Front bite with lips retractedHow common is severe tooth wear?

A study from the Netherlands (Prevalence of tooth wear in adults. Int J Prosthodont. 2009 Jan-Feb;22(1):35-42.) examined the prevalence of tooth wear in adults and assessed correlations using a systematic review. The study found that males have more wear than females. It also revealed that the percentage of adults with severe tooth wear is about 3 percent at age 20, and increases to 17 percent by age 70. To put this in the context of your practice:

  • 1 in 33 patients at age 20 exhibit tooth wear
  • 1 in 6 patients by age 70

It's obviously a progressive condition.

People's teeth wear more as they get older. Is tooth wear really a problem? As dentists, of course we feel that it's a problem. In fact, oftentimes we consider it a much bigger problem than our patients do.

Is tooth wear always bad? If you ask an anthropologist you'll get a very different response than you and I will give. Anthropologists view tooth wear as part of the aging process and so in fact, it could be considered a normal phenomenon of humans.

A study done in Adelaide, Australia (Tooth wear: the view of the anthropologist. Clin Oral Investig. 2008 Mar;12 Suppl1:S21-6. Epub 2007 Oct 16.), found from an anthropologist's point-of-view:

  • Tooth wear progresses as you get older.
  • Tooth wear is a normal physiological phenomenon.
  • Wear is considered pathological only if pulpal exposure or tooth loss occurred.
  • Attrition and abrasion have been known to exist in hunter-gatherers for thousands of years.
  • The prevalence of erosion in these populations has been insignificant.
  • In particular, non-carious cervical lesions to date have not been observed within these populations and therefore should be viewed as “modern day” pathology and not ancestral.

As dentists, the key in terms of our initial fear is to identify the etiology because this would have a huge impact on the prognosis for the future. And yes, tooth wear is a problem.

Steve Ratcliff, D.D.S., M.S., Spear Faculty and Contributing Author


Commenter's Profile Image Harry Batt DDS
April 12th, 2012
I have restored cases like this and they often come back to bite you. When the patient breaks a tooth off inside of the crown you made the blame is always placed on restoring dentist. Reducing teeth that already have received years of tensile stress further weakens them. You can only bend a wire so many times before it breaks. The old saying "Fools rush in" may apply. Patient's will not consistently wear a night guard. I am not saying don't restore but this type of case. But this may be the most challenging type of case to treat. Prepare to be "married" to this case for the foreseeable future.