What Is Abfraction?

Something that I commonly see in my practice as a general dentist is a condition we call abfraction.These lesions are not caused by bacteria and are not considered to be decay. We find them on the outside surface of the teeth down by the gumline. It’s likely that if you run your fingernail over your teeth down by the gums, you’ll detect some little notches.These notches are caused by flexure of the tooth structure.

We put a lot of pressure on our teeth, and sometimes, that pressure is enough to cause the teeth to flex slightly. Now, enamel is really hard, but similar to other crystals, it does not flex well. If the forces create enough flexure, it can cause the enamel to become detached from the underlying tooth structure, and it splinters and flakes. This typically occurs at the gumline where the enamel is thin. It manifests as a v-shaped notch.

Abfractions aren’t usually bothersome. Sometimes, they catch food or cause sensitivity to touch or to temperature. Many remain untreated throughout a patient’s life. When I do treat them, I usually bond composite resin over the affected site. The treatment is minimally invasive (we’re not sacrificing any additional tooth structure), and many times, it can be done without using anesthetic. The tooth structure is cleansed and dried, a bonding agent is applied, and the resin is placed and molded into position. It is then hardened by a curing light. Lastly, the filling is smoothed and polished.

It is reasonable to wonder why a lesion should be fixed if it doesn’t hurt. The reason that you should consider having these abfractions sealed is because once the enamel is gone, a softer substrate called dentin is exposed to the oral cavity. We know that the mouth is a violent place. Our tissues are constantly being exposed to abrasive forces (both in the hard foods we eat as well as our hygiene habits) along with erosive forces that are present due to the acidic nature of some of our common foods and beverages. The dentin is not designed to hold up against these forces, and these lesions can progress rapidly. 

I know a lot of dentists like me who prefer to err on the conservative side of dental treatment. Often, we elect to watch these lesions and defer treatment until observed progression has occurred. If you visit your dentist regularly and good records are kept, including intraoral photographs, then discovering any advancement in the abfraction is straightforward. As soon as there’s notable progression, an appointment can be scheduled to seal the lesion and protect the tooth.

One final recommendation your dentist might make would be the use of some type of mouthguard. These lesions occur because of excessive pressure that is being exerted on the teeth. Wearing a guard while you sleep serves to distribute occlusal forces evenly across all the teeth, minimizing the pressure applied to any particular area of your mouth. I would recommend a mouthguard made of hard material. Soft guards protect your teeth, but they sometimes cause more clenching, which can lead to issues with the temporomandibular joint (TMJ). I often will give my patients an appliance that not only protects the teeth but also prevents clenching and grinding. It’s called an anterior bite plane, and it works great. 

Be sure to see your dentist often. Your dentist can work with you to guide you towards any needed treatment that will help you enjoy a healthy mouth and a healthier life.  

Plumb Dental offers general dentistry for the entire family, including preventative care, root canals, implant restoration, cosmetic work—even whole smile makeovers. To schedule an appointment, call (435) 673-9606 or visit our website at plumbdental.com.