Abfraction Lesions – What Caused Them and What You Can Do About It.

Abfraction lesions are faults that form at the bottom of the tooth where it meets the gum. They are often caused by excessive forces and abrasion. Gum recession, often caused by gum disease can increase your risk of developing abfractions.  This post explains what abfraction lesions are, what causes them and the link with periodontal disease and gingival recession. 

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What Are Abfraction Lesions?

Abfraction lesions are wedge-shaped defects that can occur at the neck of the tooth (usually just under the gumline). They are characterized by the loss of tooth structure in the form of small, V-shaped notches or grooves.  

Signs and Symptoms of Abfraction Lesions

Abfraction lesions are characterised by V-shaped notches near the gum line on the lip and cheek side of the teeth (labial/buccal), which you may spot when you look in the mirror or feel with your tongue. You may be aware of food getting stuck in these notches. 

It usually affects the incisors (front-facing teeth) and premolars (teeth between the pointy canines and molars).

Typical features include:

• A wedge-like “V” or “C” shape at the base of the tooth
• Tooth wear facets – Well-defined, sharp, flat and shiny wear marks
• Cracked teeth
• Tooth sensitivity to hot or cold – Abfraction is typically not painful, but it can cause tooth sensitivity, especially to hot and cold temperatures. This sensitivity may be more of an issue when the lesions are first forming. 
• Gum recession – this is not a symptom of abfraction but is often present at the same time and may increase your risk of developing abfractions. Take a look our 101 guide to find out more about gingival recession.

If abfractions are left untreated it can result in worn and shiny areas on the tooth, chipping of the tooth surface, and loss of enamel or exposed dentin. Over time, the loss of enamel can make the tooth more susceptible to bacteria and tooth decay, weakening the tooth’s structure and potentially causing it to become loose or even lost. 

What Causes Abfraction Lesions?

The exact cause of abfraction lesions is still a topic of debate among dental professionals. 

However, they are believed to result from excessive stress or forces applied to the tooth, which leads to the breakdown of tooth structure at the cervical area (where the tooth meets the gum line).

It is thought that the excessive forces cause flexure or bending of the tooth structure, particularly at the thin cementum layer near the gum line, leading to microfractures and eventual loss of tooth substance.

Main Causes

Bruxism: Teeth grinding or clenching can exert excessive force on the teeth, making them more susceptible to abfraction.

Malocclusion: Poorly aligned teeth or a misaligned bite can result in uneven distribution of forces during biting or chewing, increasing the risk of abfraction.

Other Causes

Chewing hard objects: chewing pen lids, nails and other items can cause flexing or bending of teeth contributing to the formation of abfraction lesions.

Abrasive toothbrushing: Aggressive brushing with a hard-bristled toothbrush or using abrasive toothpaste can wear away tooth enamel near the gum line, making the teeth more vulnerable to abfraction.

Acidic diet: Frequent consumption of acidic foods and beverages can contribute to the erosion of tooth enamel, weakening the tooth structure and making it more prone to abfraction.

Dietary factors: While abrasive and acidic foods were mentioned earlier, other dietary factors can also contribute to abfraction lesions. For instance, a diet lacking essential nutrients that support healthy teeth and gums may weaken the tooth structure and increase the risk of abfraction.  Drinking soda and caffeinated drinks increase the acidity of the mouth which increases the risk of abfractions.  

Illnesses: Eating disorders such as anorexia and bulimia as well as Gastrointestinal reflux disease (GERD) can increase the acidity of the mouth and increase the risk of abfractions. 

Risk Factors

Gum Recession: Gum recession is when the edge of the gum shrinks back exposing the tooth roots. The surface of tooth roots lacks enamel and is much softer than the crown of the tooth and is at risk of developing abfractions.  Gum recession affects tooth stability, and causes pain and tooth sensitivity.

Tooth morphology: Certain tooth shapes or anatomical characteristics may make teeth more susceptible to abfraction. For example, teeth with thin enamel, reduced thickness of dentin near the gum line, or uneven distribution of forces due to tooth shape irregularities could be more prone to abfraction.

