Many early studies laid the foundation for our understanding of the mechanics of chewing, the physiological role of chewing for the cow, and how chewing behavior is affected by dietary characteristics. However, the dairy cow has changed significantly over the past decades, as have the types of diets fed and the production systems used. The plethora of literature published in recent years provides new insights on eating and ruminating activity of dairy cows. Lactating dairy cows spend about 4.5 h/d eating (range: 2.4-8.5 h/d) and 7 h/d ruminating (range: 2.5-10.5 h/d), with a maximum total chewing time of 16 h/d. Chewing time is affected by many factors, most importantly whether access to feed is restricted, intake of neutral detergent fiber from forages, and mean particle size of the diet. Feed restriction and long particles (≥19 mm) have a greater effect on eating time, whereas intake of forage neutral detergent fiber and medium particles (4-19 mm) affects rumination time. It is well entrenched in the literature that promoting chewing increases salivary secretion of dairy cows, which helps reduce the risk of acidosis. However, the net effect of a change in chewing time on rumen buffing is likely rather small; therefore, acidosis prevention strategies need to be broad. Damage to plant tissues during mastication creates sites that provide access to fungi, adhesion of bacteria, and formation of biofilms that progressively degrade carbohydrates. Rumination and eating are the main ways in which feed is reduced in particle size. Contractions of the rumen increase during eating and ruminating activity and help move small particles to the escapable pool and into the omasum. Use of recently developed low-cost sensors that monitor chewing activity of dairy cows in commercial facilities can provide information that is helpful in management decisions, especially when combined with other criteria. Although accuracy and precision can be somewhat variable depending on sensor and conditions of use, relative changes in cow behavior, such as a marked decrease in rumination time of a cow or sustained low rumination time compared with a contemporary group of cows, can be used to help detect estrus, parturition, and some illnesses. This review provides a comprehensive understanding of the dietary, animal, and management factors that affect eating and ruminating behavior in dairy cows and presents an overview of the physiological importance of chewing with emphasis on recent developments and practical implications for feeding and managing the modern housed dairy cow.