Enamel erosion: how it differs from abrasion and wedge-shaped lesions, whether enamel grows back and how to stop it

What is enamel erosion?

Enamel erosion is the loss of the hard tissues of a tooth caused by acids that, unlike in tooth decay, do not come from bacteria. The British prevention guidance Delivering better oral health (DBOH, updated in 2025) defines it as the chemical loss of tissue caused by acids from outside the body, that is from food and drink, or from inside it, that is from the stomach.

Erosion rarely acts alone. DBOH stresses that tooth wear usually has several causes at once: erosion, abrasion from brushing and contact between the teeth act together and jointly change the shape of the tooth. Some wear is natural with age, which is why its severity is always assessed in relation to the patient’s age.

Tooth wear is common, but in most people it does not progress quickly. In the 2009 survey of adults in England, 77% of those examined had some wear, 15% moderate wear and 2% severe wear, and in a European study of people aged 18 to 35, erosive wear of at least moderate severity was found in 29% (Bartlett et al., 2013).

Erosion, abrasion, attrition and abfraction: how do you tell them apart?

Erosion, abrasion, attrition and abfraction differ in their cause: erosion is caused by acid, attrition by contact between teeth, abrasion by a toothbrush, toothpaste or hard objects, and abfraction is attributed to overloading in the bite. DBOH defines attrition as tissue loss through tooth-to-tooth contact, and abrasion as loss caused by objects other than teeth, such as a toothbrush or hard objects.

Abfraction is the most disputed. DBOH describes it as a notch at the gum margin, associated with vigorous brushing, and does not recommend using the term, while a review of 28 clinical studies found the role of the bite in the development of lesions at the necks of teeth to be unestablished (Senna et al., 2012). Non-carious lesions at the necks of teeth, commonly called wedge-shaped, are nonetheless very common: in a review of 24 studies they affected 46.7% of adults on average (Teixeira et al., 2020).

The table sets out the four types of wear. In practice a single tooth often shows signs of several of them at once, and the cause is settled only by an examination and a conversation about habits.

Acidic drinks and reflux: where do the acids that damage enamel come from?

The acids that damage enamel come most often from drinks and food. DBOH lists fizzy drinks other than unflavoured sparkling water, wine, energy and sports drinks, smoothies, fruit teas, sour sweets, foods with vinegar and acidic fruit eaten in large amounts, as well as some medicines, such as chewable vitamin C tablets or inhaled asthma medicines.

A meta-analysis of 71 observational studies linked erosion to frequent eating of acidic foods (odds ratio 2.40), to fizzy drinks (1.43) and to reflux of stomach contents (2.27); the authors advise asking people at risk above all about reflux symptoms and diet (Marschner et al., 2024). DBOH points out that fruit should not be discouraged for anyone, unless it has been identified as a risk factor.

Stomach acid reaches the mouth with reflux, with frequent vomiting, including in pregnancy, and with eating disorders. An international consensus of doctors, known as the Montreal consensus, concluded that erosions are more common in people with reflux disease, especially on the tongue and palate sides of the teeth, and a review in the International Journal of Dentistry (2012) points out that the dentist is sometimes the first person to notice the effects of reflux without the typical symptoms. In that case the doctor establishes and treats the cause, and the dentist protects the teeth.

What does enamel erosion look like, and what are its symptoms?

At first, enamel erosion looks like a loss of shine: DBOH describes a matt surface resembling frosted glass. Over time, hollows exposing the dentine appear on the molars and may merge, and on the front teeth the edges become thinner and shorter; according to DBOH, wear is more common on the palate side of the upper incisors than on the lip side.

A common symptom is sensitivity to cold and acidic things, which according to DBOH can appear even with slight wear, especially at the necks of the teeth. Sensitivity in itself does not mean that erosion is progressing, however; its treatment is described in a separate article on sensitive teeth. The list brings together signs worth showing a dentist.

• A matt surface without shine, resembling frosted glass.
• Thinner and shorter edges of the front teeth, a flattened tooth shape.
• Hollows on the chewing surfaces of the molars, in which the dentine is exposed.
• Changes on the palate side of the upper teeth, more common with reflux.
• Brief pain with cold or acidic things in several teeth, often at the necks.

How does a dentist assess erosion: what is the BEWE index?

A dentist assesses erosion on the BEWE scale (Basic Erosive Wear Examination), developed in 2008 as a simple index for everyday practice. In each of the six parts of the dentition, the score of the most worn surface is recorded: 0 means no wear, 1 an initial loss of enamel surface texture, 2 a distinct defect involving less than half of the surface, and 3 a defect of half the surface or more.

