Incidence and progression of dental erosion in adolescents and adults: results from the 6th German Oral Health Study (DMS • 6).

OBJECTIVES: Exposure to acidic and mechanical forces results in the continuous loss of dental hard tissue over the course of life, commonly referred to as tooth wear. However, longitudinal data on tooth wear are limited. Particularly, data on acid-induced wear, such as dental erosion, are scarce. This study assessed the incidence and progression of dental erosion over 9 years in adolescents and adults using data from the 6th German Oral Health Study (DMS • 6). METHOD AND MATERIALS: The sample included 371 adolescents and 341 adults from the DMS • 6 cohort who were first examined in 2014 (baseline) and reexamined in 2023 (follow-up). Dental erosion was assessed using the basic erosive wear examination (BEWE). Prevalence estimates, distributions of the maximum scores, and risk-level classifications were determined at baseline and follow-up. Additionally, the incidence rates of clinically manifest erosive defects and disease progression rates were calculated, and the mean changes in the BEWE score sums and changes in the restoration patterns were analyzed. RESULTS: During the observation period, the prevalence of erosive tooth wear increased by approximately 2.6 percentage points to 18.8% among adolescents and by 10.8 percentage points to 53.6% among adults. The incidence rates of clinically manifest erosive defects among adolescents and adults were 1.2 and 5.4 per 100 person-years, respectively. Furthermore, the maximum BEWE score in the two groups progressed in 1.2 and 4.0 cases per 100 person-years, respectively. Pronounced tissue loss affecting ≥ 50% of the tooth surface was observed exclusively in a small proportion of adults (2%). Participants with erosive lesions at baseline received almost twice as many restorations during follow-up as those without erosion. In posterior sextants with remitted clinically manifest defects, nearly three times as many newly restored teeth, particularly those with extensive five-surface restorations, were observed compared to those in sextants without changes in the erosion status. CONCLUSION: Compared with other countries, the incidence of erosions among German adolescents was relatively low. However, comparability is limited because the incidence estimates in this study refer exclusively to clinically manifest erosive defects and do not include the initial loss of surface structures. The larger number of newly placed extensive restorations among affected individuals suggests that restorative treatment is attributable to erosion rather than to caries. However, the contribution of mechanical wear was not evaluated in this study. Although the incidence of dental erosion is low in adolescents, it is substantially higher in adults; nonetheless, few individuals exhibit severe clinical manifestations. The findings suggest that the prevalence of tooth wear in middle-aged adults may increase modestly in the future with potential implications for dental care needs. (Quintessence Int 2026;57(Suppl):S90-S97; doi: 10.3290/j.qi.b6955490).