What Are Abfractions?

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An abfraction is an area in the mouth where the gingival tissue has receded. With an abfraction, there is root exposure and degradation of the tooth structure. The result is an undermined, pitted appearance along the base of the tooth. Some patients describe it as “I’m getting a hole on the side of my tooth” or “My tooth is starting to look long.”

What Causes Abfractions?

Some common causes of an abfraction are teeth clenching, grinding, aggressive brushing, periodontal disease, or misaligned teeth.

Teeth clenching or grinding puts excessive pressure and force against the gumline and enamel at the base of the teeth. If someone is an aggressive brusher or uses a medium or stiff-bristled toothbrush, the gum tissue and enamel can literally be brushed away. Untreated periodontal disease due to plaque and tartar buildup can also cause bone and gum loss.

Misaligned teeth can cause an unnatural and uneven bite, which also puts excessive pressure and force against the gum line and tooth structure, which results in unusual wear. These areas can range from being highly sensitive to completely asymptomatic.

What Happens If Abfractions Are Left Untreated?

Not all abfractions require treatment. Mild cases where patients exhibit no symptoms and the abfraction is not advancing can be monitored. In moderate to severe cases, food and plaque become trapped in those areas, leading to tooth decay on the root structure and eventual tooth loss. Areas where abfraction lesions continue to advance can result in a tooth fracture since the tooth structure continues to be lost from the base. Once a fracture occurs, these teeth are often not restorable, as the tooth breaks off down to the gum line.

Are There Ways to Treat Abfractions?

Treatment for abfractions will vary depending on the severity of the condition. For mild cases, tooth structure can be restored with a simple filling or crown. Gingival or gum grafting may be needed for moderate to severe cases or where multiple abfractions are present throughout the mouth.

During a gum grafting procedure, healthy tissue is surgically transposed to the area where the gingival tissue has been lost to replace it and cover the exposed root surface. There are cases where a combination of gum grafting and a filling or crown are necessary. Orthodontics or braces may also be needed to correct misalignment and properly straighten teeth to prevent undue force when biting and prevent future abfractions.

Can Abfractions Be Prevented?

Routine dental visits at least every six months include an exam where the dentist and hygienist will see if an abfraction is starting. Oral hygiene also plays a crucial role.

Brushing along the gumline helps prevents plaque and tartar buildup, but it is essential not to brush aggressively. Soft-bristled electric toothbrushes are recommended for the best cleaning power and gentle effectiveness. Manual brushes can lead to aggressive brushing and often come with medium or hard bristles, which are never recommended.

Wearing a mouth guard or occlusal guard daily, typically at night, is necessary if teeth clenching or grinding is a habit. Lastly, braces may be recommended to stop abfraction lesions from starting or worsening if the teeth are misaligned.

The photo above shows a misalignment between the back teeth and the front canine. The patient bites down heavier on the back teeth than on the front, which is why there is more wear and the teeth appear to sit lower than the canine to the far right of the photo. Orthodontics would be the appropriate treatment for this patient. This patient was also an aggressive brusher for many years and used only a manual toothbrush with stiff bristles. A soft electric toothbrush is necessary to prevent the abfractions from getting worse and protect the teeth and gums. The patient also grinds his teeth, which is particularly evident by the flat top edge of his canine tooth, a tooth that usually appears sharp on the end. However, the enamel has been ground down, giving the tooth a flatter appearance.

Don’t Wait to Seek Treatment for an Abfraction

Symptoms of an abfraction can include tooth sensitivity, getting food stuck at the base of your teeth near the gum line, a visible indentation between the bottom of your teeth and your gums, and receding gums. Don’t wait to seek treatment if you have any of these symptoms. Contact Leesburg Family & Cosmetic Dentistry today to see what could be causing your symptoms and pursue the appropriate treatment to save your smile!