Dental erosion: how acid wears teeth away, and how to stop it

The American Dental Association (ADA) defines dental erosion as the chemical loss of the tooth's mineralised tissue as a result of exposure to acids that do not come from the bacteria in the mouth. The 2015 consensus report of the European Federation of Conservative Dentistry (EFCD) describes erosive wear as the cumulative loss of tooth tissue through a chemical and mechanical process not caused by bacteria, and writes that its most obvious sign is the tooth losing its natural surface texture and contours. It is important not to confuse it with decay: in decay the acid is produced by bacteria in plaque and the result is a cavity; in erosion the acid comes from outside or from the stomach, and the surface thins over a wide area.

Erosion rarely stays on its own. Enamel softened by acid is more vulnerable to mechanical effects such as brushing or clenching; that is why the consensus report defines the process as both chemical and mechanical. The difference from the other two types of wear is in its appearance. In wear caused by tooth rubbing against tooth (attrition), flat surfaces with sharp edges form on the lower and upper teeth that fit exactly against each other. In wear caused by an outside factor such as hard brushing (abrasion), notches with sharp outlines appear at the gum line, at the neck of the tooth. In erosion, by contrast, the surfaces have rounded contours and are silky, shiny and look melted.

The ADA describes the typical appearance of erosion as loss of enamel tissue, surfaces that look silky, shiny or melted, and chewing surfaces that are cupped, flattened or smoothed. Small craters can form on the tips of the cusps of the back teeth. The biting edges of the front teeth thin and look translucent when held up to the light. Fillings can be left standing proud of the surface because the tooth tissue around them has dissolved. Cleveland Clinic also lists yellowing of the teeth: as the enamel thins, the yellowish dentine underneath becomes more visible.

Where the wear is gives a clue to where the acid comes from. The ADA writes that erosion linked to self-induced vomiting is typically seen on the palate-side surfaces of the upper front teeth; with reflux, it notes that acid coming up into the mouth is particularly harmful during sleep and can bathe the lower back teeth while lying on your back. With acid from outside, for example from a habit of sucking lemons or holding acidic drinks in the mouth, the lip-side surfaces of the front teeth and the chewing surfaces of the lower back teeth stand out. Your dentist can estimate the source by looking at the map of the wear; that is why you should mention any history of reflux, heartburn or vomiting openly at the examination.

Erosion is more common than people think. In a study examining 3,187 people aged 18–35 in seven European countries, marked wear was found in 29% of participants; the highest level was in the United Kingdom. Heartburn or acid reflux, repeated vomiting, living in the countryside, using an electric toothbrush and snoring were found to be associated with wear; consumption of fresh fruit and fruit juice was also associated with wear. This is a cross-sectional study: it shows not that these factors cause wear, but that they are seen more often in people who have wear.

A broader summary of the risk factors comes from a 2024 meta-analysis. Examining 71 observational studies, the authors found erosive wear to be significantly associated with male sex, stomach contents coming up into the mouth (odds ratio around 2.3), digestive diseases, acidic foods (odds ratio around 2.4), dietary supplements and fizzy drinks. The authors recommend that dentists focus particularly on reflux symptoms and eating habits. The EFCD report also lists drinks with a low pH and a high buffering capacity as the main risk, and calcium content as the main protective factor; it also includes occupations involving acidic liquids or vapours in the risk group.

Eating disorders should be mentioned separately, because the dentist may be the first person to notice one. In a 2015 meta-analysis, the likelihood of dental erosion in people with an eating disorder was around 5 times higher than in the control group, and around 7 times higher in those who made themselves vomit; saliva flow was also reduced. The ADA writes that the frequency of erosion in bulimia has been reported at over 90%. Erosion is rare in pregnancy, but the ADA notes that it can be seen in pregnancies with prolonged severe vomiting. In all these situations, repairing the teeth only lasts if it is dealt with together with the underlying problem.

