This study investigated the relationship between water fluoridation, socioeconomic status, and tooth wear in 14-year-old children in northwest England. The prevalence of tooth wear was compared between children in fluoridated versus non-fluoridated districts. Tooth wear was scored on anterior and molar teeth. The results showed that children in non-fluoridated districts were 1.5 times more likely to have tooth wear compared to children in fluoridated districts. Additionally, fluoridation and using fluoridated toothpaste twice daily provided protection against dental erosion. The risk of tooth wear was also found to increase with greater affluence.