Dental Erosion (Acid Wear of the Teeth)
Dental erosion is the slow dissolving of tooth enamel by acid that does not come from bacteria — acid from drinks and foods, or acid from the stomach. Each acid contact softens a thin layer of the tooth surface, and brushing, chewing or grinding then wipes that softened layer away. Over years the teeth become smoother, thinner, shorter and more sensitive. The wear that has happened is permanent, but research shows its progress depends heavily on how often acid touches the teeth, on saliva, and on medical conditions such as reflux and eating disorders that the teeth can quietly reveal.
Table of Contents
What Dental Erosion Is
Dental erosion is defined in the dental literature as an acid-related loss of tooth structure that does not involve microorganisms (germs). That one detail separates it from tooth decay (dental caries). In decay, bacteria living in dental plaque eat sugar and produce acid right against the tooth. In erosion, the acid arrives from outside the plaque — from a glass of soda, a lemon, a sports drink, or stomach acid coming up into the mouth.
Dentists split erosion into two kinds by where the acid comes from:
- Extrinsic erosion — acid from outside the body, usually acidic foods and drinks, sometimes acid vapours or liquids at work, or certain medicines and supplements.
- Intrinsic erosion — acid from inside the body: stomach acid that reaches the mouth through reflux, regurgitation or repeated vomiting.
Erosion rarely works alone. A consensus report from the European Federation of Conservative Dentistry describes the condition as erosive tooth wear: a chemical-mechanical process in which acid weakens the surface and everyday mechanical forces — brushing (abrasion), tooth-against-tooth contact and grinding (attrition) — remove what the acid has weakened. The result is a cumulative loss of hard tooth tissue, recognised by the loss of the tooth’s natural surface shape and contour.
It is common. A narrative review of the world’s prevalence data estimated, as a rough mean, that erosion affects 30% to 50% of children’s baby teeth and 20% to 45% of adults’ permanent teeth, with prevalence rising with age. In a 2024 study of 3,551 adults examined in seven European countries, some sign of erosive tooth wear (a score of 1 or more on the Basic Erosive Wear Examination) was found in 97.6% of participants, and it continued to increase with age.
How Acid Dissolves Enamel
Enamel, the hard outer shell of the tooth, is made mostly of a calcium phosphate mineral. Under it lies dentine, a softer, more mineral-soluble layer that is connected to the nerve. Whether a liquid dissolves enamel is a matter of chemistry: its acidity (pH — the lower the number, the more acidic) and how much calcium and phosphate it already carries.
A review of the chemistry of erosion explains the key idea of a critical pH. In plaque fluid, with its usual calcium and phosphate content, enamel starts to dissolve below a pH of about 5.5. For erosion the threshold moves: a product that contains more calcium and phosphate than plaque fluid, such as yoghurt, has a lower critical pH and is less likely to dissolve enamel, while a liquid with little calcium and phosphate dissolves it at a higher pH.
The same review describes the sequence. Erosion starts with softening of the enamel surface, then moves on to loss of volume, with a softened layer persisting on the surface of the tissue that remains. Enamel contains less soluble mineral than dentine, so it erodes more slowly; once erosion reaches dentine, the loss speeds up.
A review of beverage chemistry lists what makes a drink or food more erosive: a low pH, a high titratable acidity and buffer capacity (how much acid it holds in reserve, so saliva struggles to neutralise it), and low calcium and phosphate. Drinks rich in calcium and phosphate cause less demineralisation. How a drink is taken also matters: the same review reports that swishing a drink around the mouth tends to cause more erosion, because the thin layer of liquid touching the tooth keeps being refreshed and never becomes saturated with dissolved mineral.
Causes and Risk Factors
A review of the causes of erosion names nutrition, saliva, general diseases and mechanical stress as the main influences, and lists frequent intake of acidic foods and drinks, occupational acid exposure, and drugs or diseases that reduce saliva flow as factors that raise the risk.
