We think of our teeth as sturdy, anchored pieces of bone, and, for the most part, they are. Every day we subject them to hard foods and (possibly) misaligned bites, and they still serve us well without buckling. Sometimes, however, the force is just too much, and over time tooth abfraction develops.

What is tooth abfraction?

Tooth abfraction (also referred to as an abfraction lesion) is a change in the actual structure of the tooth near the root. This structural change is not caused by cavity.

Instead, this change appears as a small, wedge-shaped divot in the tooth, just below the gumline. It’s almost as if a chunk of tooth has been removed. Think of what a cantilevered building looks like, with the upper floors hanging out over the lower floors, and you have a good idea of what this condition looks like.

Abfraction doesn’t only affect the hard enamel of the outer tooth. This type of dental condition can also damage the dentin inside your tooth. Curiously, the body will sometimes manufacture more dentin in an effort to protect the soft tooth pulp, but this only prolongs the continued inevitable deterioration.

Tooth abfraction is not as common as cavity or other periodontal disease. Many clinicians themselves may see very few cases in their practice.

What causes abfraction in your teeth?

Abfraction is a controversial dental condition. Since tooth decay is not present, there is very little agreement on what actually causes abfraction.

Most dentists can agree that tooth abfraction has at least four potential causes, two of which are within a patient’s control.

1. Regular forces on the teeth, applied over time

Forces act on the teeth every day when we chew or bite down. Known as occlusal forces, this cause of abfraction occurs gradually over time.

When teeth press together, a force is exerted on the teeth. This force causes minor flexion (bending) at the tooth’s roots. For people with properly aligned teeth, this is not a potential cause of abfraction lesion. The force created by misaligned teeth is much greater than that of a proper bite and therefore may be more likely to produce abfraction lesion.

2. Bruxism

Bruxism is the leading cause of many dental conditions. Abfraction is no different.

The force with which bruxers clench and grind their teeth is adequate to produce dental abfraction, but with one catch. Not everyone who has tooth abfraction has bruxism, and not everyone with bruxism has tooth abfraction. So it’s a potential factor but not a cut-and-dried cause.

3. Oral hygiene

One of two potential causes of abfraction that patients can control is oral hygiene. The likelihood of developing dental abfraction increases when the following oral hygiene practices are in place:

  • The toothbrush is hard-bristled: Hard-bristled toothbrushes cannot only damage the gums but can also remove protective enamel over time.
  • Patients brush too hard: Brushing too hard (especially with a hard-bristled brush) removes more than just the soft plaque that builds upon teeth. Overbrushing can also work to remove enamel and dentin, setting up good conditions for abfraction lesion.
  • Patients use abrasive toothpastes: Abrasive toothpaste such as those used for whitening are fine for teeth when used sparingly and under the supervision of a dentist. Patients who use very abrasive toothpaste for extended periods, however, are also wearing down their tooth’s enamel.

4. Diet

A diet high in acidic foods and sugars does exactly the same thing as the things mentioned in oral hygiene: it eats away at a tooth’s enamel.

It is highly unlikely that just one of the previous four factors would lead directly to tooth abfraction. In combination, though, these factors may cause your teeth to weaken and buckle. Because most dental professionals see few cases of dental abfraction in their practice, they may not spot it right away. This can make it even more complicated to treat.

What’s the best tooth abfraction treatment?

As always, the best treatment of most dental conditions (including this one) is prevention. Here are three steps you can take today to prevent abfraction.

Step 1: Clean up your diet

If you routinely drink soda, see if you can cut back or eliminate that altogether.

This improves your overall health as you reduce the sugar in your diet, and it reduces the damage to your teeth.

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