Abfraction

Abfraction is a theoretical concept explaining a loss of tooth structure not caused by tooth decay (non-carious cervical lesions). It is suggested that these lesions are caused by forces placed on the teeth during biting, eating, chewing and grinding; the enamel, especially at the cementoenamel junction (CEJ), undergoes large amounts of stress, causing micro fractures and tooth tissue loss.

It suggests that they are caused by flexural forces, usually from cyclic loading; the enamel, especially at the cementoenamel junction (CEJ), undergoes this pattern of destruction by separating the enamel rods. As teeth flex under pressure, the arrangement of teeth touching each other, known as occlusion, causes tension on one side of the tooth and compression on the other side of the tooth. This is believed to cause V-shaped depressions on the side under tension and C-shaped depressions on the side under compression. This theory of abfraction is disputed by some who think that these types of enamel lesions are due to over-zealous brushing. Studies by T. C. Abrahamsen have shown that toothpaste (not the toothbrush) is abrasive enough to cause this type of damage if the patient is too aggressive in brushing the teeth in a very hard and vigorous "sawing" motion. Abrahamson suggests that the term "toothbrush abrasion" be replaced with the term "toothpaste abuse".

Treatment of abfraction lesions can be difficult due to the many possible causes. To provide the best treatment option the dentist might determine the level of activity and predict possible progression of the lesion. It is recommended when an abfraction lesion is less than 1 millimeter, monitoring at regular intervals is a sufficient treatment option. If there are concerns around aesthetics or clinical consequences such as dentinal hypersensitivity, a dental restoration (white filling) may be a suitable treatment option.