Abfraction: Symptoms, Causes, and Treatment

Abfraction (AF) is the loss of dental matter around the gumline caused by physical forces placed on the tooth. Excess or irregular pressure, as in tooth grinding or clenching (bruxism), misalignment (malocclusion), and excessive toothbrushing, can cause enamel (the outer shell of teeth) and dentin (the middle layer) to wear away at the juncture of the tooth and gums.

Since abfraction can lead to gum recession and contribute to tooth loss or decay, it’s critical to recognize its signs and seek prompt dental care.

This article discusses the symptoms and causes of AF, how it differs from tooth decay, and treatment options.  

Symptoms of Abfraction

Most commonly, abfraction affects the incisors (front-facing teeth) and premolars (teeth between the pointy canines and molars). The loss of tooth matter, called an abfraction lesion, is usually seen on the outer surfaces of teeth where they meet the gums.

Typical features of AF include:

• A wedge-like "V" or "C" shape to the abfraction lesion
• Occasional yellowing or browning at the margins of a missing tooth
• Flattened, worn, and shiny sections of teeth, called facets
• Chipping or cracking of teeth
• Tooth sensitivity to hot or cold
• Gum erosion

Causes of Abfraction

The exact mechanism of how abfraction causes teeth to erode is debatable. A prevailing theory is that the stress and pressure placed on the teeth by chewing, grinding, jaw clenching, or other means causes microfractures in the crystalline structure of tooth enamel and dentin. Over time, this leads to deformation and degradation.  

However, abfraction can also arise in people who don’t clench or grind teeth or have a malocclusion, leading researchers to believe toothbrushing is the fundamental cause.

Preventing and Treating Abfraction

While abfraction can be painless, it can affect tooth stability and make teeth susceptible to other issues if untreated. Dental and orthodontic treatments for underlying causes, and changing certain habits can help prevent and treat this condition.

Habits or Conditions That Affect Abfraction

Abfraction can result from conditions affecting the bite or causing jaw clenching. The health of impacted teeth can also worsen when combined with other types of tooth erosion. Factors associated with abfraction include:

• Malocclusion
• Oral habits (e.g., excess chewing, thumb-sucking, pen chewing)
• Tooth grinding or jaw clenching
  
• Excessive brushing
• Stress

Several conditions cause other tooth erosion that worsens AF, mainly due to increased acidity in the mouth. These include:

• Gastrointestinal reflux disease (GERD): GERD (causing acid reflux)
• Eating disorders such as anorexia and bulimia
• Consuming foods or drinks that raise acidities, such as soda or coffee

Dentists monitor and assess for these factors in diagnosing and evaluating AF. Therapies for associated mental or physical health conditions and lifestyle changes can all play a part in abfraction treatment.

Treatment Options for Abfraction

Treatment for abfraction depends on the severity and presence of symptoms or other types of tooth degradation. While AF can’t be entirely reversed, several treatments can manage and prevent it. These include:

• Occlusal adjustment: Treats the misalignment at the root of AF by reshaping the surfaces of teeth to remove interferences of your bite.  
• Orthodontic treatments: Retainers, braces, and other orthodontic instruments can prevent the progression of AF.
• Mouth guards: Used to prevent tooth grinding. Speak to your dentist about custom night guards or mouth guards for the best results.
• Fillings and restorations: While AF doesn’t always lead to cavities, fillings or natural-looking dental restorations may be needed. The overall success of these approaches varies, however, and may not prevent AF progression.  
• Tooth sensitivity treatments: Therapeutic toothpaste or in-office treatments, such as specialized adhesives that prevent stimuli from accessing the nerves, may help.
• Root coverage surgery: Since AF can expose the roots of teeth due to gum recession, dental surgery or the placement of a restoration may be needed. 

What to Ask Your Dentist

If you’re considering treatment for AF, it’s important to understand the condition and your options. Essential questions to ask your dentist include:

• What are my treatment options, and what are the goals of treatment?
• What can I do at home to improve my outcome?
• Will special care be needed as I recover?
• Are there any risks with treatments for AF?
• What follow-up is necessary?
• Do you have recommendations for dental products I can use?
• What can I do to improve my overall oral health?

Outlook: Abfraction and Gum Recession

Abfraction lesions are associated with gum recession, which can expose the roots of the teeth, affect tooth stability, and cause pain and tooth sensitivity. The course of treatment often depends on the health of the affected gums, even in asymptomatic and tolerable cases.

Correcting the underlying causes of symptomatic cases and restoration procedures may not fix the issue entirely but can help. Studies have found that correcting malocclusion with orthodontic procedures can stop the progression of gum loss. Furthermore, surgeries to restore gums using grafts (transplanted tissue) successfully manage this issue.      

Difference Between Abfraction, Abrasion, and Erosion

There are three primary types of tooth matter loss categorized by their mechanisms of action: abfraction, abrasion, and erosion.

Abfraction

The loss of tooth matter due to abfraction arises from mechanical and physical forces on the teeth. The force that causes the deterioration of tooth enamel is internal, often caused by misaligned bites, tooth grinding, or jaw clenching. The enamel and dentin layers are thought to wear away because of structural problems, taking on a characteristic wedge-like shape.

Abrasion

Abrasion is caused by the deterioration and loss of enamel due to outside forces. As with abfraction, tooth malocclusion or grinding can be factors; however, the leading causes are external and can include:

• Excessive toothbrushing
• Biting nails, smoking tobacco from a pipe, or chewing on pens
• Denture clasps (appliances used to secure dentures in place) or other orthodontic appliances
• Certain tooth powders or pastes

Erosion

When teeth deteriorate due to the chemical composition of the mouth—as opposed to bacteria—it’s considered erosion. This type of deterioration often arises due to external factors that raise the acidity in the mouth.

Erosion can also arise if you have digestive issues, such as GERD. The acids from the stomach can migrate to the mouth, breaking down tooth enamel and causing problems.

Summary

Abfraction is the loss of tooth matter at the gumline due to mechanical forces on the teeth. It can arise due to teeth grinding or misalignment and causes a wearing away of the enamel and dentin layers, as well as gum recession in affected areas. It can increase the risk of tooth loss, cavities, and other issues.

Treatments for abfraction vary and involve realigning the teeth with orthodontics, wearing mouth guards, getting restorations, and having gum surgery. While treatment can’t completely reverse this process, it can stop its advancement and prevent complications.      

A Word From Verywell

Treatment for abfraction is important to prevent teeth from degrading or getting worse. Talking to a provider can also help you make positive changes to your habits to improve your outcomes. Give your dentist a call if you’re experiencing discomfort, pain, or sensitivity—or if you suspect tooth erosion without symptoms.