Is erosive tooth wear a truly non-bacterial condition? A scoping review.
Level 5 - mechanism / opinion, no new human data
Scoping review synthesizing heterogeneous in vitro, in situ, and observational studies with a single randomized trial
PubMed 42342198 · doi:10.1016/j.jdent.2026.106859
What was done
A scoping review following PRISMA-ScR guidelines searched five major databases up to April 2026 for primary research (in vitro, in situ, or clinical) examining oral biofilm ecology, erosion-associated dysbiosis, or microbiome pathways in erosive tooth wear (ETW). From 2,355 records identified, 16 full-text articles were screened and 7 studies were included (3 observational, 1 randomized, and 3 in situ/ex vivo).
What was found
The 7 studies were highly heterogeneous in design, outcomes, and targets. Two studies showed oral biofilms reduced enamel erosion but offered limited dentin protection. Two studies found bioactive compounds reduced bacterial adhesion, modified pellicle structure, and improved erosion protection. Three studies examining microbial ecology reported inconsistent results: one found no difference in microbial counts, one found similar alpha- and beta-diversity with taxon-level differences, and one found lower microbial diversity, proteolytic degradation, and metabolic profiles consistent with acid-adapted communities. No pooled effect estimates were reported.
Why it matters
This review questions the traditional assumption that erosive tooth wear is entirely non-bacterial, highlighting potential ecological and metabolic roles of the oral microbiome in modulating erosion.
Limits
The evidence base is limited to 7 heterogeneous studies, predominantly non-clinical or observational with only one randomized trial. Findings across microbial diversity and community analyses were inconsistent, precluding firm mechanistic or clinical conclusions.
Cited by
- context Stripping away the oral biofilm causes tooth erosion, sensitivity, and exposure leading to tooth wear.