Tooth wear

GENErAL

Epidemiology, aetiology and prevention of tooth wear

A. Johanna Leven*1 and Martin Ashley2

Key points
This paper summarises the clinical presentation Prevalence of tooth wear and aetiological factors Strategies for prevention of tooth wear are
of erosion, attrition and abrasion. are discussed in detail. described.

Abstract
Tooth wear is a commonly reported finding globally; however, many patients are unaware of having tooth wear.
Identifying early signs of erosion, abrasion or attrition and determining the risk factors contributing to a patient’s
tooth wear may help to prevent further loss of enamel and dentine in the future. Appropriate prevention should be
instigated, or appropriate referral made to other health professionals, when conditions such as gastroesophageal
reflux or eating disorders are suspected. This paper presents the epidemiology and aetiological factors for tooth
wear, as well as identifying the common clinical presentations of tooth wear. Patient perspectives on tooth wear and
preventive techniques that can be utilised are also discussed.

Introduction
Tooth wear is a common dental finding in
the general population, both within the UK
and globally. The majority of these patients
present with normal physiological wear, which
is expected over time, but a small proportion
of patients experience more extensive
pathological tooth wear.1 It can be a complex
and time-consuming condition to manage, as
treatment may require restoration of numerous
teeth, with or without reorganisation of the
occlusal scheme. Treatment might be carried
out over a number of appointments, utilising
potentially direct and indirect methods
of restoration. Therefore, the cost of this
treatment to patients, the NHS and health
insurance schemes can be high. There are
numerous risk factors which can contribute
to tooth wear. It is helpful if these factors can
1
Consultant in Restorative Dentistry, University Dental
Hospital of Manchester, Manchester, UK; 2Consultant
and Honorary Professor in Restorative Dentistry and
Oral Health, University Dental Hospital of Manchester,
Manchester, UK.
*Correspondence to: A. Johanna Leven
Email address: johanna.leven@mft.nhs.uk
Refereed Paper.
Submitted 10 August 2022
Revised 19 October 2022
Accepted 1 November 2022
https://doi.org/10.1038/s41415-023-5624-0
be identified from a patient’s history as far as
possible in order to control them. This not
only reduces the risk of further pathological
wear but will improve the predictability of any
treatment which is planned. Ideally, identifying
and controlling risk factors early may eliminate
the need for patients to ultimately need any
restorative treatment in the longer-term.
Epidemiology of tooth wear
Many patients will be unaware of the issue and
evidence of tooth wear may only be picked
up during a dental examination, while other
patients will actively seek treatment for the
condition.1 A degree of physiological tooth
wear is expected throughout life and increasing
age is a risk factor for increased severity of
tooth wear. A systematic review found 17% of
70-year-olds presented with severe tooth wear
compared to 3% of 20-year-olds.2 An average
reduction in crown length of 1.01 mm for
maxillary central incisors and 1.46 mm for
mandibular central incisors by a median age
of 70 years can be expected.3 Pathological tooth
wear is generally a slow process. Rodriguez
et al. demonstrated 77.7% of patients with
tooth wear into dentine and who reported
risk factors for ongoing tooth wear showed
median wear <15 μm over a six-month period;
however, approximately 2% of teeth measured
had wear >100 μm in six months. The authors
suggest the generally slow rate of wear could
not account for the amount of loss of tooth
structure to date and therefore, it is likely that
highly active periods of tooth wear occurs in
‘bursts’, while at other times being relatively
inactive.4 Clearly, a patient’s individual risk
factors would affect how active the tooth wear
process is. Monitoring of ‘at risk’ patients is
therefore important to detect patients who may
experience more frequent bursts of tooth wear,
which may result in more rapid and severe loss
of enamel and dentine.
Worldwide-reported prevalence of tooth
wear varies considerably and has been quoted
between 29–60% of the global population.1
The higher figure of 60% was reported in a
cross-sectional study carried out in six Arab
countries, of which Oman had the highest
proportion of participants with severe wear
when measured using Basic Erosive Wear
Examination index scoring.5 Eating more
than six times per day was reported as having
a significant correlation with tooth wear in this
population.6 In total, 29% of Europeans are
reported to have moderate tooth wear and 3%
have severe wear, with the UK found to have
the highest levels of tooth wear in Europe.7 The
2009 Adult dental health survey8 demonstrated
there had been an increase in moderate tooth
wear from 11–15% from 1998 in the UK and

