Dental Erosion in Essen-Rüttenscheid: Recognising and Treating Acid-Related Tooth Wear

With dental erosion, the tooth loses mineralised tissue through the chemical action of acids without bacteria, as in classical caries, being the primary cause.

Enamel may be affected first. As tissue loss progresses, the underlying dentine may also become exposed.

In everyday language, people often simply refer to “acid damage”.

Clinically, however, the process is more complex: acid can soften the tooth surface, while chewing, friction, clenching or other mechanical influences may further increase visible wear.

For this reason, the term erosive tooth wear is now commonly used.

Both can lead to loss of hard tooth tissue, but the mechanism is different.

Caries

In caries, bacteria metabolise fermentable carbohydrates and produce acids within dental plaque. This causes local demineralisation of hard tooth tissue.

Dental erosion

With erosion, acid comes into direct contact with the tooth surface from outside the body or from within the body.

Possible sources include:

• acidic drinks and foods,
• frequent regurgitation,
• gastro-oesophageal reflux,
• or repeated vomiting.

Erosion is therefore not simply “caries without a cavity”.

The distribution and surface shape of the defects can also differ.

In reality, different forms of tooth wear often occur together.

Erosion

Chemical exposure to acids plays an important role.

Attrition

Tooth structure is worn away through direct tooth-to-tooth contact, for example with pronounced clenching or grinding.

Abrasion

Mechanical influences from foreign objects or habits wear away tooth structure.

These categories are clinically useful, but they are not always cleanly separable.

A tooth surface already weakened by erosion may, for example, wear more quickly under mechanical loading.

The shape of a single defect should therefore not be used to infer one cause prematurely.

Early erosive changes can remain inconspicuous for a long time.

Possible observations include:

• tooth surfaces that look unusually smooth or glossy,
• flattening of chewing surfaces,
• changes to cusps and incisal edges,
• increasing translucency of thin incisal edges,
• areas appearing more yellow as dentine becomes more visible,
• sensitivity to cold, touch or acidic stimuli,
• or changes around existing fillings that appear more raised than the surrounding tooth structure.

None of these signs alone proves dental erosion.

Similar changes can also occur with other forms of tooth wear.

Not necessarily.

As long as mainly enamel is affected, erosion may remain largely symptom-free.

If dentine becomes exposed, teeth can become more sensitive. Some patients then notice symptoms with:

• cold drinks,
• acidic foods,
• touch,
• or toothbrushing.

More advanced defects can also cause functional symptoms.

The absence of pain does not rule out progressive tooth wear.

Frequent contact with acidic drinks can increase the risk of erosive tooth wear.

Current systematic evidence shows associations in particular with certain dietary and drinking habits, including carbonated or acidic drinks.

It is not only what is consumed that matters.

Frequency and contact time may also play a role.

A drink sipped over a long period or held in the mouth creates a different exposure pattern from occasional consumption with a meal.

This does not mean that every patient must completely avoid all acidic foods and drinks.

The first goal is to identify the individual's exposure realistically.

Acidic foods and fruit juices can contribute to acid exposure.

This should not lead to blanket dietary advice to avoid fruit altogether.

With erosive tooth wear, it is more useful to consider, among other things:

• how often acidic products are consumed,
• whether they are taken repeatedly between meals,
• how long they remain in contact with the teeth,
• and whether other risk factors are present at the same time.

Dietary advice should therefore not consist merely of a list of “forbidden foods”.

Yes.

Acid can reach the teeth not only from food and drink.

Intrinsic acid from the stomach may also be relevant, for example with repeated regurgitation or vomiting.

A 2024 systematic review found, among other things, associations between erosive tooth wear and regurgitation or digestive disorders.

This does not mean:

“Dental erosion = reflux.”

The dental findings may be a clue, but gastro-oesophageal disease cannot be diagnosed from the teeth alone.

It can be a reason to ask about corresponding symptoms.

If the wear pattern and medical history suggest possible intrinsic acid exposure, medical assessment may be appropriate.

This applies, for example, when there are additional symptoms such as frequent acidic regurgitation or known stomach problems.

The role of the dental practice is to recognise the dental findings and not overlook possible medical associations.

Diagnosis and treatment of reflux disease, however, belong within medical care.