The largest pooled analysis so far, a 2024 systematic review and meta-analysis of 71 observational studies, found these factors significantly linked with erosive tooth wear in adult teeth (an odds ratio, or OR, above 1 means more erosion among people with that factor; 2.0 means roughly twice the odds):
| Risk factor | Odds ratio (95% confidence interval) |
|---|---|
| Consumption of acidic foods | 2.40 (1.44–4.00) |
| Regurgitation (stomach contents coming up) | 2.27 (1.41–3.65) |
| Digestive disorders | 1.81 (1.48–2.21) |
| Nutritional supplements | 1.73 (1.28–2.35) |
| Carbonated drinks | 1.43 (1.17–1.75) |
| Male sex | 1.30 (1.16–1.44) |
| Seasoning sauces | 1.28 (1.13–1.44) |
The authors concluded that symptoms of gastroesophageal reflux disease and dietary factors are the most important things to look at when screening for erosion.
Acidic drinks and foods
A review chapter on acidic beverages reports that recent systematic reviews confirm frequent carbonated and soft drinks as the main dietary factor linked to erosive wear. Vitamin C (ascorbic acid, as chewable tablets or drinks), frequent natural fruit juice, and acidic snacks or sweets are also significantly associated with more wear, while higher intake of milk and yoghurt is associated with less. A 2023 systematic review of 19 studies on carbonated drinks noted that the pH of most commercial carbonated drinks is lower than the critical pH for enamel, and that both the pH and the length of exposure shape the damage.
Stomach acid
Stomach acid is far stronger than most dietary acids. The European consensus lists reflux and vomiting among the patient-related causes, together with drinking and eating habits, medications and dietary supplements. A narrative review of world prevalence data found that only two risk groups showed a clear impact on erosion: people with gastroesophageal reflux disease and people with eating disorders that involve vomiting. These links are covered in their own section below.
Saliva
Saliva is the mouth’s own defence. A 2023 systematic review of 15 studies describes how saliva protects against erosion by neutralising and clearing acids from both outside and inside the body, by forming the acquired pellicle (a thin protein film that coats the teeth and slows acid contact), and by supplying the calcium and phosphate needed to re-mineralise softened enamel. Low salivary flow, acidic pH, systemic illness and acidic diet all tip the balance toward erosion. The chemistry review adds that clinical reports show acid exposure combined with too little saliva produces more dissolution. Conditions and medicines that cause dry mouth therefore raise the risk.
Occupation and other factors
The European consensus also lists occupational exposure to acidic liquids or vapours.
Symptoms
Early erosion usually causes no pain at all, which is why it is often found by a dentist rather than noticed by the person. A clinical review of diagnosis describes the early signs as:
- Loss of enamel texture — the fine natural ridges and pits of the tooth surface disappear.
- A silky, glossy look, sometimes with a dulling of the surface shine.
- Cupping — small scooped-out hollows on the chewing tips of the back teeth.
- Fillings “standing proud” — the tooth around a filling wears down while the filling material does not, so the filling sits higher than the tooth.
As enamel thins, other changes can follow:
- Yellowing, as the yellower dentine shows through thinner enamel.
- Translucent, see-through edges on the front teeth, which may chip.
- Sensitivity to cold, hot, sweet or acidic things once dentine is exposed — see Tooth Sensitivity. In the seven-country European study, dentine sensitivity was significantly associated with erosive tooth wear.
- Shorter or flatter-looking teeth after many years of wear.
The pattern of wear can hint at the source of the acid. A review of eating disorders and oral health notes that in eating disorders involving vomiting, the risk of erosive wear is mainly on the palatal surfaces of the upper front teeth — the inner surfaces that face the tongue and the roof of the mouth, where stomach acid strikes first.
How Dental Erosion Is Diagnosed
Erosion is diagnosed by looking. There is no blood test or X-ray that shows it early. The diagnosis rests on two things:
- A careful clinical examination of every tooth surface for the signs listed above.
- A detailed history (what dentists call the anamnesis) of diet, drinks, sports, work, medicines, supplements, reflux symptoms, vomiting and general health. A review on causes notes that this combination is how the individual risk factors are identified.
The Basic Erosive Wear Examination
The European consensus names the Basic Erosive Wear Examination (BEWE) as a suitable index for classifying erosive tooth wear. The mouth is divided into six sections (sextants), the most affected surface in each is scored from 0 (no wear) to 3 (hard-tissue loss over half the surface or more), and the scores are added up to give an overall risk level. It is the same index used in the seven-country European prevalence study.
Measuring change over time
The clinical review describes monitoring progression with diagnostic models (casts of the teeth) or clinical photographs. Newer methods, such as three-dimensional scans of the teeth, are also used to compare wear between visits.
