Abnormalities of Teeth qxd

A

BFRACTION

: I have avoided this because I am not sure it exists but it is in the lit-

erature and you should be familiar with the term. It is proposed that with each bite,

occlusal forces causes the teeth to flex ever so little. Constant flexing causes enam-

el to break from the crown, usually on the buccal surface. Does this really happen?

If it does, why don’t we all have it? ("Abfraction lesions: myth or reality." 

Journal

of Esthetic & Restorative Dentistry

15(5):263-71, 2003)

As the following slides will show, it is not always easy to distinguish between attri-

tion, erosion and abrasion, they may coexist. Slides #28 and #29 are of a 21-year-

old man who had occlusal wear that had flattened the occlusal surfaces and loss of

enamel on the buccal surfaces that cannot be explained by occlusion. Is the occlusal

wear just an example of advanced attrition and the buccal lesions caused by erosion

or abfraction? We could not identify a reason for erosion and he denied nocturnal

bruxing or coarse diet that could account for the wear. Slide #30 shows advanced

wear on the occlusal and incisal surfaces presumably due to end to end occlusion

coupled with erosion. We could not identify an erosive agent but there is an almost

identical picture in your text that identifies it as erosion. (Neville’s 2nd ed. Oral and

Maxillofacial Pathology)

Slides #31 and #32 are two different people with what appears to be erosion but I

was not able to identify a chemical or dietary habit that could account for it. Slide

#33 is a little less mysterious. Notice the loss of enamel on the lingual surfaces

caused by long term, daily exposure to gastric acid reflux in a patient with bulimia.

And finally Slide #34 is abrasion caused by tooth brushing. Toothbrush abrasion is

common but usually not to the extent seen here.