Risk Assessment: Tooth Wear

  • David BartlettEmail author
  • Saoirse O’Toole


Tooth wear is the multifactorial process where acids and mechanical challenges either act alone or together remove enamel and then dentine. The interaction of acids and mechanical processes, attrition and abrasion, has led to increasing adoption of the term “erosive tooth wear”. This term acknowledges that most tooth wear is multifactorial, often with acids having some role in the progression. Risk assessment of tooth wear should focus on the frequency, duration and interplay of the causes. This chapter provides an overview of risk factors and discusses their individual and synergistic role in tooth wear progression. Risk characteristics are categorised by severity and existing clinical presentation. The basic erosive wear examination (BEWE) is advocated as a basic tool to screen for tooth wear. Patient health and behaviours can change which may necessitate repeating risk assessments on a regular basis when uncontrolled wear is diagnosed. Patients need to be informed not only of the risk of progression but also on the risks of restorative treatment. There is evidence that progression can be slowed to physiological levels with elimination of risk factors. Practitioners are reminded that tooth wear is a slow process and preventive approaches are encouraged.


  1. 1.
    Carvalho TS, Colon P, Ganss C, Huysmans MC, Lussi A, Schlueter N, et al. Consensus report of the European Federation of Conservative Dentistry: erosive tooth wear—diagnosis and management. Clin Oral Investig. 2015;19:1557–61. Scholar
  2. 2.
    Jaeggi T, Lussi A. Prevalence, incidence and distribution of erosion. In: Lussi A, Ganss C, editors. Erosive tooth wear - from diagnosis to ther. 2nd ed. Basel: Karger; 2014. p. 55–74.Google Scholar
  3. 3.
    Bartlett DW, Lussi A, West NX, Bouchard P, Sanz M, Bourgeois D. Prevalence of tooth wear on buccal and lingual surfaces and possible risk factors in young European adults. J Dent. 2013;41:1007–13. Scholar
  4. 4.
    El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63:871–80. Scholar
  5. 5.
    Smink FRE, van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep. 2012;14:406–14. Scholar
  6. 6.
    Goodwin TM. Hyperemesis Gravidarum. Obstet Gynecol Clin North Am. 2008;35:401–17. Scholar
  7. 7.
    Vakil N, Van Zanten SV, Kahrilas P, Dent J, Jones R, Bianchi LK, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20. Scholar
  8. 8.
    Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. Br Med J. 1999;319:1467–8. Scholar
  9. 9.
    O’Toole S, Bernabé E, Moazzez R, Bartlett D. Timing of dietary acid intake and erosive tooth wear: a case-control study. J Dent. 2017;56:96–104. Scholar
  10. 10.
    Lussi A, Schaffner M. Progression of and risk factors for dental erosion and wedge-shaped defects over a 6-year period. Caries Res. 2000;34:182–7. Scholar
  11. 11.
    Hasselkvist A, Johansson A, Johansson AK. A 4 year prospective longitudinal study of progression of dental erosion associated to lifestyle in 13-14 year-old Swedish adolescents. J Dent. 2016;47:55–62. Scholar
  12. 12.
    O’Toole S, Bartlett D. The relationship between dentine hypersensitivity, dietary acid intake and erosive tooth wear. J Dent. 2017:0–1.
  13. 13.
    Mulic A, Tveit AB, Hove LH, Skaare AB. Dental erosive wear among Norwegian wine tasters. Acta Odontol Scand. 2011;69:21–6. Scholar
  14. 14.
    Ashley P, Di Iorio A, Cole E, Tanday A, Needleman I. Oral health of elite athletes and association with performance: a systematic review. Br J Sports Med. 2014:1–7.
