We conclude our series on dental wear with a brief discussion of Abfraction.
This occurs during grinding or bruxing of the teeth.
If your teeth are not properly aligned then it is possible that one or several of the teeth may be subjected to a greater force than they can bear. This will often cause the enamel at the neck of the teeth to flex. Continued flexing and stressing of the tooth causes the enamel and dentin to separate from one another.
The neck of the tooth is the area that is closest to the gum line. The enamel in this area is quite thin and when the force is too much for the tooth to bear, the enamel tends to fracture. This leaves a notch in the tooth near the gum line (see image above). The Abfraction seen in this picture is most probably the result of Attrition (see blog Dental Attrition on September 9, 2013). If a tooth has a filling in the area of the neck of the tooth and it is subjected to a greater than normal force, then it is common for the filling to ‘pop’ out.
Treating the problem
To correct the problem, the chewing forces need to be distributed evenly. Orthodontics (see blog Get ready to Brace Yourself posted on September 2, 2012) is the best way to deal with a malocclusion. However, the answer may be as simple as adjusting the bite; perhaps some selective grinding of the tooth that is being subjected to too much force.
If a filling has fallen out from the excessive force, then it is best to deal with the problem (adjust the bite) first then re-fill the tooth otherwise, it is likely that the filling will fall out again. Restoring the tooth after the bite has been corrected will prevent further damage.
Inter-play between the Different Types of Wear
Abfraction is not as common as Attrition, Abrasion and Erosion which we discussed in previous blogs.
It is rare that one of these wear ‘processes’ act on their own. There is usually an inter-play between them. One of the more damaging combinations is the erosion-abrasion one. The dissolution of the enamel by acids (erosion) accompanied by the wear caused by mechanical abrasive forces has quite an effect on the substance of the tooth.
The key is to focus on prevention of further tooth loss by making changes i.e. wearing a night guard, adjusting the bite, orthodontics (braces), fluoride (to re-mineralise damaged tooth structure, making lifestyle changes ( i.e. eating less acidic foods, using a soft tooth brush instead of a hard one, changing your brushing technique etc.)
Whatever the case, your dental team should be able to identify the type of wear by performing a proper clinical exam and asking the patient certain pertinent questions that will give clues as to what type of wear is present.
At our dental clinic, we work together with you, our patient, to solve the problem.
Yours in good dental health,
Dr. Robert Axelrad