Abfraction – Where Do They Come From?

Do your find yourself having more and more sensitivity to all elements? Though sensitivity can be caused by numerous reasons, but a common cause might be something that is more preventable than you might think. Until recently, abfraction was thought to be caused by improper toothbrushing techniques.

An abfraction lesion is now known to be the loss of tooth structure seen clinically on the cheek side of a tooth near and often under the gumline. It is identified by its sharply demarcated horizontal notch-like appearance. While a cavity may develop in the area due to the exposed dentin, the decay process is not responsible for the abfraction.

The Cause

deep-abfraction-notches
Abfraction is caused when two opposing teeth¾one top and one bottom tooth¾meet improperly during chewing and nonfunctional clenching or tooth grinding habits. At that point of stress, the tooth will “flex” very slightly. When a bite relationship is not correct, teeth undergo forces of compression and tension from the opposing teeth. In this way, the tooth is flexed slightly every time the teeth fully close.

This chronic flexing of the tooth causes a loss of tooth substance (enamel and dentin) at the gumline where the enamel is the thinnest. Enamel is brittle and cannot easily bend. As the tooth is moved back and forth (because the bite is off or because you grind your teeth), pieces of enamel fracture. The dentin, or underlying tooth structure, is more elastic and can bend slightly. The bending of the tooth will slowly damage the tooth, and a notch will eventually become visible.

One characteristic of abfraction that can make diagnosis difficult is that it may be partially or entirely under the gum tissue. At one time, it was thought that this type of tooth notching was caused by improper brushing habits, such as forcefully scrubbing back and forth against the neck of the tooth. While it is true that you can actually wear a notch in the tooth by brushing too hard in a see-saw fashion, the first tissue to wear away under those conditions is the gum tissue. Unlike abfraction, abrasion occurs above the gumline. In contrast, an abfraction occurs many times under the gum, or is partially covered by gum tissue.

Treatment

In most cases, abfraction can be treatment in a short procedure. A tooth-colored, bonded resin material is often placed to restore the notched tooth, and is a relatively easily restoration to accomplish. If the notch extends deep under the gumline, the tissue may have to be removed to expose the extent of the notched area in order to restore it.

Preventing Abfraction

Abfraction caused by teeth flexing can be prevented with the use of a mouthguard(day or night). Lab-made guards are a great way to add a barrier between your upper and lower teeth to prevent grinding and clenching but is only effective if patients are able to use it daily. If a mouthguard sounds like an unattractive solution, using Botulinum toxin(Botox) injection can be a highly effective solution as well. Botox injected directly into the jaw muscle can help relax the muscle in the area that causes the tension in your jaw. To learn more about Botox injection, click here.

Abfraction can be prevented and treated. Call us today to find out how we can help!

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