Does Gum Disease Cause Abfraction Lesions?

Yes and no. Gum disease does not cause abfraction lesions but makes them more likely to happen. This is because gum disease increases the chances of gum recession and affects the stability and alignment of the teeth. 

If you have abfraction lesions in combination with red, inflamed gums that bleed when you brush your teeth you may have gum disease which has exposed tooth roots making you more susceptible to abfractions. 

Gum recession

Periodontitis can cause the gums to recede, exposing the tooth root. The root surface lacks protective enamel, making it more vulnerable to factors like tooth flexure and occlusal forces that contribute to abfraction lesions.

Altered occlusion

Gum disease can affect the alignment of teeth, leading to changes in the bite or occlusion. When teeth do not come together correctly, it can result in uneven distribution of forces during biting and chewing, increasing the risk of abfraction lesions.

Inflammation and tissue destruction

The chronic inflammation associated with gum disease can affect the health and integrity of the supporting structures of the teeth, including the bone and periodontal ligament. Weakened support can make teeth more susceptible to abfraction lesions.

It’s important to note that while gum disease and abfraction lesions may be related, they are distinct conditions that require separate diagnoses and treatment. Proper oral hygiene, regular dental check-ups, and addressing gum disease are crucial steps in maintaining overall oral health and minimizing the risk of abfraction lesions. Consulting with a dentist or periodontist is recommended to assess the specific condition of your gums and teeth and to determine the appropriate treatment approach. If you have gum disease you can find out more about what you can do about it at home without a dentist.

Treatment For Abfraction Lesions

Treatment for abfraction lesions may involve a combination of approaches, depending on the extent of the damage. This can include dental bonding, dental fillings, dental crowns, or other restorative procedures to rebuild the damaged tooth structure and prevent further deterioration. 

Treat Underlying Causes

Dentists may also address underlying causes, such as bruxism and periodontal disease. 

• Bruxism – Mouthguards or occlusal adjustments may be suggested to reduce the excessive force on the teeth. 
• Treatment of periodontal disease – will help prevent further gum recession and loss of supporting structures. This will reduce the risk of further areas in the mouth being put at risk of abfraction lesions. 
• Toothpaste – Advice will be given on the correct toothpaste to use to help prevent further abrasion and reduce any sensitivity.
• Orthodontics – future damage can be prevented by realigned teeth. 
• Advice – if an acidic diet or eating disorders are contributing factors you will be given diet advice and where to seek further help. 
• Gum recession – Gingival (gum) grafts may be used to cover exposed roots. 

It’s important to consult with a dental professional if you suspect you have abfraction lesions or any other dental concerns for an accurate diagnosis and appropriate treatment.

Summary

Abfraction lesions are V-shaped defects that occur at the bottom of the tooth near the root. They are caused by excessive force and stress on the tooth roots. Roots exposed due to gum recession and gum disease increase your risk of developing abfractions. 

The interplay between various factors, including tooth structure, occlusal forces, and oral habits, can make the condition complex and multifactorial. Therefore, a comprehensive evaluation by a dental professional is necessary to determine the specific causes and develop an appropriate treatment plan.

Frequently Asked Questions

Is it the same as erosion and abrasion?

No, abfraction is different to erosion and abrasion. Take a look at our post on the difference between abfraction, abrasion, and erosion. 

Is abfraction the same as a cavity?

Abfraction and cavities are two different dental conditions. Abfraction refers to the wedge-shaped breakdown of tooth structure resulting from mechanical forces on the teeth. On the other hand, cavities are holes that form due to tooth decay caused by bacteria and plaque. However, when abfraction is combined with other forms of tooth decay, it can increase the chances of developing cavities.

When do you restore abfraction lesions?

Restorative treatment for abfraction is typically recommended when you have symptoms are present or when it has resulted in cavities, tooth sensitivity, pain, or compromised tooth stability. In cases with significant gum recession, a combination of tissue grafting surgeries and restorative procedures may be considered to address the condition effectively.