If you’ve noticed a dent or indentation on your tooth – a dent that is near the intersection of your tooth and gum line – and you are also experiencing dental sensitivity, you probably think you’ve got a cavity. But that’s not necessarily so. In fact, it could be that you have an abfraction of teeth – which is not a cavity. That doesn’t mean that everything is hunky-dory. However, there are several treatment options for abfractions, and your dentist can assess and correct the situation.
What is Abfraction?
The technical definition of abfraction of teeth is a non-carious cervical lesions (NCCL). In plain English, that means that your tooth is losing some of its mass/structure. These NCCLs occur gradually and are usually visible as an indentation (called an abfraction lesion) at the front of the tooth, near the gum line. Their appearance on the tooth surface and the way they feel in your mouth mimics that of a cavity (dental caries), but they are not related to typical tooth decay.
Multiple things can cause an abfraction, so discovering the cause of the indentation is important before your dentist can begin to treat the disorder and prevent more damage going forward.
Tooth Sensitivity
If you’re just starting to experience tooth sensitivity, you may be unaware it’s happening (in the early stages). Tooth sensitivity can range from annoying to painful – though if sensitivity progresses to severe teeth sensitivity or worse, tooth pain, you should go see your dentist right away.
If you have tooth sensitivity or tooth discomfort, you’ll usually notice it when you consume particularly hot or cold food/beverages, and sometimes sweets. The most common sensitive teeth causes are due to abrasion and erosion of the outer layer (tooth enamel) of the tooth. When that happens, the middle layer of the tooth – the dentin – becomes exposed. Enamel protects dentin – which is full of tiny tubes that lead to the inner layer (the pulp). When these tubes in the dentin are exposed, they stimulate the nerve endings in the pulp. Therefore, you feel the heat and cold of what you’re consuming.
The Relationship Between Abfractions and Teeth Sensitivity
Abfractions and tooth sensitivity are often linked – and for a very good reason. This is because abfractions expose softer portions of the teeth, mimicking the actions of dental caries. However, just because you have tooth sensitivity and a visible indentation does not necessarily mean you have an abfraction, as tooth damage and tooth sensitivity could also be symptoms of cavities, gum disease, or a cracked tooth. For that reason, any time you have a combination of tooth sensitivity and tooth disfigurement, you should contact your dentist.
A Detailed Explanation of How Abfractions Lead to Tooth Sensitivity
As an abfraction occurs and progresses, you lose the outer, protective layer of enamel near the baseline of the tooth (near the gum line). When this happens, it exposes the middle layer of your tooth (dentin). Because dentin is porous and lays right on top of the inner layer of the teeth (pulp), it is very close to nerve endings in the tooth roots. Those nerve endings are extraordinarily sensitive. So, when you have an abfraction, you will most likely experience tooth sensitivity any time you consume something hot or cold.
Signs and Symptoms
Abfractions can occur on any tooth. However, they most commonly occur on the incisors (front four, most forward teeth) and premolars (located between the sharp canines and molars at the back of the mouth). And that is because these teeth take a tremendous amount of stress (through a litany of factors that we discuss further below). So, if you see an indentation in the surface of your incisors or premolars – one that is near the gum line, there’s a good chance you have an abfraction. Abfractions occur on this part of the tooth due to erosion and/or gum recession.
Abfractions Indicators
When looking for common signs indicating the presence of abfractions, be vigilant for:
- Dents – An indentation in the gum line of your tooth that resembles a wedge or “C” shape
- Feeling – Increased or sudden tooth sensitivity to heat or cold, as well as sweets
- Appearance – Discoloration of affected teeth (yellow or brown)
- Facets – Sections of teeth that appear flattened, worn, and shiny
- Structural problems – Chipped or cracked teeth
- Gum line – Erosion of the gums, leaving more of the tooth exposed
These specific symptoms related to tooth sensitivity in abfraction cases are the most common.
What Causes Tooth Abfraction?
Dentists have determined that several causes and treatments for tooth abfractions. Originally, it was thought that excessive force (during chewing or teeth grinding) was the only culprit, but studies show that there are likely several factors involved. These include biological, chemical, and behavioral aspects.
Abfraction causes include:
- Bruxing – teeth grinding
- Malocclusion – misalignment of the teeth
- Mineral depletion – Acids (present in foods and beverages or from reflux) or even abrasive factors (brushing your teeth too hard)
Because of the combination of factors that can lead to abfraction, your dentist may have to make an educated guess as to its source. And they will look for facets and gum erosion to help guide them. Also note that abfractions become more common with age.
Treatment
Just like there are several causes of abfraction, there are also several treatment paths – these typically depend upon the severity of the abfraction itself – AND how it was caused. Your dentist should also take into account your aesthetic concerns when determining a treatment plan. Note that while abfraction cannot be completely reversed, a dentist can manage and prevent it so that you enjoy full functional and sensation relief, while also regaining a winning smile.
Dental Treatments Oral Hygiene Recommendations
You and your dentist will determine a treatment plan based on the severity of the abfraction and how it was caused. This might include:
- Fillings and restorations: An abfraction is not a cavity, but it can be restored much in the same way that a cavity is restored. Your dentist can use composite or tooth-colored filling to fill in the indentation caused by the abfraction.
- Mouth guards: If your abfraction was caused by teeth grinding (bruxism), your dentist may fit you for a custom mouth guard for use during sleep or other times.
- Orthodonture: Retainers and braces can be used to help stop the progression of an abfraction.
- Occlusal adjustment: If your abfraction is due to a jaw alignment problem, your dentist will address these issues and try to adjust your alignment.
- Tooth sensitivity treatments: Not all toothpaste is the same. Some can even be overly abrasive and help cause the conditions for abfraction. If so, your dentist may recommend therapeutic toothpaste or specialized sealants or adhesives. The same goes for the toothbrush. And a toothbrush abrasion is a common precursor to sensitive teeth pain.
- Root coverage surgery: If you experience significant gum recession, your oral health team may recommend restoration surgery to replace lost gum tissue.
Effective Management Techniques
The good news is that, in most cases, you can manage your oral health to either prevent abfractions from occurring, or stop them from growing if they do occur – while also minimizing any damage and discomfort you may experience because of abfraction. Abfraction is often painless. However, it is necessary to address this condition, as it can affect tooth stability and lead to other problems if ignored.
Preventive Measures
There are things you can do to help prevent abfraction – specifically to help avoid tooth erosion. First, you should avoid all excess stress on the teeth – this includes jaw clinching, teeth grinding (bruxism), excessive brushing (2 minutes, 2-3 times a day is plenty), and any oral fixations (such as chewing on a pen, thumb-sucking, constant gum chewing). A misaligned jaw can also lead to problems and should be addressed. Constant stress is detrimental to many aspects of your health – and includes your oral health, so try your best to avoid constant stress.
Constant acidity in the mouth is also a factor in abfractions, therefore, you should address acid reflux (GERD). Also avoid over-consumption of coffee and sodas, as well, as these drinks promote acidity. Acidic foods, such as citrus, should also be avoided. Eating disorders (such as anorexia and bulimia) are also highly detrimental to your oral health.
If you have or think you have an abfraction, don’t wait, contact a dentist today. If you live in north Georgia, know that Parrish-Childs Dentistry is here for you. Our highly qualified and friendly staff understands every aspect of abfraction and will help you receive the care that serves you best. Call Parrish-Childs Dentistry in Gainesville today at 770-536-0581 and let us help ensure your optimum oral health.
