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Dental Abrasion: Causes, Symptoms & Treatment

Dental abrasion refers to the mechanical wear of tooth hard tissue caused by external forces. It can lead to tooth sensitivity and structural loss.

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Things worth knowing about "Dental abrasion"

Dental abrasion refers to the mechanical wear of tooth hard tissue caused by external forces. It can lead to tooth sensitivity and structural loss.

What is Dental Abrasion?

Dental abrasion is the mechanical wear of the hard tissues of the tooth caused by repeated friction or pressure from an external source. Unlike dental erosion, which is caused by chemical agents such as acids, abrasion is purely mechanical in nature. It most commonly affects the tooth enamel and, in more advanced cases, the underlying dentin. Dental abrasion is a widespread condition that can occur at any age but tends to increase with advancing age.

Causes

The most common cause of dental abrasion is incorrect tooth brushing technique. This includes using excessive pressure, a hard-bristled toothbrush, or a horizontal scrubbing motion. Additional causes include:

Improper brushing technique: Aggressive scrubbing, especially in the cervical (neck) area of the teeth
Hard-bristled toothbrushes: Firm bristles increase the level of mechanical wear
Abrasive toothpastes: Toothpastes with a high abrasive content (high RDA value) accelerate tooth wear
Parafunctional habits: Nail biting, chewing on pens, ice cubes, or other hard objects
Oral piercings: Lip or tongue piercings can cause localized abrasion through constant contact with tooth surfaces
Occupational exposure: Inhalation of dust or grinding particles in certain professions

Symptoms

The symptoms of dental abrasion often develop gradually and may go unnoticed at first. Common signs include:

Wedge-shaped defects at the gum line, visible as notches or indentations
Tooth sensitivity to cold, heat, or sweet foods and beverages
Changes in tooth shape, such as flattening of the incisal edges
Discoloration due to exposure of the yellowish dentin layer
In advanced cases, pain and increased susceptibility to cavities

Diagnosis

Dental abrasion is diagnosed by a dentist through a clinical examination. The dentist evaluates:

The extent and location of the defects
The wear pattern to help identify the underlying cause
The condition of the gums and surrounding tooth-supporting structures

Standardized indices such as the BEWE index (Basic Erosive Wear Examination) or the TWI (Tooth Wear Index) may be used for classification. Photographs or dental impressions can be taken to monitor progression over time.

Treatment

Treatment of dental abrasion depends on the severity of the damage and the underlying cause. The primary goals are to eliminate the cause and to protect or restore the affected tooth structure.

Prevention and Behavioral Changes

Switching to a soft-bristled toothbrush
Adopting correct brushing technique (e.g., the Bass technique)
Using toothpastes with a low RDA value
Avoiding nail biting or chewing on hard objects
Addressing and treating bruxism (teeth grinding) if present

Dental Treatment Options

Fluoride application: Strengthening remaining tooth structure with fluoride gels or varnishes
Desensitization: Treatment of hypersensitive teeth with specialized agents
Composite fillings: Wedge-shaped defects can be restored using tooth-colored composite resin
Veneers or crowns: Prosthetic solutions may be indicated in cases of extensive wear

References

Lussi, A. & Jaeggi, T. (2008). Erosion -- Diagnosis and Risk Factors. Clinical Oral Investigations, 12(Suppl 1), S5-S13. DOI: 10.1007/s00784-007-0179-z
Bartlett, D. & Shah, P. (2006). A Critical Review of Non-Carious Cervical (Wear) Lesions and the Role Played by Abfraction, Erosion, and Abrasion. Journal of Dental Research, 85(4), 306-312.
World Health Organization (WHO): Oral Health -- Key Facts. Available at: www.who.int/news-room/fact-sheets/detail/oral-health

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