Telling erosion apart from other wear
Erosion often appears alongside other kinds of wear, which makes the diagnosis complex. Attrition (tooth-on-tooth wear, as in bruxism) tends to leave flat, matching facets on opposing teeth; abrasion (from a hard brush or abrasive habits) tends to leave notches near the gumline; and decay starts as a chalky or brown area under plaque. Erosion leaves smooth, rounded, shiny surfaces with no bacterial cause.
Treatment
Dental care for erosion has two parts, and the European consensus is explicit about their order. Preventive management aims to reduce or stop the progression of the lesions. Restorative management aims to reduce pain and dentine sensitivity or to restore appearance and function — and, in the consensus statement’s words, it should only be used together with preventive strategies, because a filling placed on teeth still bathed in acid continues to be undermined at its edges.
Finding and addressing the source of the acid
The clinical review describes the first step as recognising the process early, then deciding whether the main cause is intrinsic (stomach acid) or extrinsic (diet, drinks, work). The beverage-chemistry review describes dentists assessing a full diet record — what is eaten and drunk and how often — and tailoring dietary changes to the individual. When reflux or vomiting is suspected, medical evaluation of the underlying condition is part of care (see the section below).
Topical agents
Laboratory research has tested several products applied to eroded enamel. The evidence is almost entirely in vitro (on extracted teeth in the laboratory), not in people:
- Casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), a compound derived from milk protein that delivers calcium and phosphate to the tooth surface. A 2022 systematic review found only four in vitro studies that met its criteria; CPP-ACP was the only product that significantly increased enamel hardness and reduced tooth wear.
- Fluoride. The same 2022 review found no anti-erosion effect from the fluoride toothpastes tested in its two included studies (one of which carried a high risk of bias). A 2023 review of 34 in vitro studies reached a different reading: fluoride-based varnishes, toothpastes and solutions appeared successful at halting erosion and encouraging remineralisation. Dental guidelines commonly include fluoride products in erosion care. The site’s Fluoride section covers the separate debate over fluoride safety and informed consent.
Restoring worn teeth
For severe erosion, the 2023 review lists composite (tooth-coloured resin) restorations, veneers and crowns, and describes direct composite restorations — bonded straight onto the tooth with little or no drilling — as the less invasive option for the aesthetic and functional problems erosion causes. Bonding is also used to cover exposed, sensitive dentine.
Prevention
The research on prevention describes which conditions are linked with less erosion. It centres on three ideas: how often acid touches the teeth, how long it stays, and how well the mouth can recover between contacts.
- Frequency matters more than any single exposure. The beverage-chemistry review identifies frequent consumption of carbonated drinks, fruit juices and acidic snacks as the risk pattern. Each contact starts a new softening cycle.
- Contact time matters. The same review reports that swishing a drink in the mouth causes more erosion than a quicker contact, and the carbonated-drink review found that exposure duration shapes the damage.
- Calcium-rich foods are protective. Higher intake of milk and yoghurt is associated with less erosive wear, and the European consensus names calcium concentration as the major protective factor in foods and drinks. Whole plain yoghurt, kefir and cheese are naturally rich in calcium and phosphate.
- Saliva repairs early damage. Saliva neutralises acid, coats the teeth in a protective pellicle, and supplies minerals for re-hardening. Anything that keeps saliva flowing works in the teeth’s favour, and anything that dries the mouth works against them.
- The softened surface is fragile. Because erosion is a chemical-mechanical process, the acid-softened layer is more easily worn away by brushing, grinding or abrasive habits than sound enamel is.
- Treating the internal source. When reflux or vomiting drives the erosion, the review on reflux and dental erosion found the link strong enough that controlling the underlying condition is part of protecting the teeth.
Erosion as a Clue to Reflux and Eating Disorders
Erosion is one of the few dental findings that can point to a hidden medical condition. Two conditions stand out in the research.
Gastroesophageal reflux disease (GERD)
Gastroesophageal reflux disease is a condition in which stomach contents flow back up into the food pipe (oesophagus), and sometimes into the throat and mouth. A 2025 systematic review of 22 studies found a significantly higher prevalence of dental erosion in adults with GERD or with laryngopharyngeal reflux (reflux that reaches the throat and voice box) than in healthy adults — and, in the other direction, a higher prevalence of reflux among people with erosion.