BRITISH DENTAL JOURNAL | VOLUME 234 NO. 6 | MArch 24 2023 439

© The Author(s) under exclusive licence to the British Dental Association 2023.
 GENErAL

77% of adults demonstrated some degree of

tooth wear of their anterior teeth, which can
be explained partly by the physiological wear
expected with age. However, 2% had wear
involving secondary dentine. Plus, 4% of adults
aged 16–24 had moderate wear and 0.5% had
severe wear. The survey reported men had a
higher incidence of tooth wear than women,
which correlates with other studies.2,9,10,11,12
Social deprivation is also reported as a risk
factor for tooth wear.9

Aetiology

Numerous factors can contribute to higher

incidence of tooth wear, but very often, tooth Fig. 1 Pitting of enamel on labial surfaces due to extrinsic acid
wear is multifactorial in nature, resulting
from intrinsic acid, extrinsic acid, abrasion
or attrition. Genetic conditions affecting
the enamel and dentine structure, such as
amelogenesis imperfecta and dentinogenesis
imperfecta, are potential further risk factors
that may make teeth more susceptible to tooth
wear. A dry field, magnification and good
lighting are helpful to aid early detection
of the initial signs of tooth wear, which can
be subtle.

Erosion
Erosion is generally part of a multifactorial
process, as an acid attack softens the enamel
Fig. 2 Incisal and occlusal erosive cupping defects
and dentine, which then renders the surface
layers of the tooth susceptible to removal
via mechanical processes, such as attrition
and abrasion. The estimated mean global
prevalence of erosion is reported to be
20–45%.10
Intrinsic acid is a significant cause of erosive
wear. In a study of adult patients with gastro-
oesophageal reflux disease (GORD), it was
reported that between 9–75% showed signs of
erosion on at least one tooth versus between
0–40% in the control group.11 A controlled
cross-sectional study of female students
between 15–18 years of age found that of those
suffering from bulimia nervosa, dental erosion
was found in 45% of those with the eating
disorder compared to 8.8% among controls.12
Fig. 3 Severe palatal erosion as result of intrinsic acid
A Norwegian study suggested the risk factors
for erosion for men and women were different.
Repeated vomiting, GORD and drinking Numerous potential sources of extrinsic point these can dissolve. Typically, these drinks
fruit juice were significantly associated acids may be present in a patient’s diet. also have a high titratable acidity, which will
factors in women, but for men, consuming Carbonated drinks, white wine, cider, citrus require a longer period of time to neutralise.15
soft drinks was a significant factor linked to fruit and vinegar, to name a few, are common A study of 300 participants in the UK16
erosion13 Evidence suggests that gastric acid causes of erosion. These foods and drinks demonstrated a strong association between
may be linked to more severe tooth wear in typically have a pH lower than the critical pH three or more daily intakes of acid and erosive
comparison to dietary acids.14 5.5 (enamel) and pH 6.7 (dentine), at which tooth wear. The same study found that acidic

440 BRITISH DENTAL JOURNAL | VOLUME 234 NO. 6 | MArch 24 2023

© The Author(s) under exclusive licence to the British Dental Association 2023.
 GENErAL

of more active or rapid wear. Intrinsic acid

typically results in wear of the maxillary
palatal surface ‘perimolysis’ and occlusal-
lingual aspect of first mandibular molar
teeth,21 (Fig. 3) whereas extrinsic acid is more
associated with wear of the labial aspects
of teeth.

