Abstract

Objectives: Erosive tooth wear (ETW) is a prevalent, irreversible condition; however, despite the availability of numerous anti-erosive dentifrices, heterogeneity among systematic reviews limits clear clinical guidance. This umbrella review synthesizes and critically appraises the highest-level secondary evidence on the effectiveness of anti-erosive dentifrices on enamel and dentin. Materials and methods: An umbrella review of systematic reviews and meta-analyses was conducted following PRISMA 2020 and Joanna Briggs Institute guidance. Searches were performed in PubMed, Embase, Scopus, Web of Science, and the Cochrane Library up to January 2026. Reviews evaluating fluoridated and non-fluoridated dentifrices under in vitro, in situ, or clinical conditions were included. Methodological quality and certainty of evidence were assessed using AMSTAR 2, and ConQual approach, respectively. Fiindings were synthesized narratively due to substantial heterogeneity. Results: Eight systematic reviews met the inclusion criteria. Across reviews, fluoridated dentifrices generally reduced enamel and dentin tissue loss versus non-fluoridated controls, predominantly in vitro and in situ models. Stannous-containing formulations (stabilized SnF2 and multi-ion fluoride systems) most consistently showed greater protection than conventional NaF/NaMFP comparators under erosive and erosive-abrasive protocols. Evidence for calcium-based and biomimetic technologies was heterogeneous and largely short-term experimental. Overall certainty of evidence was moderate for stannous-based systems and low or very low for emerging technologies. Conclusions: Secondary evidence indicates that fluoridated dentifrices, particularly stannous-containing formulations, demonstrate the most consistent experimental protection against erosive and erosive-abrasive tissue loss. However, as the evidence base is dominated by in vitro/in situ models and short follow-up, these findings should not be over-interpreted as proof of reduced clinical ETW progression. Clinical evidence is more established for dentine hypersensitivity outcomes, whereas ETW-specific patient-centered outcomes remain scarce. Clinical relevance: Stannous-containing dentifrices may be preferred for patients at increased erosive risk based on consistent experimental protection. Nevertheless, as evidence is largely short-term and surrogate-based, dentifrice selection should be integrated within comprehensive preventive care. Long-term, independently funded clinical trials with standardized ETW and patient-reported outcomes remain necessary to strengthen evidencebased guidance.