Tooth Wear Explained: Erosion, Abrasion and Attrition

Key takeaways

• Tooth wear has four patterns: erosion (acid), abrasion (brushing and objects), attrition (tooth against tooth) and abfraction (bite stress at the gum line).
• They usually act together: acid-softened enamel wears away much faster under brushing or grinding.
• Lost enamel does not grow back, so the aim is to find the cause and stop progression early.
• Repairs range from bonding over sensitive notches to onlays and crowns for heavily worn teeth.

What tooth wear is and why it matters

Tooth wear is the loss of tooth surface from causes other than bacteria, which separates it from decay. Some wear is a normal part of ageing. It becomes a problem when it is faster than expected or causes symptoms: sensitivity, thin or sharp edges, chipping, teeth that look shorter, or yellowing as dentine shows through.

Enamel cannot regenerate (the tooth anatomy guide explains why), so what is lost stays lost. Advanced wear can shorten the teeth, change the bite and the smile, and need extensive restoration. Caught early, often at a routine check-up, it can usually be stopped with simple changes to habits.

Erosion: enamel lost to acid

The American Dental Association (ADA) defines dental erosion as a chemical process: acid dissolving the tooth's hard tissue, where the acid does not come from bacteria. Friction is not part of erosion itself, although it makes the damage worse.

The acid comes from two directions. The diet: soft drinks, fruit juices, citrus fruit, sports and energy drinks, vinegar and wine; the ADA identifies frequent soft drinks, particularly carbonated sodas, as a primary risk factor for erosive tooth wear. The stomach: acid reflux (gastro-oesophageal reflux disease, or GERD), especially damaging during sleep when saliva flow drops, and frequent vomiting, for example from severe pregnancy sickness or an eating disorder.

Eroded teeth develop a smooth, glossy or "melted" look, with cupped or flattened biting surfaces. Fillings may stand proud of the tooth, teeth can look more yellow, and they often become more sensitive. Stomach acid tends to affect the inner surfaces of the upper teeth first. Identifying the source is the first step; if reflux is suspected, see your doctor as well as your dentist. Reflux as a cause of sensitivity is covered in tooth sensitivity causes.

Everyday acids: sparkling water, soft drinks and sipping habits

How often and how long teeth are bathed in acid matters more than the total amount. Each acidic mouthful softens the enamel surface, and saliva needs time to neutralise the acid and help it recover. Sipping slowly over hours never gives it that chance.

Sparkling water is a common worry. Dissolved carbon dioxide makes it slightly more acidic than still water, yet according to the ADA's MouthHealthy guidance plain sparkling water had about the same effect on enamel as regular water. Citrus flavours add acid, and added sugar makes it a sugary drink that feeds decay. Heavy daily sipping is the pattern to avoid; see also sports drinks vs water.

Habits that limit acid exposure:

• keep acidic drinks to mealtimes, and finish them in one sitting rather than sipping;
• drink plain still water between meals;
• use a straw positioned behind the front teeth, as the ADA suggests;
• rinse with water after acidic food or drink instead of brushing straight away.

Abrasion: brushing wear at the gum line

Abrasion is wear caused by something other than teeth rubbing against them. The commonest cause is toothbrushing with a hard brush, a scrubbing side-to-side technique, heavy pressure or a very abrasive toothpaste. Habitually biting pens, nails or hairgrips, and the clasps of a poorly fitting partial denture, can also do it.

Brushing abrasion typically shows as notches at the gum line, where enamel is thinnest and wears through to the sensitive dentine. Once gums recede, the softer root surface wears even faster. Prevention is simple: a soft-bristled brush, gentle technique and fluoride toothpaste, letting the bristles do the work rather than force. The brushing technique guide shows how.

Attrition: tooth-to-tooth wear from grinding

Attrition is wear from teeth rubbing against each other. A little happens with normal chewing over a lifetime, but grinding and clenching (bruxism) speed it up sharply. Because grinding often happens during sleep, many people do not realise they do it until a dentist points out the wear.

Signs include flat, shiny patches on biting surfaces that match the opposing teeth, shorter front teeth with straight, even edges, chipped or cracked enamel, and sometimes aching jaw muscles or morning headaches. Once enamel is worn through, the softer dentine wears faster and can form small craters.