Fig. 4 a, b) Patient with canine guidance demonstrating lateral excursive movement.
Flattening of canine cusp tip evident which can be suggestive of a parafunctional habit
Fig. 5 a, b) Matching incisal wear facets between maxillary and mandibular teeth
Fig. 6 Dento-alveolar compensation in the region of the severely worn maxillary incisors has
resulted in the gingival zeniths of the incisors being lower than the canine and premolar teeth
fruit intake at mealtimes did not correlate to
an increased risk of erosion but eating fruit
between meals or over a long period of time
does carry an increased risk. Acidic drinks,
however, had a strong correlation with erosive
tooth wear, regardless of when they were
consumed. Drinking acidic drinks at higher
temperatures is also linked to an increased risk
of erosion.17
Professional wine tasters have been shown to
have a higher prevalence of erosive tooth wear
than the general population.18,19,20 Occlusal
surfaces of mandibular first molars were most
commonly affected in this group.18
There are a number of characteristic signs
of erosion. Early erosion in enamel initially
causes loss of surface contour, leading to
smooth polished or shiny surfaces, or pitting
of the enamel surface (Fig. 1). More advanced
erosion into dentine results in cupping defects
or dished out lesions on the occlusal surfaces
and progressive loss of dentine, which may
result in the pulp space becoming visible or
even exposed (Fig. 2). Anterior teeth may
start to appear more translucent and fractures
of the incisal edge can occur.21 Erosion may
result in pre-existing amalgam restorations
being left ‘proud’, as tooth surface loss has
occurred around the restoration. Patients may
complain of sensitivity where there are areas
of exposed dentine. Rates of pulpal necrosis
in tooth wear are generally low, as tooth wear
is typically a slow process, allowing time for
dentine repair. However, exposure of the pulp
space, symptoms of pulpal inflammation, or
acute sensitivity may potentially be evidence
Attrition
Attrition is a major cause of tooth wear.
Attrition was the predominant cause of tooth
wear in patients referred to secondary care in
Glasgow, UK, and the majority of patients were
found to be men.9 It is the result of friction
between opposing teeth and is frequently
associated with para-functional habits.22
Flattening of canine cusp tips can be an early
sign of parafunction, particularly in young
patients (Fig. 4). More generalised attrition can
affect the occlusal/incisal aspects of all teeth
but is most noticeable anteriorly. The enamel
becomes flattened, eventually exposing dentine,
and patients often develop matching occlusal
wear facets between the arches, which may
be more noticeable in patients with an edge-
to-edge incisal relationship or may become
apparent when the patient performs protrusive
or lateral excursive movements (Fig. 5). Dento-
alveolar compensation prevents loss of occlusal
vertical dimension as teeth become reduced in
height but can result in a noticeable step down
in the gingival zenith level (Fig. 6), or patients
having increased gingival display when smiling
(Fig. 7). Fractures of teeth or restorations,
tooth mobility and even pulpal necrosis may
be associated.23
Active parafunction may be evident from
oral ulcerations, scalloping of the peripheral
borders on the tongue as a result of tongue
thrusting, or linea alba of the buccal mucosal
due to repetitive frictional trauma from the
teeth24,25 (Fig. 8). Hypertrophic masseter and
temporalis muscles may be apparent.23 Bruxism
can present in both adults and children.
In the majority of cases, bruxism is a result of
central nervous system stimulation, which may
be triggered by numerous factors.23 A recent
systematic review reported that individuals
with sleep bruxism were found to have higher
levels of self-reported stress.26 Parafunctional
habits can occur when the patient is asleep or
awake. Another systematic review found rates
of generically termed bruxism was reported
to be between 8–31% in the population;
more specifically, the prevalence of ‘sleep
bruxism’ was found to be 12.8% (± 3.1%)
and ‘awake bruxism’ between 22.1–31% in

BRITISH DENTAL JOURNAL | VOLUME 234 NO. 6 | MArch 24 2023 441

© The Author(s) under exclusive licence to the British Dental Association 2023.
 GENErAL