What happens as erosion progresses? Cleveland Clinic writes that once enamel has been lost it does not form again, and that pain starts as the wear approaches the nerve. When dentine is exposed, sensitivity to cold increases; the edges of the front teeth can thin and break, and the back teeth can become shorter. With advanced wear affecting the whole mouth, the height of the teeth decreases markedly and the repair turns into a more extensive plan. The 2017 European consensus statement recommends making the decision to repair according to the severity of the wear, its effects and the patient's wishes, and delaying repair as long as possible.

The definitive distinction is made at an examination. The first list covers signs suggesting that the wear comes from acid; the second list covers signs suggesting another cause or a situation needing a more detailed assessment.

According to the EFCD report, effective management starts with screening for early signs and assessing all the causes. Repair comes at the end of this sequence.

1. 1

   Grading the wear

   The EFCD recommends the Basic Erosive Wear Examination (BEWE) for classification. The mouth is divided into six sections, the most affected surface in each section is scored on a four-step scale (0–3), and the total score is linked to risk levels that guide treatment. This score and photographs make it possible to see at later check-ups whether the wear is progressing.

2. 2

   Investigating the source of the acid

   You are asked about diet, drinks, supplements, medicines, reflux symptoms, vomiting and your occupation. A food and drink diary kept for a few days makes visible how many times a day the teeth meet acid.

3. 3

   Referral to a doctor if needed

   If there are reflux symptoms, it is necessary to work together with gastroenterology or a GP (family doctor), and with a mental health specialist if an eating disorder is suspected. As long as the source of the acid continues, any repair to the teeth also keeps wearing away.

4. 4

   Preventive care

   Fluoride toothpaste and, if needed, fluoride applied by the dentist are recommended. A 2026 umbrella review writes that toothpastes containing stannous fluoride gave more consistent protection than conventional fluoride toothpastes in laboratory and intraoral models, but that this should not be taken as evidence that wear slows down in the clinic.

5. 5

   Monitoring

   For severe wear, the European consensus statement recommends diagnosis, prevention, counselling and monitoring, and delaying repair as long as possible. If the wear has stopped and there are no complaints, regular check-ups may be enough.

6. 6

   Minimally invasive repair when needed

   If there is sensitivity, a problem with function or a problem with appearance, a repair is done. The EFCD writes that repair aims to reduce pain and sensitivity and to restore appearance and function, and that it should only be carried out together with preventive measures; the European consensus recommends a minimally invasive approach based on bonding techniques.

Treatment is stepped according to the severity of the wear, the sensitivity and your expectations. At every step, control of the source of the acid continues.

Below are wrong decisions often made in this area, and what they cost.

The progression of erosion is determined above all by daily habits. The recommendations below come from the ADA, Cleveland Clinic and research; the plan specific to you is made by your dentist.

1. With acidic drinks and food

   Reduce how often you have them, have them with a meal, do not hold them in your mouth, use a straw. The ADA also recommends drinking water with meals and chewing sugar-free gum to increase saliva flow.

2. After acid

   The ADA recommends rinsing the mouth with water rather than brushing straight after an acidic drink; Cleveland Clinic recommends waiting at least 30 minutes to brush after eating. The European study of 3,187 people, however, found no association between waiting to brush after breakfast and the degree of wear. The evidence on this is not consistent; brushing twice a day with fluoride toothpaste, gently and without pressing, seems more important.

3. When there is vomiting or reflux

   Rinse your mouth with water, with water to which bicarbonate of soda has been added, or with milk. If you have reflux symptoms, discuss their treatment with your doctor; the teeth cannot be protected without controlling the source of the acid.

4. At check-ups

   Cleveland Clinic recommends more frequent check-ups for people prone to erosion. Photographs and the BEWE score are used to monitor whether the wear has stopped.

Treatment of erosion can range from preventive care to repair covering the whole mouth; we do not give figures here. The main items that determine the scope are:

Degree and extent of the wear

Mild wear on a few surfaces and advanced wear in which many teeth have shortened are very different in scope.

Type of repair

Composite repair, ceramic overlays, laminate veneers and crowns require different materials and laboratory processes.

Changing the bite height

If the height of the teeth has shortened markedly, the planning, the trial stage and the number of appointments increase.

Treating the underlying cause

Treatment of reflux or an eating disorder is planned as a process separate from the dental treatment.