A custom-made night guard takes the wear instead of the teeth and spreads the forces, and managing triggers such as stress also helps. See teeth grinding solutions for causes and options, and the night guards page for how a custom guard is made.

Abfraction: stress notches near the gum line

Abfraction is a sharp-edged, wedge-shaped notch at the neck of the tooth, sometimes just below the gum margin where a toothbrush barely reaches. It is thought to result from biting forces concentrating at the neck: the tooth flexes slightly under load and small pieces of the thin enamel there break away. These notches are often seen in people who clench or grind, and can make teeth sensitive.

How much abfraction contributes is debated: a review by Shellis and Addy in Monographs in Oral Science found the evidence insufficient to establish whether it is an important cause of tooth wear in the mouth. In practice, most notches have more than one cause.

That is especially true in older adults, in whom gum-line notches are common. Years of firm horizontal brushing wear the root surface once gums recede, bite stress flexes the tooth at the neck, and acid softens the surface so both work faster. Because the notches expose dentine, they often ache with cold or brushing. Management is straightforward: a soft brush and gentle technique to stop progression, a night guard where grinding plays a part, and tooth-coloured bonding to fill the notch and seal the sensitive surface.

How the types overlap, and the signs to watch for

The four types rarely act alone. The same review found the most important interaction to be acid damage that makes the surface easier to wear away by abrasion, the major factor in wear on biting surfaces and at the gum line. Saliva helps but cannot prevent this.

Watch for new sensitivity to cold, sweet food or brushing, teeth that look shorter or more yellow, edges that chip or feel sharp, and a bite that feels different. Dentists may photograph wear at check-ups to track whether it is progressing.

Preventing further wear

• Find the cause: note what you eat and drink for a few days, and tell your dentist about reflux, vomiting or grinding.
• Cut acid exposure: acidic drinks with meals only, plain water in between.
• Time your brushing: rinse with water after acid, and wait before brushing.
• Brush gently with a soft brush and fluoride toothpaste. The ADA notes that several studies suggest fluoride treatments help protect enamel against erosion, and a dentist may suggest higher-fluoride toothpaste or varnish if your risk is high.
• Protect against grinding with a custom night guard, and wear a mouthguard for contact sports.
• Treat the medical cause: reflux or frequent vomiting needs medical care, not just dental repair.

Repairing worn teeth: bonding, onlays and crowns

Repairs last longer once the cause is under control; otherwise the new surfaces wear too. Options depend on how much tooth has been lost:

• Monitoring and prevention for early wear without symptoms.
• Desensitising toothpaste or varnish for exposed dentine.
• [Dental bonding](/services/dental-bonding) to fill gum-line notches, cover exposed dentine and rebuild worn edges with little or no drilling.
• Onlays in ceramic or gold to rebuild worn back-tooth cusps.
• Crowns for heavily worn or cracked teeth.
• A planned rebuild of many teeth where severe wear has shortened the bite.

Onlays are made in a laboratory and priced individually; the guide to onlays, inlays and crowns compares them. Restorations can also chip under grinding, so a night guard is often recommended after worn teeth have been rebuilt.

Practical decision guide

General dental decisions should preserve healthy tooth structure whenever possible. A good plan moves from diagnosis to the least-invasive durable treatment, then to prevention so the same problem does not repeat.

Check this first

• X-rays, pulp vitality, crack lines, gum pocketing, bite contacts, and how much natural tooth remains.
• Whether the problem is active disease, old restoration failure, trauma, wear, or a cosmetic concern.
• Whether a filling, onlay, crown, root canal, extraction, or monitoring is the right next step.

When to book sooner

• Pain wakes you at night, lingers after hot or cold, hurts on biting, or comes with swelling.
• A crown or filling falls out, a tooth cracks, or a sharp edge is cutting the tongue or cheek.
• You notice pus, fever, spreading swelling, or difficulty opening, swallowing, or breathing.

Questions to ask at the appointment

• What is the diagnosis, and what evidence supports it on the x-ray or clinical exam?
• What is the smallest treatment that solves the problem predictably?
• What failure signs should I watch for after treatment?

Dubai patient note

If insurance is involved, ask whether pre-approval is required, what codes will be submitted, and what alternatives are clinically acceptable if coverage is limited.