Abfractions and Abrasions

Dental diagnosis
Overview
Abfraction in upper canine tooth

Abfractions and abrasions appear very much the same—both are notches at the gumline. The difference is what causes them.

Abfractions and abrasions are an ongoing source of discussion in dentistry because, clinically, they are nearly identical, their primary treatment options are the same, and bruxism (tooth grinding) and improper alignment of the jaws and/or teeth (malocclusion) must be ruled out for both.

An abfraction is an angular notch at the gumline caused by bending forces applied to the tooth. An abrasion is a rounded notch at the gumline that may be visibly indestinguishable from an abfraction, although in cross-section abrasions are generally not as angular and have more of a saucered appearance.

With abrasions, it is believed that heavy toothbrushing forces applied to exposed tooth roots reduce the surface over time to produce the rounded notch. Abfractions, on the other hand, are caused by one of two things:

  1. Chronic heavy forces on teeth, such as may be produced by clenching or grinding the teeth (bruxing).
  2. Normal forces on teeth which are improperly aligned (malocclusion).

Abfractions that have been present for awhile may become rounded through the abrasive action of a toothbrush, especially if the teeth are continually exposed to an acidic environment, which is known to soften tooth structure.

Ruling out abfractions can save the patient time, money and unnecessary treatment. However, misdiagnosing an abfraction as an abrasion can prevent a patient from receiving needed care, and cause treatment of the abfraction to be unsuccessful.

How is this dental diagnosis established?

Ruling out an abfraction to diagnose an abrasion involves close visual inspection of the shape of the lesion, an evaluation of the patient’s bite (occlusion), a discussion of the patient’s brushing habits, and an evaluation for other signs/symptoms supporting the diagnosis of a tooth clenching or grinding habit (bruxism).

Symptoms that support a diagnosis of bruxism include pain, popping, clicking, grating, or locking of the jaw joints (TMJ dysfunction); headaches (particularly radiating from the temples); fatigue and/or pain from the chewing muscles (myalgia); wear planes on the teeth (attrition); reduced vertical dimension of occlusion (i.e. how far closed the lower jaw can rotate depends on where the upper and lower teeth meet. If the teeth are worn, the lower jaw can rotate farther closed- potentially causing significant problems); and a history of broken, chipped or cracked teeth and failing dental restorations.

Treatment options

Treatment options for the notch-shaped lesions themselves are the same for abfractions and abrasions, generally consisting of either tooth-colored fillings to cover the notch, or covering the notch with a connective tissue graft (a surgical periodontal procedure).

Dentists may elect not to restore abfractions until they reach a depth of approximately 1 millimeter, although the conditions leading to their formation need to be understood and may require treatment. Some abfractions and abrasions cause temperature sensitivity or sensitivity to sweets, which can be conservatively treated in the short term with desensitizing compounds (e.g. paint-on solutions, special toothpastes, etc.). Magnified photographs or stone casts of the teeth can be used to monitor the abfraction / abrasion lesion for changes over time.

If the patient’s bite is a factor in development of abfractions, treatment recommendations may include orthodontic tooth movement or a bite adjustment (equilibration). Other treatment may be recommended. If the cause of abfractions is not treated, the lesions themselves may re-occur.

Related diagnoses

Because abfraction lesions are caused by abnormally high bite stress on the affected teeth, orthodontics, bite adjustments (occlusal adjustments), and/or night guards (occlusal guards or splints) may be recommended when abfractions are diagnosed. These treatments are intended to evenly distribute bite forces across all of the teeth, reducing stresses on individual teeth. They do nothing to address the cause of abrasions. However, use of a soft toothbrush and gentle brushing technique may prevent new abrasions.