Some people with reflux have no heartburn they notice. In a 2022 study of 80 dental patients examined with the Basic Erosive Wear Examination, the extent of erosion rose with reflux symptoms among people with no current GERD diagnosis. Twenty-eight patients with more severe erosion were evaluated in a gastroenterology department; GERD was diagnosed in 27 of the 28, and 9 of them had denied any past history of the disease. Of 20 who underwent upper endoscopy, 6 had oesophageal lesions — erosive oesophagitis in 5 and Barrett’s oesophagus (a change in the lining of the food pipe that raises the risk of oesophageal cancer) in 1. The authors concluded that for some patients, erosion may be the only clinical sign of untreated or undertreated reflux.
Eating disorders
A systematic review and meta-analysis of eating disorders and tooth erosion, which notes that eating disorders carry the highest rates of illness and death of any mental disorder among adolescents, found that people with an eating disorder had 12.4 times the odds of tooth erosion (OR 12.4, 95% CI 4.1–37.5). Among people with an eating disorder, those who self-induced vomiting had 19.6 times the odds compared with those who did not (OR 19.6, 95% CI 5.6–68.8). The authors concluded that the evidence suggests a causal relationship between tooth erosion and eating disorders with purging.
A review of eating disorders and oral health — covering binge eating disorder, bulimia nervosa and anorexia nervosa — describes oral health professionals as having a unique role in early diagnosis. In eating disorders that involve vomiting, the erosion is concentrated on the inner, tongue-side surfaces of the upper front teeth; the same review reports emerging evidence of frequent gum inflammation and gum recession linked to compulsive toothbrushing.
Complications
- Permanent loss of tooth structure. Enamel does not grow back. Once worn away, it is replaced only by restorative materials.
- Dentine sensitivity and pain. Exposed dentine reacts to cold, heat, sweet and acid. The European consensus lists reducing pain and dentine hypersensitivity as one aim of restorative treatment.
- Higher risk of decay. The 2023 carbonated-drink review describes eroded enamel as rougher, which favours bacterial adhesion and raises the risk of tooth decay.
- Changes in appearance and function. Teeth can become yellow, thin, chipped, shorter and flatter, affecting the bite and smile. The 2023 review of treatments describes erosion as causing both aesthetic and functional problems.
- Failing fillings. Tooth around fillings wears faster than the filling, leaving edges exposed.
- A missed medical condition. Reflux and eating disorders can have serious consequences when they go undiagnosed — in the 2022 dental-clinic study above, endoscopy found oesophageal lesions in 6 of 20 patients examined. Erosion can be the first visible sign.
Warning Signs and Urgent Signs
Signs that point to dental erosion
- Teeth that look glassy, smooth or shiny, with the natural surface texture gone.
- Small hollows on the chewing tips of the back teeth, or fillings that sit higher than the tooth around them.
- Front teeth with see-through or chipping edges, or teeth that look shorter or more yellow than before.
- New sensitivity to cold, sweet or acidic food and drink.
- Wear on the inner surfaces of the upper front teeth — the pattern most linked with stomach acid.
- A sour or acid taste in the mouth, frequent heartburn, regurgitation, chronic hoarseness or throat clearing — possible signs of reflux reaching the mouth.
Signs medical and dental services treat as urgent
- Vomiting blood or material that looks like coffee grounds, or black, tarry stools — signs of bleeding in the upper digestive tract, which emergency departments treat as an emergency.
- Difficulty or pain swallowing, food sticking, or unintended weight loss together with reflux — alarm features that gastroenterology guidelines treat as reasons for prompt endoscopy.
- Chest pain that may be mistaken for heartburn — chest pain with breathlessness, sweating, or pain spreading to the arm, neck or jaw is a sign of a possible heart attack.
- Repeated self-induced vomiting, fainting, a racing or irregular heartbeat, or severe weakness in someone with an eating disorder — repeated vomiting depletes potassium and other salts, which can cause dangerous heart-rhythm problems.
- A worn tooth with severe throbbing pain, swelling of the gum or face, or fever — signs of a tooth abscess. Swelling that spreads to the floor of the mouth or neck, or difficulty swallowing or breathing, is a spreading infection that can be life-threatening.
