Understanding Abfraction Teeth: Causes, Symptoms, and Treatment Options

If your dentist diagnosed you with a tooth abfraction, you might be confused about what that means, and you’re not alone. Most of us know to be on the watch for cavities and gum disease, but we’re not always warned about abfractions!

An abfraction refers to a loss of tooth structure in the location where the tooth and gum meet. The weakened area is usually shaped like a wedge or V and isn’t related to the typical causes of tooth damage, like bacteria, cavities, or infection. These small pockets or notches are also called lesions.

This dental condition is usually the result of teeth grinding or a side effect of malocclusions. To fix the abfraction, you must determine the cause of it and treat that first. 

So what causes abfractions, and should you be worried if you have them?
This blog covers everything you need to understand about abfractions in teeth, including the causes, symptoms, and treatment options in dentistry and at home.

How Do Abfractions Form?

Abfractions refer to any lesion on the enamel where tooth tissue is lost. The official dental term is a non-carious cervical lesion, or NCCL.

These notches have various clinical appearances. In some cases, it can be hard to recognize them if you don’t know what you’re looking for.

Created from a mixture of normal wear and tear and abnormal tooth functioning, abfractions can happen to anyone. These notches are a combination of biological, chemical, and behavioral factors, as we’ll discuss later.

Sometimes, they come with side effects. In other cases, the patient is asymptomatic. 

Regardless of the reason behind the condition, if you understand how they form, you can reduce the damage they cause. 

What’s Going on Under the Surface When You Bite?

When we perform simple daily activities, like chewing and speaking, forces and pressure are applied to the teeth. Depending on your usage, these actions add extra stress to the gum line.

For example, there’s a significant pressure difference applied to the enamel and gums with a meal of soup and salad versus steak and potatoes. And those who chew gum frequently throughout the day also add unnecessary stress to their teeth.

Weakening of the Cementum and Enamel

Connecting your upper and lower teeth is a part of life. But the enamel and cementum part of the teeth meet in this sensitive area.

Enamel covers the dentin, which protects the soft dental pulp and system of nerves inside the tooth. When enamel is worn away, the dentin and nerves are exposed, resulting in tooth sensitivity and pain.

Cementum is a calcified substance that covers the tooth root. Its job includes protecting the root as well as working with the periodontal ligament to attach the tooth to the jaw bone. Cementum is almost as hard as bone, but not as hard as enamel. Like bone and enamel, this root protector can be worn away and weakened.

Continually chewing, biting, and clenching cause weakening of the enamel, dentin, and cementum. Over time, this will eventually break or fracture the enamel close to the gum line (called the cementoenamel junction), resulting in an abfraction.

While it can happen to anyone, it’s more common in malocclusions (crooked or misaligned teeth) than in mouths with correct bites.

Are Abfractions Dangerous?

An abfraction diagnosis can be minor or severe, depending on how long it’s been going on.

It’s common for people to have this condition with no symptoms — until the problem is so far gone that the nerves are exposed, and tooth sensitivity starts happening regularly.

Dental abfractions wear away the tooth’s structure at the edge of the enamel, along the gum line. This is where the cementum layer begins. Excessive stress and pressure on this area from malocclusions or bruxism (grinding and clenching) damage this vulnerable spot, creating lesions.

To Ignore or Not to Ignore an Abfraction

On its own, an abfraction doesn’t sound too dangerous and, in fact, can exist without any symptoms. The most important thing to consider is that it slowly weakens the tooth's overall structure.

Your teeth are then at greater risk of:

• Chipping
• Fracturing
• Cracking
• Eroding
• Decaying

You’ll also likely notice tooth sensitivity because of the gum recession.

The lesions that develop due to mechanical stress can’t heal independently. Instead, the protective layer continues to erode, increasing the risk of tooth decay and sensitivity. Untreated decay leads to serious dental issues like infections, needing root canal procedures, or even tooth loss.

So, should you take an abfraction seriously? Definitely. The earlier you catch the problem and treat it, the easier (read: less painful and less expensive) the fix will be.

How Can You Recognize an Abfraction?

So, if you don’t have symptoms or they’re pretty mild, how can you catch an abfraction before it’s too late?

First, you should get familiar with your smile. Like any other part of your body, it has natural characteristics that you take for granted. The surfaces of your teeth are smooth and have a specific shade. Your gums may feel tender when you brush or floss, but overall, you know what to expect and what’s an unusual sensation.

When you recognize your “normal” characteristics, you notice when things are out of the ordinary faster. With an abfraction, the earliest signs are usually caught when you feel a less-than-smooth surface with your tongue or food gets stuck in the area frequently.

It’s atypical and a warning that something is not quite right.

