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# 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.

Updated Nov 12, 2026

## Key points

- Erosion = acid; attrition = grinding; abrasion = brushing or objects.
- Palatal erosion of upper incisors: think of reflux or bulimia.
- Wait after acid before brushing.

## 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.

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## Connections

## Related 3

- [Enamel, dentine, cementum and pulp: histology and defects](https://durgical.com/en/dentistry/enamel-dentine-cementum-and-pulp-histology-and-defects/)
- [Temporomandibular joint and the muscles of mastication](https://durgical.com/en/dentistry/temporomandibular-joint-and-the-muscles-of-mastication/)
- [Gut and autoimmune disease in the mouth](https://durgical.com/en/dentistry/gut-and-autoimmune-disease-in-the-mouth/)

## Related conditions 3

- [Gastro-oesophageal reflux disease (GERD)](https://durgical.com/en/conditions/gastro-oesophageal-reflux-disease/)
- [Bulimia nervosa](https://durgical.com/en/conditions/bulimia-nervosa/)
- [Temporomandibular disorder](https://durgical.com/en/conditions/temporomandibular-disorder/)

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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](https://www.ncbi.nlm.nih.gov/books/NBK482466/) (StatPearls Publishing (NCBI Bookshelf), 2024); [Physiology, Tooth](https://www.ncbi.nlm.nih.gov/books/NBK538475/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Gastroesophageal Reflux Disease (GERD)](https://www.ncbi.nlm.nih.gov/books/NBK554462/) (StatPearls Publishing (NCBI Bookshelf), 2024); [Bulimia](https://medlineplus.gov/ency/article/000341.htm) (MedlinePlus, US National Library of Medicine, 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/dentistry/tooth-wear-and-sensitivity-erosion-attrition-abrasion-and-bruxism/