Key Research Papers
- Kanzow P, Wegehaupt FJ, Attin T, Wiegand A. Etiology and pathogenesis of dental erosion. Quintessence International. 2016;47(4):275-8. PubMed PMID: 27022647
- Lussi A, Schlueter N, Rakhmatullina E, Ganss C. Dental erosion — an overview with emphasis on chemical and histopathological aspects. Caries Research. 2011;45(Suppl 1):2-12. PubMed PMID: 21625128
- 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. Clinical Oral Investigations. 2015;19(7):1557-61. PubMed PMID: 26121968
- Donovan T, Nguyen-Ngoc C, Abd Alraheam I, Irusa K. Contemporary diagnosis and management of dental erosion. Journal of Esthetic and Restorative Dentistry. 2021;33(1):78-87. PubMed PMID: 33410255
- Saads Carvalho T, Lussi A. Chapter 9: Acidic Beverages and Foods Associated with Dental Erosion and Erosive Tooth Wear. Monographs in Oral Science. 2020;28:91-98. PubMed PMID: 31940633
- Dipalma G, Inchingolo F, Patano A, Guglielmo M, Palumbo I, Campanelli M, et al. Dental erosion and the role of saliva: a systematic review. European Review for Medical and Pharmacological Sciences. 2023;27(21):10651-10660. PubMed PMID: 37975390
- Marschner F, Kanzow P, Wiegand A. Anamnestic risk factors for erosive tooth wear: Systematic review, mapping, and meta-analysis. Journal of Dentistry. 2024;144:104962. PubMed PMID: 38552999
- Schlueter N, Luka B. Erosive tooth wear — a review on global prevalence and on its prevalence in risk groups. British Dental Journal. 2018;224(5):364-370. PubMed PMID: 29495027
- West NX, Davies M, Sculean A, Jepsen S, Faria-Almeida R, Harding M, et al. Prevalence of dentine hypersensitivity, erosive tooth wear, gingival recession and periodontal health in seven European countries. Journal of Dentistry. 2024;150:105364. PubMed PMID: 39317300
- Inchingolo AM, Malcangi G, Ferrante L, Del Vecchio G, Viapiano F, Mancini A, et al. Damage from Carbonated Soft Drinks on Enamel: A Systematic Review. Nutrients. 2023;15(7). PubMed PMID: 37049624
- Né YGS, Souza-Monteiro D, Frazão DR, Alvarenga MOP, Aragão WAB, Fagundes NF, et al. Treatment for dental erosion: a systematic review of in vitro studies. PeerJ. 2022;10:e13864. PubMed PMID: 36389398
- Inchingolo F, Dipalma G, Azzollini D, Trilli I, Carpentiere V, Hazballa D, et al. Advances in Preventive and Therapeutic Approaches for Dental Erosion: A Systematic Review. Dentistry Journal (Basel). 2023;11(12). PubMed PMID: 38132412
- Wang J, Zhou Y, Lei D. Relationship Between Laryngopharyngeal Reflux, Gastroesophageal Reflux Disease, and Dental Erosion in Adult Populations: A Systematic Review. Digestive Diseases and Sciences. 2025;70(3):1078-1090. PubMed PMID: 39826062
- Ellis AW, Kosaraju A, Ruff RR, Miller CB, Francis JM, Vandewalle KS. Dental erosion as an indicator of gastroesophageal reflux disease. General Dentistry. 2022;70(6):46-51. PubMed PMID: 36288075
- Hermont AP, Oliveira PA, Martins CC, Paiva SM, Pordeus IA, Auad SM. Tooth erosion and eating disorders: a systematic review and meta-analysis. PLoS One. 2014;9(11):e111123. PubMed PMID: 25379668
- Rangé H, Colon P, Godart N, Kapila Y, Bouchard P. Eating disorders through the periodontal lens. Periodontology 2000. 2021;87(1):17-31. PubMed PMID: 34463986
PubMed Topic Searches
Connections
- Dentistry & Oral Health
- Tooth Decay (Dental Caries)
- Tooth Sensitivity (Dentin Hypersensitivity)
- Dry Mouth (Xerostomia)
- Bruxism (Teeth Grinding and Clenching)
- Tooth Abscess (Dental Abscess)
- Oral Microbiome
- Gum Disease
- Gastroesophageal Reflux Disease
- Barrett’s Esophagus
- Eating Disorders
- Bulimia Nervosa
- Sjögren’s Syndrome
- Fluoride
- Calcium