This paper reports a European expert consensus statement on guidelines for the management of severe tooth wear. It focuses on the definition of physiological versus pathological tooth wear and recommends diagnosis, monitoring and counseling to define the activity of the wear. Restorative intervention should be delayed wherever possible, depending on patient wishes and the severity and activity of the wear. When restorative intervention is indicated and agreed with the patient, a conservative minimally invasive approach is recommended. Several examples of adhesive minimally invasive treatment protocols are presented.