<p>This study ascertained if posterior occlusal support influences tooth wear on anterior and posterior teeth. Adult patients (<i>n</i> = 250) were examined by three trained and calibrated examiners. Data was collected on the severity of tooth wear in each sextant using the basic erosive wear examination. Individual sextant scores were summed to provide the overall tooth wear risk profile for each subject. The pattern of loss posterior occlusal support and the relative number of missing units were also recorded. Chi- squared tests of independence were used on cross tabulated data to understand the relationship between posterior occlusal support and the severity of anterior and posterior tooth wear and the risk profile for tooth wear. Bilateral loss of posterior support was associated with tooth wear of upper anteriors (<i>p</i> &lt; 0.001) while both bilateral (<i>p</i> &lt; 0.001) and unilateral (<i>p</i> = 0.009) loss of posterior support was associated with tooth wear of lower anteriors. Loss of two or more functional pairs of posterior teeth either unilaterally or bilaterally was associated with lower and upper anterior tooth wear. The components of loss of posterior occlusal support- the pattern of loss and the relative reduction in the number of missing units were associated with tooth wear on upper and lower anterior teeth. While there were differences in the severity of wear from right to left sextants, this could not be attributed to loss in posterior support. The overall management of advanced tooth wear should include the replacement of missing units to improve posterior support.</p> Graphical Abstract <p></p>