adults.27 Conversely, Wetselaar et al. found

sleep bruxism was self-reported by 16.5% of
the adult Dutch population compared to 5%
reporting awake bruxism.28
Nocturnal bruxism may be secondary to
nocturnal GORD, occurring via sleep arousal
(that is, a shift in sleep states) and swallowing.
Miyawaki et al. reported that patients with
bruxism demonstrated higher frequency of
nocturnal rhythmic masticatory muscle activity,
as well as a higher frequency and percentage of
time of GORD episodes, compared to a non-
bruxing participants. It is believed that arousal
during sleep caused by upper airway resistance
Fig. 7 Patient with generalised severe tooth wear with increased gingival display
leads to a stress response throughout the body.
Arousal due to apnoea causes pulse rate and
respiratory rates to increase and triggers release
of stress hormones. Increased muscle activity in
the jaw inspired by this stress response may be
a cause for clenching or grinding.29
Higher rates of tooth wear into dentine have
been found in patients taking ecstasy (MDMA
[3,4-methylenedioxymethamphetamine]):
60% compared to 11% in non-users. This
cohort also reported high rates of bruxism
(89%) and xerostomia (>90%) and users
reported consuming as much as three cans
of carbonated drinks when using the drug.30
Both of these studies demonstrate the often- Fig. 8 Linea alba apparent on buccal mucosa
multifactorial nature of tooth wear.
Schizophrenia and medications such as
selective 5-hydroxytryptamine re-uptake
inhibitors, and some antipsychotic medications,
have been linked to bruxism.31 A literature
review of ten studies concluded that there also
may be, in part, a genetic link to bruxism.32
The use of smartphones has been suggested
as factor in parafunction. When compared to
the control of using a phone without internet
access, smartphones demonstrated a significant
link to bruxism and temporomandibular
joint disorders in a group of young adults in
Israel.33 Aspects of smartphone use, such as
stress from overuse, interrupted sleep due to
being awakened by notifications, and stress as
a result of negative information received via
Fig. 9 Buccal abrasion particularly evident on maxillary and mandibular canines
the smartphone, were reported to contribute
to parafunctional habits.
The link between a lack of posterior teeth Abrasion which may be because these teeth are in the
and attritive wear is discussed in a number of Abrasion is caused by wear from a foreign cross-over zone during toothbrushing and
studies but often, the evidence is anecdotal. object, such as a toothbrush and toothpaste, and often present the most prominent surfaces of
No definitive link between a shortened dental creates smooth cupping or V-shaped lesions on the most prominent teeth35 (Fig. 9). Brushing
arch and severity of attrition has been proved.22 the labial and cervical aspects of teeth. Patients three or more times per day has a significant
Indeed, a small study by Kowaza et al. found with recession and exposed cementum and positive correlation with tooth wear and so
that the more posterior teeth which were dentine are more at risk of abrasion, as these are it is important to question patients about
missing in fact resulted in lower maximal bite less wear resistant than enamel.35 Canine and their oral hygiene routine.6 Toothpastes such
force on the remaining anterior teeth.34 premolar teeth are most commonly affected, as whitening or smokers’ toothpastes can

442 BRITISH DENTAL JOURNAL | VOLUME 234 NO. 6 | MArch 24 2023

© The Author(s) under exclusive licence to the British Dental Association 2023.

