Dental Erosion Index
Tooth Surface Loss Assessment by Erosion Index · Also known as: tooth wear index, erosion severity index, TSL index
The Dental Erosion Index is a systematic clinical assessment tool that quantifies the severity of tooth surface loss caused by non-carious erosive agents (acidic substances, mechanical abrasion, or biological factors). Multiple index systems exist (e.g., Lussi Index, Basic Erosive Wear Examination or BEWE), each scoring erosion based on the extent and depth of surface loss on coronal and cervical tooth surfaces. Erosion assessment is critical for identifying patients at risk for advanced tooth loss, determining preventive interventions, and guiding restorative management.
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When to use it
Screen for dental erosion in all patients, particularly those with known risk factors: gastroesophageal reflux disease (GERD), bulimia nervosa, frequent acidic drink consumption, high-acid diet (citric fruits), or occupational acid exposure. Repeat assessment annually in high-risk patients or every 2–3 years in low-risk patients. Assume tooth surfaces are accessible and visible; heavily restored dentitions may obscure native surface loss.
Strengths & limitations
- Non-invasive, systematic clinical assessment without special equipment beyond routine dental instruments
- Standardized indices enable reproducible, comparable documentation of erosion severity across patients and time points
- Early detection of erosion enables intervention before advanced restorative needs arise
- Helps identify behavioural or systemic risk factors (dietary, medical) amenable to prevention strategies
- Guides patient education and counselling on prevention (acid avoidance, protective measures)
- Clinical indices assess only surface morphology, not the underlying biochemical or mechanical etiology
- Distinction between erosion and other wear types (abrasion, attrition) can be difficult in advanced cases
- Scoring is subjective, particularly at borderline severity levels; inter- and intra-examiner variability can occur
- Two-dimensional visual assessment may underestimate three-dimensional depth of loss
- Indices do not directly quantify rate of erosion progression; longitudinal assessment requires repeated examinations
Frequently asked
What is the difference between erosion and abrasion?
Erosion is smooth, cupped, or sloping loss of tooth surface caused by chemical (acid) or biological attack. Abrasion is a v-shaped notch at the gingival margin caused by mechanical trauma (aggressive toothbrushing, abrasive objects). Erosion affects cusp/incisal surfaces and all surfaces equally; abrasion localizes to the cervical area. Clinical presentation and location help distinguish the two.
Can erosion be reversed?
No. Once enamel and dentin are lost to erosion, they do not regenerate naturally. Remineralization therapies may stabilize surface changes and prevent further loss, but surface loss cannot be reversed. Prevention and early intervention are essential.
What dietary factors cause erosion?
Acidic substances erode enamel and dentin. Common culprits include citric acid (citrus fruits, sport drinks), phosphoric acid (colas, energy drinks), and acetic acid (vinegar). Frequency and duration of acid exposure matter more than total acid consumption; sipping acidic drinks throughout the day is more erosive than consuming the same amount in one sitting.
When should eroded teeth be restored?
Restoration depends on severity, functional impact, and aesthetic concerns. Mild erosion (enamel loss only) typically requires prevention only. Moderate erosion (dentin exposed but limited loss) may require fluoride treatment or composite bonding. Severe erosion with substantial loss may require crowns, particularly on anterior teeth for esthetics or posterior teeth for restoration of occlusal anatomy. Address underlying erosion causes before extensive restoration to avoid future loss of restorations.
Sources
- Lussi, A., Jaeggi, T., & Zero, D. (2004). The role of diet in the aetiology of dental erosion. Caries Research, 38(1), 34-44. DOI: 10.1159/000074360 ↗
- Bartlett, D. W., Lussi, A., West, N. X., Bouchard, P., Sanz, M., & Bourgeois, D. (2013). Prevalence, aetiology and consequences of erosive tooth wear. European Journal of Oral Sciences, 121(1), 1-6. link ↗
- Ericson, D., & Ericson, T. (2010). Erosion of the teeth in patients with eating disorders. Acta Odontologica Scandinavica, 68(5), 297-304. link ↗
How to cite this page
ScholarGate. (2026, June 3). Tooth Surface Loss Assessment by Erosion Index. ScholarGate. https://scholargate.app/en/dentistry/dental-erosion-index
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
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