Repeated vomiting can expose the teeth to substantial acid loads.

This may occur with various gastrointestinal conditions or eating disorders.

Again, the dental findings must not be used to diagnose the cause of vomiting.

If an eating disorder is known or suspected, dental care should be non-judgemental and medically sensitive.

Protecting hard tooth tissue is only one part of the necessary healthcare.

Saliva helps protect tooth surfaces.

It dilutes and buffers acids, supports natural remineralisation of superficial demineralisation and contributes to the protective pellicle on the teeth.

With pronounced dry mouth, this protection may be reduced.

For noticeable erosive tooth wear, it is therefore also relevant to ask whether:

• persistent dry mouth is present,
• medications are being taken that may affect salivary flow,
• or other medical conditions are present.

Dry mouth also does not prove that it is the sole cause of erosion.

Diagnosis is based on several components.

Medical and dental history

Possible contributing factors are reviewed first.

These may include:

• eating and drinking habits,
• acidic drinks,
• reflux or regurgitation,
• vomiting,
• medications,
• dry mouth,
• clenching or grinding,
• occupational or sports-related exposures,
• and previous changes to the teeth.

Clinical examination

The examination then assesses:

• which tooth surfaces are affected,
• what the defects look like,
• whether dentine is exposed,
• whether fillings or restoration margins are unusual,
• and whether other forms of tooth wear are present at the same time.

Documentation

The Basic Erosive Wear Examination (BEWE), for example, can be used for structured documentation.

Such an index helps record the initial findings systematically and compare them over time.

It does not replace the overall clinical assessment.

BEWE stands for Basic Erosive Wear Examination.

Tooth surfaces are assessed and documented according to the extent of erosive wear.

This can help to:

• record the baseline condition,
• describe the extent in a structured way,
• and recognise changes more readily at later reviews.

A current systematic review of tooth-wear measurement methods also shows that different indices have different strengths and limitations.

A BEWE score alone therefore does not automatically answer which treatment an individual patient needs.

Existing tooth wear does not automatically mean that it is currently progressing rapidly.

In some patients, older defects can remain stable for long periods. In others, tooth structure continues to be lost.

This distinction has a major influence on treatment planning.

Depending on the situation, monitoring may use:

• clinical documentation,
• photographs,
• models or digital scans,
• and repeated structured assessment.

Which method is used at the practice in an individual case depends on the diagnostic question.

Not every erosion needs an immediate restoration.

For early or stable changes, it may initially be appropriate to:

1. identify possible risk factors,
2. reduce further acid exposure where possible,
3. protect tooth surfaces,
4. manage sensitivity,
5. and monitor progression.

Restorative measures become more relevant, for example, when:

• there is marked tissue loss,
• dentine is exposed over larger areas,
• teeth become sensitive or painful,
• function or the bite is affected,
• the remaining tooth structure is structurally at risk,
• or the change is causing substantial aesthetic concern.

Treatment is therefore guided by severity, progression and impact — not by the diagnosis “erosion” alone.

No.

Hard tooth tissue that has already been clinically lost does not grow back in its original form.

This is different from remineralisation of very superficial demineralisation.

Fluorides and other preventive measures can support the resistance of the remaining tooth surface and form part of a protection strategy.

They cannot rebuild a cusp or incisal edge that has already been lost through erosion.

That is why early recognition matters.

Measures need to match the suspected exposure.

Possible elements of a prevention plan include:

• reducing the frequency of acidic drinks and snacks,
• avoiding prolonged contact with acidic drinks,
• not unnecessarily holding or swishing acidic drinks in the mouth,
• consuming acidic products in more defined periods rather than continuously throughout the day,
• using appropriate fluoride-containing oral-care products,
• taking dry mouth into account diagnostically,
• and arranging medical assessment if intrinsic acid exposure is suspected.

Individual recommendations should not be applied mechanically to every patient.

There is not sufficiently strong evidence to present a rigid rule such as “always wait exactly 30 minutes” or “always wait 60 minutes” as a universal medical requirement on this page.

Studies of erosive tooth wear show that dietary frequency and acid contact are important factors. Observational data at the same time call blanket post-meal waiting recommendations into question.

It is therefore more useful to consider the overall acid exposure and oral hygiene individually rather than making one fixed number of minutes the centre of prevention.