also be more abrasive compared to standard
toothpastes. Popular trends such as charcoal
toothpastes may be particularly detrimental,
as some preparations are highly abrasive. In
addition, activated charcoal may negate the
available fluoride to re-mineralise enamel due
to the high affinity of activated charcoal to bind
fluoride ions.36
Significant abrasion can occur where natural
teeth oppose unpolished or unglazed porcelain
restorations, particularly in the presence of a
parafunctional habit and those consuming a
high volume of acidic drinks.37,38 Sometimes,
unusual patterns of wear can be seen on
the incisal aspects of teeth from musical
instruments or habits such as chewing pens or
fingernails repetitively.
Patient perspective
Patients may pursue a dental consultation,
seeking treatment for their tooth wear. In
studies reviewing the complaints of patients
referred to secondary care for the management
of tooth wear, aesthetic concerns were the
predominant complaint of patients, followed
by dentine hypersensitivity. Problems with
function and pain were less commonly
reported in this cohort.9,39
Moderate to severe erosive tooth wear
negatively impacts quality of life, with
stronger associations found in younger
patients, women, and those of a higher
socioeconomic background.40 Several studies
have demonstrated that more severe tooth
wear is associated with a greater impact on
quality of life.41,42,43
However, patients are often unaware of
having worn teeth or the risk factors associated.
Informing and educating patients about their
oral health is a key part of prevention. For
example, 61% of patients surveyed by Ahmed
et al. reported they had only been aware
of having tooth wear for six years or less.9
A questionnaire-based study in Norway of
patients aged 20–25 showed these patients had
limited knowledge of dental erosion. The study
also found that patients preferred to receive
information on erosion from dental health
professionals in the surgery supplemented by
relevant written information.41
Dentists may be the first professional to
raise concerns of GORD or potential eating
disorders with patients. The latter can be a
difficult conversation to broach with patients.
However, patients with eating disorders are
likely to have anxiety about causing damage
BRITISH DENTAL JOURNAL | VOLUME 234 NO. 6 | MArch 24 2023
© The Author(s) under exclusive licence to the British Dental Association 2023.
to their teeth. Dynesen et al. showed that
patients with eating disorders want their
dental professional to be able to discuss their
eating disorder with them and communicate
empathically toward them.42
Prevention
Treatment of tooth wear is challenging and
therefore, prevention at an early stage is key.
Standard dietary advice to prevent erosion
from dietary acids, such as reducing acid
consumption, drinking through a wide bore
straw, avoiding snacking between meals,
avoiding swilling drinks around the mouth,
and neutralising acids with dairy products,
such as low-fat milk and cheese, are all useful
messages to reinforce with patients. Patients
vomiting regularly should rinse the mouth
with fluoride mouthwashes after an episode
of vomiting and chew sugar-free xylitol gums
to promote saliva flow. It has been suggested
that toothbrushing after acid consumption or
vomiting is best avoided to reduce the risk of
removing demineralised enamel and dentine;
however, O’Toole et al. found that brushing
within ten minutes of acid consumption in
fact did not increase the risk of tooth wear.16
Toothbrushing immediately after vomiting is
probably not unusual, as it makes the mouth
feel cleaner. However, patients should be
encouraged to avoid this until some method
for diluting or neutralising the acidity has
been used.
Sodium fluoride dentifrices have been
demonstrated to promote remineralisation
and increase resistance of enamel to erosion.43
Therefore, prescription of high fluoride
toothpastes is advocated for patients at risk of
erosion. Formulations containing titanium or
tin have been found to be even more effective
in comparison to standard fluoride products
in prevention of erosive tooth wear. It is
thought stannous fluoride preparations work
by reducing enamel surface loss rather than
remineralisation of softened enamel.44
Counselling patients to avoid potentially
detrimental habits, such as chewing fingernails
or other objects, is recommended, in addition
to reviewing a patient’s toothbrushing
technique. Patients brushing excessively
should be advised to reducing brushing to
twice per day and use an electric toothbrush
with a pressure sensor.
There is weak evidence from case reports and
case studies to support the use of hypnotherapy
to manage nocturnal bruxism but very little
GENErAL
recent literature and no systematic reviews
exist on the topic.45,46 However, there are a
numerous clinics offering this service, which