  15. 15.
    Alaraudanjoki V, Laitala M-L, Tjäderhane L, Pesonen P, Lussi A, Ronkainen J, et al. Influence of intrinsic factors on erosive tooth wear in a large-scale epidemiological study. Caries Res. 2016;50:508–16. Scholar
  16. 16.
    Glossary of Prosthodontics. The glossary of prosthodontic terms. Prosthet Dent. 2005;94:10–92. Scholar
  17. 17.
    Manfredini D, Winocur E, Guarda-Nardini L, Paesani D, Lobbezoo F. Epidemiology of bruxism in adults: a systematic review of the literature. J Orofac Pain. 2013;27:99–110.CrossRefGoogle Scholar
  18. 18.
    Ohmure H, Oikawa K, Kanematsu K, Saito Y, Yamamoto T, Nagahama H, et al. Influence of experimental esophageal acidification on sleep bruxism: a randomized trial. J Dent Res. 2011;90:665–71. Scholar
  19. 19.
    Ohmure H, Kanematsu-Hashimoto K, Nagayama K, Taguchi H, Ido A, Tominaga K, et al. Evaluation of a proton pump inhibitor for sleep bruxism. J Dent Res. 2016;
  20. 20.
    Castroflorio T, Bargellini A, Rossini G, Cugliari G, Deregibus A. Sleep bruxism and related risk factors in adults: a systematic literature review. Arch Oral Biol. 2017;
  21. 21.
    Falisi G, Rastelli C, Panti F, Maglione H, Quezada Arcega R. Psychotropic drugs and bruxism. Expert Opin Drug Saf. 2014;13:1319–26. Scholar
  22. 22.
    Guo H, Wang T, Niu X, Wang H, Yang W, Qiu J, et al. The risk factors related to bruxism in children: a systematic review and meta-analysis. Arch Oral Biol. 2017;
  23. 23.
    Hunter ML, Addy M, Pickles MJ, Joiner A. The role of toothpastes and toothbrushes in the aetiology of tooth wear. Int Dent J. 2002;52:399–405. Scholar
  24. 24.
    Lippert F, Arrageg MA, Eckert GJ, Hara AT. Interaction between toothpaste abrasivity and toothbrush filament stiffness on the development of erosive/abrasive lesions in vitro. Int Dent J. 2017:1–7.
  25. 25.
    West NX, Sanz M, Lussi A, Bartlett DW, Bouchard P, Bourgeois D. Prevalence of dentine hypersensitivity and study of associated factors: a European population-based cross-sectional study. J Dent. 2013;41:841–51. Scholar
  26. 26.
    Fukumoto Y, Horibe M, Inagaki Y, Oishi K, Tamaki N, Ito HO, et al. Association of gingival recession and other factors with the presence of dentin hypersensitivity. Odontology. 2014;102:42–9. Scholar
  27. 27.
    Shah N, Mathur VP, Jain V, Logani A. Association between traditional oral hygiene methods with tooth wear, gingival bleeding, and recession: a descriptive cross-sectional study. Indian J Dent Res. 2018;29:150–4. Scholar
  28. 28.
    Silva AG, Martins CC, Zina LG, Moreira AN, Paiva SM, Pordeus IA, et al. The association between occlusal factors and noncarious cervical lesions: a systematic review. J Dent. 2013;41:9–16. Scholar
  29. 29.
    Pieterse S, De Jong N, De Vos N. Does fluoride rinsing have an effect on teeth status? Evaluation of preventive dental health activities for the youth of Woudenberg, The Netherlands. Int J Dent Hyg. 2006;4:133–9.CrossRefGoogle Scholar
  30. 30.
    Austin RS, Stenhagen KR, Hove LH, Tveit AB, Moazzez R, Bartlett DW. The effect of single-application fluoride treatment on simulated gastric erosion and erosion-abrasion of enamel in vitro. Int J Prosthodont. 2014;27:425–6. Scholar
  31. 31.
    Bartlett D, Ganss C, Lussi A. Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs. Clin Oral Investig. 2008;12(Suppl 1):S65–8. Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Centre for Oral Clinical & Translational Sciences, Faculty of Dentistry, Oral & Craniofacial SciencesLondonUK

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