Dental erosion is the loss of enamel caused by acids, without bacteria, and it often combines with mechanical wear. Early signs include dull enamel, small hollows on the molars and fillings that appear to stand proud: if these progress or cause sensitivity, the cause is addressed; if the condition is stable, monitoring is enough.
Worn teeth: acids and mechanical forces act differently
The term "worn teeth" covers different processes that may act alone or together. A review published in 2024 in Quintessence International distinguishes four main mechanisms of tooth surface loss: attrition (tooth-to-tooth contact), abrasion (contact with external objects, such as aggressive brushing), abfraction (flexure of the tooth at its neck) and erosion, defined as the loss of hard tissue caused by acids in the absence of microorganisms.
Distinguishing the mechanisms has a direct clinical impact: erosion requires the source of acid to be identified; the mechanical component requires the forces involved to be reduced, as in night-time bruxism. In practice, the two patterns often coexist and must be considered together, because enamel softened by acids then wears more rapidly under occlusal forces.
Early signs of erosive tooth wear
The earliest signs of erosive wear are subtle and painless. The enamel surface loses its characteristic texture and takes on a smooth, almost silky sheen, with localised dull patches. Small cup-shaped depressions appear on the chewing surfaces of the molars, resembling the bowl of a spoon.
A review published in 2021 in the Journal of Esthetic and Restorative Dentistry identifies fillings or restorations that appear to stand proud of the surrounding tooth as a characteristic sign: the restoration has not grown; the tissue around it has diminished. In other cases, the incisal edges of the front teeth become translucent and more fragile, with small chips. Taken individually, these signs may go unnoticed for years; considered together in a careful clinical examination, they form a recognisable pattern.
Intrinsic and extrinsic sources of acid exposure
Acid sources are classified as intrinsic or extrinsic. Intrinsic sources come from within the body: the main one is gastro-oesophageal reflux, often silent and nocturnal; eating disorders involving repeated vomiting also leave a recognisable pattern of erosion. Extrinsic sources come from outside: frequently consumed acidic drinks such as cola and citrus juices, very acidic foods and occupational exposures.
A 2016 review in Quintessence International emphasises that individual susceptibility also depends on the quantity and quality of saliva, systemic conditions that reduce salivary flow, certain medications and oral hygiene habits. Erosion is inherently multifactorial: there is rarely a single cause, and understanding the combination in each case is the first step towards reducing its impact without resorting to restorations.
Who should have tooth wear assessed
The typical person notices that their front teeth are shorter or more transparent than a few years ago, or has been told their teeth are wearing down without an explanation of the cause. This includes people with reflux or digestive disorders, those who frequently consume acidic drinks, those already diagnosed with bruxism and those with recently developed cold sensitivity. In all these cases, assessment aims to establish whether the wear is active and what is causing it before any restoration is discussed. People with intact teeth who only want an aesthetic change do not need this pathway: their question concerns appearance, not wear.
How we recognise and monitor wear over time
At Studio Buniato in Turin, assessment begins with a focused history covering diet, digestive disorders, medications and hygiene routines, followed by a systematic clinical examination of the quadrants. The extent of surface loss is graded using internationally recognised indices such as BEWE (Basic Erosive Wear Examination), which help determine whether the situation calls for observation, preventive measures or restorative assessment. The ORCA/IADR consensus document published in 2020 in Caries Research established common terminology for describing and comparing erosive conditions.
The decisive step is monitoring over time: photographic records and, when indicated, digital scans with 3Shape TRIOS 6 allow the condition of the teeth to be compared at intervals, showing whether wear is progressing, stabilising or stopping. This distinguishes a longstanding stable condition from an active process requiring action on its cause, following a principle similar to that guiding long-term periodontal maintenance.
When to intervene promptly and when waiting is preferable
The criterion is not the aesthetic degree of wear, but its activity and functional consequences. Prompt intervention is indicated when progression is documented by comparative images or scans, when hypersensitivity affects everyday quality of life, when the remaining tissue puts tooth vitality at risk or when the vertical dimension of the occlusion is decreasing.
Extensive restorations are not indicated straight away for someone seeking only a quick aesthetic change without first identifying and reducing the cause: there would be a risk of soon having to redo work damaged by the same acids that wore down the original enamel. Conditions stable for years, without symptoms or documented progression, also often benefit from a preventive approach before any restoration. When reconstruction becomes necessary, it is designed around the remaining tissue, with materials selected case by case, such as hand-layered feldspathic ceramic.
Frequently asked questions
If my teeth are worn, do I necessarily need veneers or restorations?
No. Not every pattern of wear requires immediate restoration. If the process is stable, symptom-free and its cause has been identified and reduced, periodic monitoring with targeted preventive measures may be indicated. Veneers and restorations become relevant when there is significant tissue loss, sensitivity to cold or sweet foods that interferes with meals, or impaired chewing function.
Can gastro-oesophageal reflux damage my enamel without me noticing?
Yes. Reflux may be silent, especially at night, and is among the most frequent intrinsic causes of dental erosion. In many cases, the dentist is the first to notice typical signs (dull enamel, cup-shaped hollows, restorations that appear to stand proud) and suggest a gastroenterological assessment. Reducing acid exposure is a prerequisite for stopping the progression of wear.
How often should the wear on my teeth be checked?
It depends on the clinical situation. An active process, with progression visible in photographs from one visit to the next, requires closer checks and a review of habits. A stable condition can be monitored at routine check-ups, with baseline photographs and comparative scans when indicated. The aim is to detect deterioration early, not to multiply visits without a clinical reason.
I have bruxism: is that the only reason my teeth are worn?
Not necessarily. Grinding wears enamel through attrition, but if acids from reflux or acidic drinks have softened the same enamel, it wears much faster. The two mechanisms often combine and must be distinguished, because a splint protects against forces but does not stop acid: in that case, the chemical cause must also be addressed.
For an individual assessment of your case, Dott. Buniato is available for a first specialist consultation with a complete diagnostic assessment.
The practice is at Corso Francia 30 in Turin, near the Principi d'Acaja stop.
References
- Kanzow P, Wegehaupt FJ, Attin T, et al. Etiology and pathogenesis of dental erosion. Quintessence International. 2016. doi:10.3290/j.qi.a35625. PMID: 27022647.
- Donovan T, Nguyen-Ngoc C, Abd Alraheam I, et al. Contemporary diagnosis and management of dental erosion. Journal of Esthetic and Restorative Dentistry. 2021. doi:10.1111/jerd.12706. PMID: 33410255.
- Dhaliwal G, Ouanounou A. Tooth surface loss: causes, management, and prevention. Quintessence International. 2024. doi:10.3290/j.qi.b5223649. PMID: 38634628.
- Schlueter N, Amaechi BT, Bartlett D, et al. Terminology of Erosive Tooth Wear: Consensus Report of a Workshop Organized by the ORCA and the Cariology Research Group of the IADR. Caries Research. 2020. doi:10.1159/000503308. PMID: 31610535.
