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Background:  Tooth wear encompasses the loss of dental hard tissues through processes including attrition, abrasion and erosion. Previous studies have identified potential associations with age, sex, salivary characteristics, socioeconomic factors and bruxism; however, findings remain inconsistent and often based on single-factor analyses. This study aimed to investigate factors associated with tooth wear, with emphasis on subject‑based bruxism, and to evaluate the relative contribution of bruxism in relation to demographic, socioeconomic, clinical, and functional factors using a multivariate analytical approach.

Methods:  Data were derived from cross-sectional dental surveys and examinations conducted in Jönköping, Sweden. Participants aged 20 to 80 years underwent standardised clinical examinations and completed questionnaires addressing oral health, symptoms, behaviours and sociodemographic factors. Tooth wear was recorded separately as erosive or physical wear (attrition or abrasion) and was also combined to represent overall tooth wear. Bruxism was assessed by subject-based self-report, and temporomandibular disorder was evaluated using the Helkimo Clinical Dysfunction Index. Stimulated salivary flow rate and buffer capacity were measured. Associations between potential explanatory factors and tooth wear were analysed using generalised linear models, and between subjective assessments and tooth wear by Spearman rank correlations.

Results:  Among 909 eligible dentate participants with adequate occlusal support, 646 had complete datasets for multivariable modelling. Physical tooth wear showed near linear correlation with overall tooth wear, whereas association between overall tooth wear and erosive wear was moderate. In adjusted analyses, subject-based bruxism, higher age, and male sex were independently associated with a higher proportion of teeth affected by tooth wear. Tooth wear was also significantly associated with reduced self-perceived chewing capacity and aesthetics. No significant associations were observed for educational level, body mass index, number of remaining teeth, temporomandibular disorder, salivary flow rate, buffer capacity, or medical-condition-related attendance.

Conclusions:  In this Swedish population, tooth wear was more strongly associated with physical loading than with erosive processes. Subject-based bruxism showed the strongest independent association with tooth wear, exceeding the impact of demographic factors. These findings highlight the clinical relevance of patient-reported clenching or grinding when evaluating tooth wear and support its potential role in identifying individuals with increased levels of tooth wear.