Occlusal surface wear scores were examined in a sample of 200 Formative period (1500 bc–ad 500) skeletons from the lower Azapa Valley in northwest Chile. Wear rate and plane (angle) were additionally evaluated using a subsample of paired first and second mandibular molars. The Formative period represents the transition from marine foraging to agro-pastoral dependence in the region, and differences in oral pathology indicate that diet varied by site location (coast vs valley interior) but not by archaeological phase (early vs late). We predicted that occlusal wear would demonstrate similar patterns, resulting from differences in food consistency, and therefore hypothesised that in coastal groups consuming greater quantities of foraged foods, occlusal surfaces should wear faster and exhibit flat molar wear, whereas among valley interior groups consuming greater quantities of agro-pastoral products, these should wear slower but exhibit more angled molar wear. Heavier posterior tooth wear was identified among coastal residents, but rate and angle of molar occlusal attrition did not differ significantly by location. Heavier overall wear and a steeper molar wear plane were identified during the early phase indicating that food consistency varied somewhat over the course of the Formative period. Overall, the results indicate that, although limited differences in tooth wear exist by site location, wear varied more over time likely reflecting a gradual transition from foraging to agro-pastoral dependence in the lower Azapa Valley. Although oral health indicators point to differences in dietary investment by location, maintenance of a mixed subsistence economy likely sustained a comparative consistency of foodstuffs. Copyright © 2011 John Wiley & Sons, Ltd.