Chips, cracks, wear (attrition), chemical erosion, and other related diagnoses associated with loss of tooth enamel may have other causes. They may also have a common cause (e.g. elevated bite stress), but a different outcome that may be treated differently. Related factors contributing to those diagnoses include using the teeth for purposes other than nutrition (factitious habits), heavy bite stress (primary occlusal trauma and bruxism); and gingival recession. Once the tooth roots are exposed, they may be very sensitive (dentin hypersensitivity). Sometimes an improper bite relationship between the upper and lower teeth (malocclusion) leads to accelerated wear of the teeth.

It’s important that all abnormal conditions in your mouth are identified and properly diagnosed, so that appropriate treatment can be prescribed, and long-term health re-established.

Author: Thomas J. Greany, D.D.S.
Editor: Ken Lambrecht
This page was reviewed by members of our review board.

This page was last updated on July 8, 2015.

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Related pages on ToothIQ.com

Attrition
Attrition
Bruxism
Bruxism
Casts
Casts
Chemical Erosion
Chemical Erosion
Cracked Teeth
Cracked Teeth
Desensitizing Medications
Desensitizing Medications
Equilibration
Equilibration
Factitious Habits
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Fillings and Core Buildups
Fillings and Core Buildups
Fluoride Treatments
Fluoride Treatment
Gingival Recession
Gingival Recession
Malocclusion
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Myalgia
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Night Guards
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Orthodontics
Orthodontics
Photographs
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Periodontal Surgery
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Primary Occlusal Trauma
Primary Occlusal Trauma

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Background information

Impact of Different Toothpastes on the Prevention of Erosion
Lussi, A, et al.
Caries Research
2008 (42): 62-67

Toothpaste Abuse?
Linn, Howard, DDS
The Journal of the American Dental Association
2005 136 (1): 20-21

Abfraction
McCubbin, James, BDS
The Journal of the American Dental Association
2002 133 (6): 690-691

Examining the prevalence and characteristics of abfractionlike cervical lesions in a population of U.S. veterans
Piotrowski, Bradley T., DDS, MSD, et al.
The Journal of the American Dental Association
2001 132 (12): 1694-1701

Information you may wish to read before making a decision on treatment

A Critical Review of Non-carious Cervical (Wear) Lesions and the Role of Abfraction, Erosion, and Abrasion
Bartlett, D.W. and Shah, P.
Journal of Dental Research
2006 85 (4): 306-312

Noncarious cervical lesions in adults: Prevalence and occlusal aspects
Pegoraro, Luiz Fernando, DDS, PhD, et al.
The Journal of the American Dental Association
2005 136 (12): 1694-1700

Attrition, abrasion, corrosion and abfraction revisited—A new perspective on tooth surface lesions
Grippo John O. BS, DDS, et al.
The Journal of the American Dental Association
2004 135 (8): 1109-1118

Brief communication: Study of noncarious cervical tooth lesions in samples of prehistoric, historic, and modern populations from the South of France
Aubry, M., et al.
American Journal of Physical Anthropology
2003 121 (1): 10-14
Editor’s notes: This article states that off-axis stresses on teeth in prehistoric times may not have been as great because the abrasive diet eaten at that time quickly reduced the occlusal cusp anatomy, such that the teeth became flat on the biting surfaces, and slid on each other without generating sideways forces.

Noncarious cervical lesions and abfractions: A re-evaluation
Litonjua, Luis A., DMD, MS, et al.
The Journal of the American Dental Association
2003 134 (7): 845-850

Stress-induced cervical lesions: Review of advances in the past 10 years
Lee William C., DDS, MA; Eakle W. Stephan, DDS
The Journal of Prosthetic Dentistry
1996 75 (5): 487-494

Noncarious dental “abfraction” lesions in an aging population
Owens BM, Gallien GS
Compendium of Continuing Education in Dentistry
1995 16 (6): 552, 554, 557-8 passim
Notes: Quiz 562

Abfractions: a new classification of hard tissue lesions of teeth
Grippo, J.O
Journal of Esthetic Dentistry
1991 3 (1): 14-19