Non-carious tooth surface loss
Separate erosion, attrition and abrasion, then assess activity and aetiology. Stabilise risk before complex reconstruction.
Understand
Erosion is chemical loss without bacterial action; attrition is tooth-to-tooth wear; abrasion is mechanical wear from other causes. They frequently coexist.
Assess
Map distribution, activity, sensitivity and diet, reflux, bruxism or habits. Serial photographs, models and wear indices can show whether change is ongoing.
Apply
Control drivers and protect exposed tissue before major rehabilitation. Avoid attributing every wear facet to bruxism or rebuilding a stable dentition without a clear indication.
Key distinctions
Tooth wear often has several causes: dietary acid may soften surfaces that attrition then removes more quickly. Record distribution and compare serial records before declaring activity. Sensitivity, function and appearance do not always require full reconstruction. A protective or additive approach may be appropriate while the drivers are addressed.
Think through a case
A teenager has cupped palatal surfaces and frequent acidic drinks. Address exposure and activity before planning veneers or composite rehabilitation.
The distinction to remember
Do not label all wear “bruxism”; erosion and abrasion have different patterns and prevention needs.
Test your recall
What is the first planning question in tooth wear?
Show answer
Is it active, and what is driving it?