OBJECTIVES: To conduct a systematic review and meta-analysis to explore the association between erosive toothwear and gastro-oesophageal reflux disease or symptoms (GERD/S). SOURCES: Electronic searches were performed in Scopus, Embase, and Web of Science databases for the identification of relevant studies, from 1980 until 2nd August 2019. STUDY SELECTION: The review protocol was registered on PROSPERO (CRD42018096959) and the review was conducted according to PRISMA guidelines. Observational studies which examined the association between erosive toothwear, and GERD/S were included and categorised according to the use of objective or subjective measures of GERD/S. Where possible, odds ratios (OR) and 95 % confidence intervals (CI) were derived and pooled in a meta-analysis. DATA: 27 studies were considered relevant for the qualitative synthesis and 19 studies were pooled. Significantly increased odds of erosive toothwear were observed in individuals with GERD/S. This trend was more strongly associated with objectively measured GERD/S (OR 4.13, 95 % CI 1.68-10.13), compared to subjectively measured GERD/S (OR 2.69, 95 % CI 1.13-6.38). Whilst heterogeneity was very high these trends remained in most sensitivity and subgroup analyses conducted. CONCLUSION: Individuals with GERD/S have a 2-4 fold increased odds ratio of also presenting with evidence of erosive toothwear compared with individuals who do not have GERD/S. CLINICAL SIGNIFICANCE: This review suggests the need for a multidisciplinary medical and dental approach to managing individuals who present with erosive toothwear or GERD/S. Timely referrals between oral health services and gastroenterology should be considered as part of effective diagnosis and management.