The etiology and treatment of occlusal tooth wear remain controversial. Longer tooth retention by the aging population increases the likelihood that clinicians will be treating patients with worn dentitions. A careful approach to interventional clinical procedures is advocated but should not curtail definitive management of patients having identifiable and potent causative agents that produce a rapid deterioration of the dentition. This article describes the epidemiology and etiology of occlusal wear and presents a conservative approach to its management.