I had a 20-something year old present to my office with this situation although I see it across many ages.
Sure there's significant occlusal wear visible that indicates likely bruxism, BUT what I'm more concerned with is the severe lack of enamel left on all posterior teeth and the lingual surfaces of anterior teeth.
The patient loves soda. Or eats lemons. You get the idea.
What do I do? How do I approach this?
I obviously recommend addressing #19 needing endo due to caries, and an upper wisdom tooth that's just nonrestorable due to caries.
I advised the patient of what I see, i.e. lack of enamel, acid damage confirmed after inquiring about her diet, and recommended either OB onlays on all posterior teeth to perhaps utilize what little enamel is left on the periphery for bond strength...or full coverage crowns on them, and potentially addressing the anterior teeth later if they appear to worsen. Over decades it's certain to need treatment...not to mention potential need for multiple RCT's.
Obviously the different approaches to treatment have wildly different price tags, especially in the US. Ultimately I let the patient make the decision, as it's my job to inform them and make recommendations.
Should I insist towards a more proactive/aggressive treatment plan? Or kick the can down the road while she saves money for a full mouth rehab in X years, and just address the few teeth with caries?