Dentist’s Guide to Tooth ErosionAttritionAbrasion & Abfraction

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How To Orofacial Pain and Oral Medicine

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March 42021

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By Glenn T. ClarkDDSMS

Learn how to diagnosemonitorand treat different types of tooth wear including erosionattritionabrasionand abfraction with this infographic based on Dr. Glenn Clark’s course on abnormal oral physiology and sensory disorders.

Want a full copy of the infographic? Download the infographic for free!

What is tooth erosion?

Tooth erosion is the wearing away of the tooth surface by an acidwhich dissolves the enamel and dentine. There are six primary causes of erosion: dietaryregurgitationenvironmentalthe flow of salivaexposed dentinand idiopathic.

Dietary sources of erosion include carbonated beveragesfruit juiceand fruit. Regurgitation sources include gastroesophageal reflux disease and eating disorders like anorexia and bulimia.

Dentists should document the severity of erosion with pictures and periodically use these models to compare erosion over time.

What is dental attrition?

Dental attrition is the wearing of the incisal or occlusal surfaces of teeth as a result of functional or parafunctional tooth-to-tooth contact. Regular attrition is slow tooth wear associated with chewing.

Sleep disorders like bruxism cause more significant tooth wear. Porcelain crowns can also wear down natural teeth. Lubrication is also indicative of the severity of dental attrition; a greater force and inadequate lubrication produce more attrition.

What is dental abrasion?

Dental abrasion is tooth wear originating from friction or mechanical forces from a foreign objectand it predominantly impacts premolars and canines. Tooth wear from abrasion typically looks like a wedge or V-shaped indentation of the tooth at the gum marginand it appears wornshiny and is often discolored at the cervical margin.

Some causes of abrasion include roughlateral tooth brushingbiting your nailschewing on penspipe smokingplacing and removing denture claspsabrasive dentifricesand stiff toothbrushes. Toothbrush abrasion can be repaired by bonding a tooth-colored filling over the abraded area of the tooth.

What is dental abfraction?

Abfraction is tooth wear from flexural forcesbut it has not been supported by dental research.

When teeth flex under pressurethey touch each other (occlusion)creating tension on one side (v-shaped depressions) and compression (C-shaped depressions) on the other side of the tooth. Researchers believe enamelespecially at the cementoenamel junction (CEJ)undergo this pattern of destruction by separating the enamel rods.

How to Perform an Occlusal Analysis

Occlusionsimply definedis how teeth meet when the lower and upper jaw come together. Proper occlusion is necessary for eatingaestheticsand disease prevention. Howevermany factors can cause malocclusion including trauma and genetics.

Six Steps for Performing an Occlusal Analysis

Dental Midline Assessment
Fremitus Testing
ErosionAttritionAbrasionand Abfraction Exam
Malocclusion
Occlusal Contact
Overbite/Overjet Assessment

ErosionAttritionAbrasionand Abfraction Exam

The severity of erosion can be measured comparing pictures of teeth over time. Attrition can be scored as follows:

0 = no wear at all
1 = small enamel wear (physiologic)
2 = large enamel wear (accelerated but no dentin exposed)
3 = large enamel & dentin exposed (less than 1/3 of crown)
4 = greater than 1/3 of crown lost

Abrasion typically looks like a wedge or V-shaped indentation of the tooth at the gum marginand it appears wornshiny and is often discolored at the cervical margin. Although it has not been supported by researchabfraction may appear as v-shaped depressions on one side of the teeth and C-shaped depressions on the other side.

Embed the Full Infographic on your Website

Want to publish the full infographic on your website? Click on the button to copy the embed code to your clipboard:
[copy tag=”button” text=”Copy the Embed Code” copied-text=”Embed Code Successfully Copied”]<a href=”https://ostrowonline.usc.edu/2021/03/04/dental-erosion-attrition-abrasion-abfraction/”><img =”width:100%;” src=”https://ostrowonline.usc.edu/wp-content/uploads/2021/03/tooth-erosion-attrition-abrasion-abfraction-infographic-usc-ostrow-online-postgraduate-dentistry-programs.png”></a><br>Infographic courtesy of the Herman Ostrow School of Dentistry of USC’s Online Programs <a href=”https://ostrowonline.usc.edu”>Herman Ostrow School of Dentistry of USC’s Online Programs</a>[/copy]

Not working? Copy the raw code here:

<a href="https://ostrowonline.usc.edu/2021/03/04/dental-erosion-attrition-abrasion-abfraction/"><img ="width:100%;" src="https://ostrowonline.usc.edu/wp-content/uploads/2021/03/tooth-erosion-attrition-abrasion-abfraction-infographic-usc-ostrow-online-postgraduate-dentistry-programs.png"></a><br>Infographic courtesy of the Herman Ostrow School of Dentistry of USC's Online Programs <a href="https://ostrowonline.usc.edu">Herman Ostrow School of Dentistry of USC's Online Programs</a>

Want a full copy of the infographic? Download the infographic for free!

Earn an Online Postgraduate Degree in Orofacial Pain and Oral Medicine

Are you interested in a variety of issues focused on orofacial painmedicine and sleep disorders? Consider enrolling in the Herman Ostrow School of Dentistry of USC’s onlinecompetency-based certificate or master’s program in Orofacial Pain and Oral Medicine.

Get More Information

References

The Herman Ostrow School of Dentistry of USC. What is Tooth Erosion? CausesDiagnosisand Treatment. August 12019.
West Indian Med J. Dental Erosion and Medical Conditions An Overview of AetiologyDiagnosis and Management. 2014 Sep; 63(5): 499–502.
PLoS One. Influence of Various Acidic Beverages on Tooth Erosion. Evaluation by a New Method. 2015; 10(6): e0129462.
PLoS One. Tooth Erosion and Eating Disorders: A Systematic Review and Meta-Analysis. 2014; 9(11): e111123.
Int J Dent. Gastroesophageal Reflux Disease and Tooth Erosion. 2012; 2012: 479850.
J Appl Oral Sci. Saliva and Dental Erosion. 2012 Sep-Oct; 20(5): 493–502.
The Herman Ostrow School of Dentistry of USC. What is dental attrition? August 6th2019.
Scandinavian Journal of Dental Research. Covariation of some factors associated with occlusal tooth wear in a selected high-wear sample. January 1994. 101(6):398-406.
The Herman Ostrow School of Dentistry of USC. 5 Ways to Treat Bruxism. February 24th2020.
The Herman Ostrow School of Dentistry of USC. Dental Erosion from Abrasion & Abfraction. August 8th2019.
The Herman Ostrow School of Dentistry of USC. The Dentist’s Guide: Tooth ErosionAttritionAbrasionand Abfraction. November 28th2019.
The Herman Ostrow School of Dentistry of USC. How to Perform an Occlusal Analysis. July 212020.

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Authors

Glenn T. ClarkDDSMS

Associate Dean of Distance Learning and Telehealth

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