely worn dentition.

Stereoscopic microwear and 3D surface texture analyses on the cheek teeth of ten Upper Triassic to Lower Cretaceous tritylodontid (Mammaliamorpha) taxa of small/medium to large body size suggest that all were generalist feeders and none was a dietary specialist adapted to herbivory. There was no correspondence between body size and food choice. Stereomicroscopic microwear analysis revealed predominantly fine wear features with numerous small pits and less abundant fine scratches as principal components. Almost all analyzed facets bear some coarser microwear features, such as coarse scratches, large pits, puncture pits and gouges pointing to episodic feeding on harder food items or exogenous effects (contamination of food with soil grit and/or dust), or both. 3D surface texture analysis indicates predominantly fine features with large void volume, low peak densities, and various stages of roundness of the peaks. We interpret these features to indicate consumption of food items with low to moderate intrinsic abrasiveness and can exclude regular rooting, digging or caching behavior. Possible food items include plant vegetative parts, plant reproductive structures (seeds and seed-bearing organs), and invertebrates (i.e., insects). Although the tritylodontid tooth morphology and auto-occlusion suggest plants as the primary food resource, our results imply a wider dietary range including animal matter.

The geometrical properties of toothbrushes play a role in developing abrasive tooth wear and non-carious cervical lesions. This study investigated the interplay between the toothbrush tuft arrangement (crossed vs. parallel) and bristle stiffness (soft vs. medium) on the abrasive dentin wear using three slurries with different levels of abrasivity (RDA: 67, 121 and 174). Twelve groups of bovine dentin samples (n = 20) were brushed with a combination of the aforementioned variables. Abrasive dentin wear was recorded with a profilometer and the resulting abrasive wear of each group was calculated and compared with each other using two-way ANOVA and pairwise tests. Toothbrushes with parallel tuft arrangement caused statistically significantly higher dentin wear compared to crossed tuft arrangement, regardless of the abrasivity level of the used slurry and the bristle stiffness. Soft crossed tuft toothbrushes caused statistically significantly higher abrasive dentin wear than medium crossed tuft toothbrushes, while soft and medium parallel tuft toothbrushes caused the same amounts of dentin wear, regardless of the RDA value of the used slurry. These results could be helpful for dentists and dental hygienists when advising patients. Crossed tuft toothbrushes could be a less-abrasive choice in comparison to parallel tuft toothbrushes.