Treatment options for tooth damage depend on whether or not it was caused by dental caries. Tooth abrasion and abfraction, which are non-carious forms of tooth damage, often pose quite a dilemma in dentistry because they appear to be nearly clinically identical, require an assessment of bruxism and malocclusion during diagnosis, plus they often require the same interventions.
While many cases of tooth destruction that require operative procedures are caused by dental caries or decay, carious processes only account for 25 percent of tooth. Non carious tooth destruction or tooth surface loss refers to the loss in tooth structure caused by a disease other than dental caries, and includes abrasion, attrition, erosion, and abfraction.
Tooth abrasion vs abfraction
An abrasion occurs when a rounded notch forms at the gumline due to bending forces applied to the tooth. If the notch is angular, then it’s referred to as an abfraction. It’s virtually impossible to distinguish between the two without the use of a cross-section view, whereby abrasions appear to be more rounded than angular, as well as a saucered appearance.
Causes of tooth abfraction
There are two primary causes of abfractions:
- Normal forces being exerted on teeth with untreated malocclusion (improper alignment)
- Chronic heavy forces being on teeth due to untreated bruxism (teeth grinding) and jaw clenching
If abfractions go untreated for some period, they tend to become rounded – rather than V-shaped – due to abrasive action when brushing. This can be further accelerated by an acidic environment that is known to soften tooth enamel and facilitate wear.
During treatment, the dentist must rule out abfractions, by ensuring that your case was not caused by malocclusion or bruxism. Getting the right diagnosis will ensure that you receive the most appropriate treatment, saving you on both time and money.
Causes of tooth abrasion
Abrasions generally involve the abnormal loss of tooth surface due to the direct application of frictional forces between contacting teeth components, using an abrasive medium.
For instance, applying too much force on your toothbrush against teeth whose roots are exposed can cause excessive wear of tooth enamel in those areas over time, resulting in a rounded notch.
These are the most common of the four types of non-carious forms of tooth damage, and occurs mostly on the cervical neck of teeth.
Some factors that may contribute to abrasions forming include:
- Wrong brushing technique – brushing too hard, using excessive force, or brushing for too long
- Bad oral habits like using floss and tooth picks with too much force, biting your finger nails, holding pins habitually between teeth, and chewing pens
- Chewing tobacco or the pipe
- Traumatic occlusion – injury of soft tissues due to orthodontic issues
- Excessive mastication (chewing) of hard / chewy / sticky foods
Iatrogenic causes of tooth abrasion include:
- Poorly fitting clasps and dentures, producing constant wear of affected surfaces
- Rough occluding surface of the restoration increasing its abrasive capability
- Dentures with porcelain teeth contradicting natural teeth
Dental abrasion lesions
Abrasion caused by poor brushing techniques typically affects the canines and premolars, causing lesions to form at the root surface of the affected teeth.
A tooth’s root surface is made of dentin, which is soft and wears easily when aggressive action is applied. The usual result is a U-shaped groove, known as a notched lesion that forms at the neck of the tooth. In some cases, the groove can get deep enough to reach the nerve or tooth pulp.
Abrasive toothpastes, like the whitening kind, are known to worsen the condition, so they should be replaced with fluoride or xylitol mouth rinse.
Symptoms of tooth abrasion
Signs and symptoms of abrasion include:
- Very smooth and polished lesion surface, since it rarely has caries activity or plaque accumulation in it
- Surrounding walls form a U-shape at an axial acute angle
- Pain when the lesion is probed or stimulated
- Lesion peripheries are separated at an angle from adjacent tooth surface
- Occasional hypersensitivity
Prevention of Tooth Abrasion
It is possible to prevent tooth abrasion by:
- Avoiding acidic foods and drinks
- Proper use of toothpicks and dental floss
- Using a soft-bristled toothbrush with gentle brushing strokes
Tooth abrasion treatment
As mentioned before, the dentist must first rule out abfractions, by ensuring that your case was not caused by malocclusion or bruxism. Your dentist can then proceed with the diagnosis to identify the cause of abrasion, taking into consideration your:
- History of oral hygiene techniques, like brushing materials
- Iatrogenic causes
- Lifestyle habits like chewing tobacco and pipe smoking
Depending on how bad the damage is, the patient can receive a variety of treatments. For large defects, the tooth has to be restored with fillings and other remedies depending on your individual case; but for minimal damage with no sensitivities, there is no need for treatment.
Tooth abrasion filling
To restore a tooth following abrasion, your dentist will use a tooth-coloured material for filling the worn away area. The common materials used are glass ionomers and composites, also referred to as plastic fillings, with a fluoride varnish finishing.
Restoration is only necessary if:
- There is caries
- There is sensitivity
- For aesthetics
- If the defect leads to periodontal concerns
- If the depth of defect is very close to tooth pulp
If your tooth is only sensitive, but is not severely worn to require a filling, your dentist may suggest a fluoride gel or rinse for home use, to enhance resistance to caries.