is evident after a search of the terms ‘bruxism’
and ‘hypnosis’ on an internet search engine.
There is no strong evidence to support the
use of occlusal splints to prevent bruxism in
non-temporomandibular joint dysfunction
patients but they may help prevent further
tooth wear and protect any restorations which
are provided.47 However, patient compliance
with splints can vary.48 A maxillary splint or
orthodontic Essix retainer could be considered
for bulimia nervosa patients to wear during
self-induced vomiting, in order to protect
the maxillary teeth from the effects of the
intrinsic acid, as long as removed immediately
afterwards and the patient then rinsing with a
fluoride mouth rinse.
Patients suspected of suffering with
undiagnosed eating disorders or GORD
should be referred to their general medical
practitioner for suitable investigations
and treatment where appropriate. Useful
further information regarding diagnosis and
management of eating disorders can be found
in the 2017 National Institute for Health and
Care Excellence guidelines.49
Conclusion
Tooth wear remains a significant dental
health issue worldwide. Aesthetic concerns
are often the main drivers for patients seeking
treatment; however, by the time patients are
aware that their teeth have become worn,
significant loss of tooth structure may have
already occurred. Therefore, early diagnosis
to facilitate prevention is key to ultimately
avoid the need for potentially extensive and
costly treatments. Education of patients and
questioning about risk factors is a vital role
for dental health professionals. Dentists may
be the first healthcare professional to detect
signs of GORD or eating disorders and may be
best placed to refer patients on to appropriate
medical care.
Ethics declaration
The authors declare no conflicts of interest.
Author contributions
The paper was written by A. Johanna Leven, who
also provided the majority of figures used in the
manuscript. Martin Ashley reviewed the paper and
provided some figures, comments for changes and
improvements.
443
 GENErAL
References
1. Bartlett D, O’Toole S. Tooth Wear: Best Evidence
Consensus Statement. J Prosthodont 2021; DOI: 10.1111/
jopr.13312.
2. Van’t Spijker A, Rodriguez J M, Kreulen C M, Bronkhorst
E M, Bartlett D W, Creugers N H J. Prevalence of tooth
wear in adults. Int J Prosthodont 2009; 22: 35–42.
3. Ray D S, Wiemann A H, Patel P B, Ding X, Kryscio
R J, Miller C S. Estimation of the rate of tooth wear
in permanent incisors: a cross-sectional digital
radiographic study. J Oral Rehabil 2015; 42: 460–466.
4. Rodriguez J M, Austin R S, Bartlett D W. In vivo
measurements of tooth wear over 12 months. Caries Res
2012; 46: 9–15.
5. Bartlett D, Ganss C, Lussi A. Basic Erosive Wear
Examination (BEWE): a new scoring system for scientific
and clinical needs. Clin Oral Investig 2008; DOI: 10.1007/
s00784-007-0181-5.
6. Awad M A, El Kassas D, Al Harthi L et al. Prevalence,
severity and explanatory factors of tooth wear in Arab
populations. J Dent 2019; 80: 69–74.
7. Bartlett D W, Lussi A, West N X, 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: 1007–1013.
8. NHS Digital. Adult Dental Health Survey 2009.
2011. Available at https://digital.nhs.uk/
data-and-information/publications/statistical/
adult-dental-health-survey/adult-dental-health-survey-
2009-summary-report-and-thematic-series (accessed
February 2023).
9. Ahmed K E, Murray C A, Whitters C J. A prospective
survey of secondary care tooth wear referrals:
demographics, reasons for concern and referral
outcomes. Br Dent J 2014; DOI: 10.1038/sj.bdj.2014.179.
10. Schlueter N, Luka B. Erosive tooth wear – a review on
global prevalence and on its prevalence in risk groups.
Br Dent J 2018; 224: 364–370.
11. Schlueter N, Tveit A B. Prevalence of erosive tooth wear
in risk groups. Monogr Oral Sci 2014; 25: 74–98.
12. Hermont A P, Pordeus I A, Paiva S M, Abreu M H,
Auad S M. Eating disorder risk behaviour and dental
implications among adolescents. Int J Eat Disord 2013;
46: 677–683.
13. Mulic A, Skudutyte-Rysstad R, Tveit A B, Skaare A B.
Risk indicators for dental erosive wear among 18-yr-old
subjects in Oslo, Norway. Eur J Oral Sci 2012; 120:
531–538.
14. Moazzez R, Anggiansah A, Botha A J, Bartlett D.
Association of achalasia and dental erosion. Gut 2005;
54: 1665–1666.
15. Fernández C E, Brandao A C S, Bícego-Pereira E C, Del
Bel Cury A A, Cury J A, Tenuta L M A. Effect of pH and
titratable acidity on enamel and dentine erosion. Clin
Oral Investig 2022; 26: 5867–5873.
444
© The Author(s) under exclusive licence to the British Dental Association 2023.
16. 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: 99–104.
17. O’Toole S, Mullan F. The role of the diet in tooth wear. Br
Dent J 2018; 224: 379–383.
18. Mulic A, Tveit A B, Hove L H, Skaare A B. Dental erosive
wear among Norwegian wine tasters. Acta Odontol
Scand 2011; 69: 21–26.
19. Chikte U M E, Naidoo S, Kolze T J, Grobler S R. Patterns
