Tooth wear and sensitivity: erosion, attrition, abrasion and bruxism
- Oral pathology
Teeth wear away not only from decay but from acid, grinding and hard brushing. The pattern of wear points to the cause.
What it is
Tooth wear is loss of hard tissue not caused by bacteria. Erosion is chemical dissolution by acid that does not come from bacteria: from the diet (soft drinks, citrus, sports drinks) or from the stomach (reflux, vomiting in bulimia or pregnancy, rumination). Attrition is wear from tooth-to-tooth contact, typical of bruxism (grinding or clenching). Abrasion is wear from external objects, typically hard brushing at the gum line or pipes and hairpins. Exposed dentine causes sensitivity: short, sharp pain to cold, sweet or touch.
How to recognise it
- Erosion from the stomach affects the palatal surfaces of the upper front teeth first.
- Erosion from the diet tends to affect the front (labial) surfaces and the biting surfaces.
- Attrition gives flat, shiny facets on matching upper and lower teeth.
- Abrasion gives V-shaped notches at the gum line, worse on the side opposite the brushing hand.
- Dentine hypersensitivity is brief, sharp and provoked; spontaneous or lingering pain suggests pulpitis.
Differential and risks
- Palatal erosion of the upper incisors in a young person can be the first sign of bulimia nervosa or silent reflux.
- Bruxism is linked to stress, sleep disorders, some antidepressants and stimulants, and causes jaw pain and broken teeth.
- Brushing right after an acid attack removes softened enamel; waiting about an hour protects it.
Next step / Initial management
- Look for the cause: diet history, reflux symptoms, vomiting, eating disorders, drugs and sleep.
- Advise reducing acidic drinks, using a straw, rinsing with water after acid, waiting before brushing, a soft brush and a desensitising fluoride toothpaste.
- Suspected eating disorder: approach with care and refer to mental health; reflux: treat and investigate as appropriate.
- Refer to the dentist for protection of worn teeth and, in bruxism, a night guard.
Test yourself
Think of the answer, then tap the question to see it.
Which tooth surfaces are eroded first by gastric acid?
The palatal surfaces of the upper front teeth.
What causes V-shaped notches at the gum line?
Abrasion, usually from hard horizontal toothbrushing.
What advice protects enamel after an acidic drink?
Rinse with water and wait about an hour before brushing, because softened enamel is easily removed.
Connections
Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.
Sources: Bruxism Management (StatPearls Publishing (NCBI Bookshelf), 2024); Physiology, Tooth (StatPearls Publishing (NCBI Bookshelf), 2023); Gastroesophageal Reflux Disease (GERD) (StatPearls Publishing (NCBI Bookshelf), 2024); Bulimia (MedlinePlus, US National Library of Medicine, 2026).
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Representative model, for educational purposes only.