The sum of the scores sets the level of risk and the next steps. A total of up to 2 means routine monitoring, 3 to 8 low risk with advice on diet and hygiene, 9 to 13 medium risk and 14 or more high risk; at the two higher levels the cause is sought, fluoride measures are considered and the changes are documented with photographs or models, with visits repeated every 6 to 12 months. The authors point out that the thresholds still need to be validated, and DBOH recommends more frequent check-ups when wear is rapid.

Does enamel grow back?

Enamel does not grow back: the body cannot produce lost enamel again. DBOH writes that remineralisation is possible only in enamel, and only when there has been no mechanical loss, and that once tissue has been lost, tooth wear becomes irreversible.

That does not mean nothing can be done. Early erosion can be stopped by limiting the teeth’s contact with acids and strengthening the surface with fluoride; DBOH recommends fluoride toothpaste twice a day and, with erosion, considering a toothpaste with fluoride or with fluoride and a tin (stannous) compound. Toothpaste will not, however, fill a defect that has already formed.

Should you brush straight after an acidic meal, and how can erosion be prevented?

After an ordinary acidic meal you can brush whenever it is convenient, because newer data do not confirm that waiting to brush protects enamel. DBOH states that there is no strong evidence that the timing of brushing matters much, and a European study of young adults did not show that waiting after breakfast affected the degree of tooth wear (Bartlett et al., 2013).

Vomiting is the exception. DBOH recommends not brushing straight after vomiting but rinsing the mouth with water instead. The popular advice to wait an hour after every acidic food has no strong support in research, which is why DBOH does not recommend it to all patients. The list sets out the prevention rules according to DBOH.

• Drink fizzy and acidic drinks with meals, not in small sips throughout the day.
• For everyday drinking choose water, including unflavoured sparkling water.
• Do not hold acidic drinks in your mouth or swish them around your teeth; a wide straw may help, although the evidence is weak.
• Brush twice a day with fluoride toothpaste, gently and without highly abrasive toothpastes.
• If you often have heartburn or reflux, or you vomit, tell your doctor and your dentist.

How are enamel erosion and worn teeth treated?

Enamel erosion is treated according to its severity: early changes are monitored and protected, and fillings, bonding, onlays or crowns are used only when a defect is deep, sensitive or changes the shape of the teeth. The European expert consensus on severe tooth wear (Loomans et al., 2017) recommends first identifying the cause, prevention and monitoring, and putting off restoration for as long as possible.

When restoration is needed and the patient agrees to it, the consensus recommends a conservative, minimally invasive approach based on adhesive restorations, that is restorations bonded to the tooth, such as composite. With very advanced wear the dentist may plan onlays or crowns, and sensitive exposed necks of teeth can be protected with a varnish or a sealing agent.

In the clinic’s price list, the item “Leczenie nadwrażliwości Duraphat za 1 ząb” (sensitivity treatment with Duraphat, per tooth) costs 40 zł, “Leczenie nadwrażliwości za 1 ząb preparat Tokujama” (sensitivity treatment with a Tokuyama agent, per tooth) 100 zł, “Wypełnienie jednopowierzchniowe” (single-surface filling) 300 zł and “Bonding 1 zęba” (bonding, one tooth) 1 000 zł. The final scope and cost are set by the dentist after the examination, and prices may change.

On the NFZ (Poland’s National Health Fund), adults have fillings made of glass ionomer cements, and of chemically cured composite only in the front teeth, from canine to canine; children and young people up to 18 also have fluoride varnishing no more than once a quarter. Onlays and crowns are not funded by the NFZ, and light-cured composite, which is used for bonding, is not part of the adult package, except for people with a moderate or severe disability, when medically indicated (legal position as of 18 October 2026).

How it works at DentalBlue

At DentalBlue in Białystok, tooth wear is assessed by the dentist during the examination, and the causes are looked for in a conversation about diet, habits and stomach complaints. The clinic provides prevention, including fluoride treatment, cosmetic dentistry with bonding, and prosthodontics when teeth need onlays or crowns. A “Wizyta bez bólu” (visit without pain, 300 zł) includes a panoramic X-ray, a consultation, an examination and a written treatment plan with the prices of each stage. The clinic is open Monday to Friday from 8:00 to 20:00 and on Saturdays from 8:00 to 16:00.