When patients think about tooth wear, they often imagine cavities, enamel erosion from acidic foods, or damage from trauma. However, there is another subtle yet significant form of tooth surface loss that often goes unnoticed until it becomes problematic: abfraction. Understanding what abfraction is, how abfraction lesions are formed, and the role of bruxism (teeth grinding or clenching) is crucial in both prevention and treatment.
What is Abfraction?
Abfraction refers to the loss of tooth structure at the cervical margin—the area near the gumline—caused by mechanical stress rather than direct decay or chemical erosion. Abfraction, unlike cavities caused by bacterial activity or erosion resulting from acids, is a stress-induced mechanical phenomenon.
Over time, repetitive forces on the teeth can create tiny flexural movements in the enamel and dentine. These forces concentrate at the narrowest point near the gumline, leading to microfractures and gradual tooth tissue loss. The result is often a wedge-shaped notch that appears along the side of the tooth.
What are Abfraction Lesions?
Abfraction lesions are the visible outcome of abfraction—the notches or defects that form at the tooth’s cervical area. They can appear shallow or quite pronounced depending on the extent of stress and how long the process has been occurring.
Common features of abfraction lesions include:
- A wedge-shaped appearance near the gumline.
- Smooth, hard surfaces (unlike decay, which feels soft when probed).
- Sensitivity to temperature changes or brushing, as dentine becomes exposed.
While abfraction lesions are not caused by bacteria, they can still make the tooth more vulnerable to sensitivity, plaque accumulation, and in some cases, secondary caries (decay forming in the weakened area).
The Link Between Abfraction and Bruxism
Bruxism—the habit of grinding or clenching teeth, often during sleep—is a key factor associated with abfraction.
When someone grinds or clenches their teeth, they subject them to non-axial forces—pressures that are not aligned with the natural vertical chewing direction. Instead of the tooth receiving a straight biting force, it bends and flexes under lateral stresses. Over time, these repetitive stresses can contribute to microscopic fatigue of enamel and dentine, which manifests as abfraction lesions.
It’s important to note that bruxism is not the only possible cause of abfraction, but it is strongly linked because of its chronic and intense stress patterns. Other contributing factors may include malocclusion (misaligned bite), habits like nail biting or pen chewing, and even certain occupational stresses (e.g., musicians who use their teeth to hold instruments or hair stylists who put bobby pins between their teeth).
Why Identifying Abfraction Matters
Early recognition of abfraction and its possible link to bruxism is critical for maintaining long-term dental health. If left unmanaged, lesions may:
- Progressively deepen, leading to increased sensitivity
- Compromise the structural integrity of the tooth
- Create aesthetic concerns near the gumline
Require restorative interventions, such as composite resin fillings or crowns
Managing and Preventing Abfraction
Management requires a multifactorial approach:
- Address the cause
- If bruxism is present, a nightguard (occlusal splint) is usually recommended to reduce stress on the teeth during sleep
- Bite analysis and occlusal adjustments may be considered if malocclusion is contributing
- Restore weakened areas
- Lesions causing sensitivity or structural concerns can be restored with bonded materials that protect the dentine
- Monitor and maintain
- Regular dental reviews help track lesion progression
Patients should avoid overly aggressive tooth brushing, which can worsen cervical defects
Abfraction and abfraction lesions may not be as widely discussed as cavities or enamel erosion, but they represent a significant dental concern—especially for patients who grind or clench their teeth. Understanding the connection between bruxism and abfraction highlights the importance of early detection, prevention, and intervention.
By addressing the underlying habits and protecting vulnerable teeth, dental professionals can help patients preserve their smiles and avoid long-term complications.
Written By
Dr. Dee
Clinical Photos, clinical content, cosmetic and restorative dentistry by Dr.Deepan Duraisamy (Dr Dee) BDS., MSc., FICCDE , FICOI , Vogue Dental Studios.
Clinical Content
Dr. Dee
Clinical Photos, clinical content, cosmetic and restorative dentistry by Dr.Deepan Duraisamy (Dr Dee) BDS., MSc., FICCDE , FICOI , Vogue Dental Studios.