This new symptom starts out painless, making it easy to pretend it’s no big deal. Over time, it increases in temperature sensitivity and starts “snagging” on extra food or the bristles of your toothbrush. 

Left alone, abfractions become more visible, too. The consistent pressure leads to translucent areas on the tooth that look worn and shiny due to enamel loss. Dental caries (cavities) from tooth decay can also be obvious when you smile.

What Causes Abfractions?

The causes of abfractions are different in everyone, but there are general triggers that make this condition more common. Overall, the issue is mechanical.

No, that doesn’t mean it’s caused by a machine. Rather, the tooth wear of an abfraction results from the mechanical motions of grinding and pressure applied to your lower and upper teeth when they close.

There are three primary sources of this motion in oral health etiology: bruxism, malocclusion, and mineral loss caused by scrubbing or abrasion to the tooth enamel.

Bruxism

Bruxism is a condition that refers to someone who clenches their jaw and grinds their teeth unconsciously. This usually happens during sleep, but some people have awake bruxism.

Studies of bruxers show that these individuals are likelier to have wedge-shaped lesions along the gingival margin (gums) associated with abfractions.
This is helpful in general dentistry because if a dentist knows their patient has bruxism, they can include a treatment plan to prevent abfractions.

Night guards (a custom-fit mouth guard worn while sleeping) prevent the upper and lower teeth from clenching and grinding and can effectively reduce the damage that causes abfractions.

Malocclusions

When a person’s teeth do not touch evenly — as in a “normal” bite — they are said to have a malocclusion. These misaligned teeth can lead to numerous health and cosmetic issues, including abfractions.

An uneven alignment places more stress on some teeth than others. As you bite, chew, or grind, the extra pressure on those teeth increases your risk of micro-fractures in the enamel and abfractions.

Malocclusions are best corrected with orthodontic treatment. The specific treatment plan will vary depending on the severity of the misalignment, the person’s overall oral health, and other factors.

Abrasion

Finally, abfractions can be an accidental side effect of trying to take care of your teeth a bit too aggressively. Scrubbing with a hard-bristled toothbrush or using abrasive toothpaste can lead to mineral loss, which weakens the tooth structure.

Aggressive brushing and flossing might sound like a great way to boost oral hygiene. In reality, it erodes your tooth enamel and contributes to quickly receding gums. These two effects increase the risk of abfractions.

Talk to your dentist about proper dental care. If you already have a cavity, tooth-colored fillings can cover the hole and protect you from further damaging the tooth and gums.

How is an Abfracted Tooth Treated?

Treatment for abfractions starts with determining the cause. From there, fixing the source helps eliminate further damage to the enamel. Wearing a custom-fit night guard from our line of high-quality guards at JS Dental Lab is the first step in reducing more damage.

The tension created by clenching and grinding is often linked to stress. Because of this connection, stress management techniques are another part of the overall treatment plan for abfractions. If you can find ways to relax when you’re anxious or before you sleep, you’re less likely to grind, clench, and add pressure to your teeth and gums.

In cases where the abfractions are due to malocclusions, orthodontic care may be suggested. Not only does effective orthodontic treatment correct dental misalignments (fixing the mouth’s natural ability to function properly), but it also boosts a person’s self-esteem.

When your abfractions have damaged your enamel to the point that you feel increased sensitivity when you brush or are exposed to cold and hot temperatures, you may benefit from toothpaste designed for sensitive teeth.

Restorative Treatment  

However, when the abfraction’s effects are already visible, you may have some restorative dentistry options to give you back your flawless smile.

Certain types of dental restorations work to rebuild the damaged or missing tooth structure at the gumline. For example, your dentist may be able to fill the lesion with tooth-colored composite resin, similar to how they fill a cavity in your tooth.

If the damage isn’t too far gone, they may be able to cover it with a veneer, a wafer-thin shell bonded to the surface enamel. Veneers are extremely popular in cosmetic dentistry, as they can hide cracks, gaps, and other imperfections, or make a tooth appear longer or shorter.

When the abfraction has resulted in severe cavities that need a root canal, a crown can protect the nerve roots and keep the tooth connected to the jawbone.

Cosmetic treatments and restorative procedures for damage caused by lesions aren’t usually covered by insurance. Before agreeing to a procedure, check with your insurer and the dentist to determine your cost.

Conclusion

Protecting your smile from internal and external damage is vital to your health.

Cavities, discoloration, and abfractions can lead to physical problems and self-esteem issues. But the fix could be as simple as grabbing a custom-fit night guard from our professionals at JS Dental Lab to prevent any more damage!

The pressure is off your teeth when you wear our night guards. Abfractions, cavities, and micro-fractures, along with the other side effects of bruxism, quickly disappear with consistent use.