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The term “dental abfraction” refers to the entire complex situation that leads to a tooth lesion. The definition also includes much of the tooth sensitivity that we see in our dental office. Areas at the gum line near the base of teeth are often sensitive, so it is a common complaint for us to hear about discomfort in this area. Patients will also complain of cold sensitivity around the necks of their teeth. This was once called “toothbrush abrasion”, but the cause is more complicated than that. It is primarily caused by the flexing of teeth in people who suffer from Bruxism (teeth grinding).
The extreme forces that cause dental abfraction typically lead to several other problems. The most common of these problems is detailed as follows:
1) Sensitivity to heat, cold, or pressure
2) Premature tooth mobility
3) Excessive surface erosion
4) Differences in occlusion
5) Excessive bone loss
6) Broken or destroyed restorations
7) Non-bacterial, non-plaque related gingival recession
8) Opening of contacts
When there is only a small amount of tooth structure gone from the neck of the tooth, and there is minor tooth sensitivity to cold, then there is little or no procedural treatment necessary for dental abfraction. We may recommend occlusal equilibration, which essentially means taking steps to adjust a person’s bite. Aside from that, we encourage more proactive dental self-care, such as dental varnishes, topical fluoride, and Sensodyne tooth paste.
More aggressive dental abfraction treatment is typically needed when we encounter significant sensitivity to cold. This state of the condition also usually involves soft tissue recession and visible loss of tooth structure. In addition to self-care at home and bite adjustment, we may fit the patient with an acrylic guard to prevent bruxism. We may also place bonding material over the root surface to cover and protect it.
In severe cases, we often find root sensitivity that is severe and irreversible. We may have to use dental bonding resin to fill the fracture in teeth, or crown the tooth for advanced coverage. Root canals are sometimes needed for such cases as well in order to save the function of the tooth even if the life of the tooth cannot be saved.
The Bonding or filling material used in the treatment of abfraction may vary.
Several types of filling materials can be used, depending on the severity of the case and the discretion of Dr. Doctor:
1. Composite resins
2. Flowable composite resins
3. Glass ionomers
As with many medical conditions, the complexity of the problem often determines both our perspective on the problem and the approach we take to solving it. In the case of abfraction, more needs to be considered than simply what material to use as filling. An overall approach to tooth health is needed to bring lasting change and improvement to the patient.
There is a range of treatment options for dental abfraction, depending on the patient and the severity of the problem.
We focus our efforts in the direction of management of forces, as we believe this is the most dominant factor in this multifactorial problem.