of tooth surface loss among winemakers. SADJ 2005;
60: 370–374.
20. Wiktorsson A M, Zimmerman M, Angmar-Månsson B.
Erosive tooth wear: prevalence and severity in Swedish
winetasters. Eur J Oral Sci 1997; 105: 544–550.
21. Bartlett D, O’Toole S. Tooth wear and aging. Aus Dent J
2019; DOI: 10.1111/adj.12681.
22. Van’t Spijker A, Kreulen C M, Creugers N H J. Attrition,
occlusion, (dys)function, and intervention: a systematic
review. Clin Oral Implants Res 2007; 18: 117–126.
23. Rees J S, Somi S. A guide to the clinical management of
attrition. Br Dent J 2018; 224: 319–323.
24. Meirelles L, Cunha Matheus Rodrigues Garcia R.
Influence of bruxism and splint therapy on tongue
pressure against teeth. Cranio 2016; 34: 100–104.
25. Przystańska A, Jasielska A, Ziarko M et al. Psychosocial
Predictors of Bruxism. Biomed Res Int 2019; 2019: 2069716.
26. Polmann H, Réus J C, Massignan C et al. Association
between sleep bruxism and stress symptoms in adults:
A systematic review and meta-analysis. J Oral Rehabil
2021; 48: 621–631.
27. 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.
28. Wetselaar P, Vermaire E J H, Lobbezoo F, Schuller A A.
The prevalence of awake bruxism and sleep bruxism
in the Dutch adult population. J Oral Rehabil 2019; 46:
617–623.
29. Miyawaki S, Tanimoto Y, Araki Y, Katayama A, Fujii A,
Takano-Yamamoto T. Association between nocturnal
bruxism and gastroesophageal reflux. Sleep 2003; 26:
888–892.
30. Milosevic A, Agrawal N, Redfearn P, Mair L.
The occurrence of toothwear in users of Ecstasy
(3,4-methylenedioxymethamphetamine). Community
Dent Oral Epidemiol 1999; 27: 283–287.
31. Reyad A A, Girgis E, Ayoub A, Mishriky R. Bruxism and
psychotropic medications. Prog Neurol Psychiatry 2020;
24: 31–35.
32. Lobbezoo F, Visscher C, M, Ahlberg J, Manfredini D.
Bruxism and genetics: a review of the literature. J Oral
Rehabil 2014; 41: 709–714.
33. Emodi-Perlman A, Hochhauser T, Winocur P, Friedman-
Rubin P, Eli I. The effect of smartphones on daytime
sleepiness, temporomandibular disorders, and bruxism
among young adults. Quintessence Int 2021; 52: 548–559.
BRITISH DENTAL JOURNAL | VOLUME 234 NO. 6 | MArch 24 2023
34. Kozawa T, Igarashi Y, Yamashita S. Posterior occlusal
support and bite force influence on the mandibular
position. Eur J Prosthodont Restor Dent 2003; 11: 33–40.
35. Litonjua L A, Andreana S, Bush P J, Cohen R E. Tooth
wear: attrition, erosion, and abrasion. Quintessence Int
2003; 34: 435–446.
36. Greenwall L H, Greenwall-Cohen J, Wilson N H F.
Charcoal-containing dentifrices. Br Dent J 2019; 226:
697–700.
37. Mehta S B, Francis S, Banerji S. A Guided, Conservative
Approach for the Management of Localized Mandibular
Anterior Tooth Wear. Dent Update 2016; 43: 106–112.
38. Al-Hiyasat A S, Saunders W P, Sharkey S W, Smith G M,
Gilmour W H. The abrasive effect of glazed, unglazed,
and polished porcelain on the wear of human enamel,
and the influence of carbonated soft drinks on the rate
of wear. Int J Prosthodont 1997; 10: 269–282.
39. El Wazani B, Dodd M N, Milosevic A. The signs and
symptoms of tooth wear in a referred group of patients.
Br Dent J 2012; DOI: 10.1038/sj.bdj.2012.840.
40. Patel J, Baker S R. Is toothwear associated with oral
health related quality of life in adults in the UK?
Community Dent Health 2020; 37: 174–179.
41. Verploegen V J N, Schuller A A. Erosive tooth wear:
Knowledge among young adults and their preferred
information sources. Int J Dent Hyg 2019; 17: 85–92.
42. Dynesen A W, Gehrt C A, Klinker S E, Christensen L B.
Eating disorders: experiences of and attitudes toward
oral health and oral health behaviour. Eur J Oral Sci
2018; 126: 500–506.
43. Nehme M, Parkinson C R, Zero D T, Hara A T.
Randomised study of the effects of fluoride and time on
in situ remineralisation of acid-softened enamel. Clin
Oral Investig 2019; 23: 4455–4463.
44. Lussi A, Buzalaf M A R, Duangthip D et al. The use
of fluoride for the prevention of dental erosion and
erosive tooth wear in children and adolescents. Eur Arch
Paediatr Dent 2019; 20: 517–527.
45. Dowd E T. Nocturnal bruxism and hypnotherapy: a case
study. Int J Clin Exp Hypn 2013; 61: 205–218.
46. Clarke J H, Reynolds P J. Suggestive hypnotherapy for
nocturnal bruxism: a pilot study. Am J Clin Hypn 1991;
33: 248–253.
47. Macedo C R, Silva A B, Machado M A C, Saconato H,
Prado G F. Occlusal splints for treating sleep bruxism
(tooth grinding). Cochrane Database Syst Rev 2007; DOI:
10.1002/14651858.CD005514.pub2.
48. Poyser N J, Briggs P F A, Chana H S, Kelleher M G
D, Porter R W J, Patel M M. The evaluation of direct
composite restorations for the worn mandibular
anterior dentition – clinical performance and patient
satisfaction. J Oral Rehabil 2007; 34: 361–76.
49. National Institute for Health and Care Excellence. Eating
disorders: recognition and treatment. 2017. Available
at www.nice.org.uk/guidance/ng69 (accessed February
2023).