Gastroesophaeal reflux disease (GERD) is the abnormal reflux of gastric contents into the esophagus. There is no gender specificity and its incidence in the American population is estimated as high as 20%. Heartburn, regurgitation, dysphagia, cough, sore throat, asthma, aspiration, laryngospasm, nausea, sinusitis, hiccups, and dental erosion and thermal sensitivity are many of the common symptoms. Many patients are asymptomatic and the presence of atypical erosion can often be the first presenting signs of GERD. The areas most effected are the posterior occlusal surfaces, palatal of the maxillary anteriors, and buccal of the lower posterior. Cuspal cupping, floating amalgams, and shinny dentin should prompt an investigation of dietary acid intake. If this is not significant then physician referral is indicated. Dental treatment should be postponed until the GERD is controlled. Restorative treatment can vary depending if the amount of tooth structure lost effects loss of occlusal vertical dimension. Excessive wear with loss of vertical dimension usually require extensive restoration and surgical crown lengthening. Frequent recare is imperative .