Fluoride-containing oral care can form part of prevention for erosive tooth wear.

Fluorides can help support the resistance of tooth surfaces. Which toothpaste or additional fluoride measure is appropriate depends on individual risk.

With pronounced erosion, dry mouth or additional caries risk, a more targeted prevention strategy may be useful.

Fluoride treatment does not, however, replace clarification of the underlying acid exposure.

If dentine is exposed, hypersensitivity can develop.

Depending on the cause and extent, desensitising measures, suitable oral-care products or restorative coverage of affected areas may be considered.

A sensitive tooth surface should not automatically be “sealed” or crowned.

It must first be clarified whether erosive tooth wear is actually present and how far it has progressed.

For localised defects, a direct composite restoration may be an option.

It can be used to restore lost tooth shape, cover sensitive areas or stabilise functionally relevant defects.

One advantage of direct restorations can be that they allow comparatively conservative additions and can be repaired if necessary.

Whether composite is appropriate depends on defect size, tooth position, occlusal loading and remaining tooth structure.

More about dental fillings

For larger defects, or where an indirect restoration is functionally more appropriate, ceramic partial restorations or crowns may be considered.

Digital CAD/CAM procedures can be used to manufacture suitable restorations.

This does not mean:

Dental erosion = automatically CEREC.

The medical decision comes first:

Which tooth structure is missing and how does the tooth need to be protected or restored?

Only then is the appropriate material and manufacturing pathway selected.

More about CEREC and CAD/CAM

With severely advanced generalised tooth wear, treatment may become more complex.

Several teeth may need to be assessed together and the overall bite situation considered.

Depending on the findings, direct and indirect restorations may be combined or more extensive prosthetic concepts may be necessary.

Such cases are not simply a sequence of individual crowns.

Treatment goals, available tooth structure, bite height, function, aesthetics and long-term repairability need to be planned together.

More about dental restorations

There is no universally best method.

Current systematic literature on moderate and severe tooth wear shows that different direct and indirect restorative concepts can be used.

The evidence does not justify claiming that composite, ceramic or full crowns are inherently superior in every situation.

Important factors include:

• extent of tissue loss,
• activity and progression,
• affected teeth,
• functional loading,
• remaining tooth structure,
• ability to address the underlying causes preventively,
• and the patient's goals.

A flat price would not be meaningful.

For one patient, diagnostic monitoring and prevention may initially be the main focus.

For another, individual small defects may need to be restored.

With severe tooth wear, more extensive functional and restorative rehabilitation may be required.

Costs therefore depend, among other factors, on:

• the number and extent of affected teeth,
• required diagnostics,
• direct or indirect restorations,
• materials,
• dental laboratory work,
• and individual insurance status.

No separate flat “dental erosion package price” has been verified for the practice, so none is stated on this page.

Dental erosion is an acid-associated, non-carious loss of hard tooth tissue.

Important points are:

• Erosion is not the same as caries.
• Chemical and mechanical wear processes can interact.
• Acid can reach the teeth through diet or from within the body, for example through repeated regurgitation.
• Erosive dental findings do not prove reflux or another general medical condition.
• Diagnosis and monitoring are based on history, clinical pattern and structured documentation.
• Not every erosion needs immediate restorative treatment.
• Advanced defects may require direct composite, indirect ceramic or more extensive restorative concepts.
• There is no universal “best” restoration or rigid toothbrushing waiting period.

The goal is first to control ongoing tissue loss as far as possible and then restore only as much tooth structure as necessary.

Further information:

Dental fillings CEREC and CAD/CAM Dental restorations

The medical assessment particularly considered current systematic reviews on risk factors and restorative treatment of erosive tooth wear, as well as European consensus work on diagnosis, prevention and management.

A current German AWMF guideline that comprehensively covers dental erosion or erosive tooth wear as an independent topic was not identified during the research. Older European consensus definitions are therefore not presented as a “current German guideline”, but are supplemented with newer systematic evidence.

A particularly important distinction is between association and an individual's actual cause: acidic diet, regurgitation or gastrointestinal symptoms may be relevant risk factors, but they do not by themselves establish the cause in an individual patient.

Editorial review date: 10 August 2026. This page does not replace an individual dental or medical diagnosis and treatment plan.