Abfraction Lesions: Causes, Symptoms, and Professional Treatment

If you notice indentations forming on your teeth where they meet the gumline, you may have abfraction lesions. These are non-carious cervical lesions (NCCL) caused by structural stress rather than decay. While they are not cavities, they can expose sensitive dentin and require professional evaluation to prevent further tooth wear.

What Are Abfraction Lesions?

Abfraction lesions are gradual losses of tooth structure that manifest as notches near the gumline. Because they expose the softer, less mineralized parts of the tooth—specifically the cementum and dentin—they can cause significant sensitivity and mimic the symptoms of a cavity. Clinical distinction: Unlike dental abrasion, which is caused by external friction, abfraction is primarily driven by internal biomechanical stress that causes the tooth to flex at the cervical region. Discovering the underlying cause is the essential first step to effective management.

What Causes Abfraction Lesions?

According to research in Clinical, Cosmetic, and Investigational Dentistry, these lesions are often multifactorial, involving a combination of chemical, biological, and behavioral factors:

• Occlusal Stress: Excessive force from clenching or grinding (bruxism) causes the tooth to flex at the gumline, leading to structural fatigue.
• Tooth Erosion: Exposure to acids from diet or reflux weakens the enamel surface, making the tooth more susceptible to mechanical wear.
• Abrasive Habits: Improper brushing techniques or the use of highly abrasive toothpastes can accelerate the loss of structure in areas already weakened by stress.

Treatment and Management

Proper treatment is based on the severity of the lesion, reported sensitivity, and aesthetic concerns. Your dentist or dental hygienist will help you identify and modify these risk factors:

• Composite Restorations: Dentists typically use tooth-colored fillings to cover notches that extend below the gums, become decayed, are difficult to clean, or expose the pulp/nerve.
• Occlusal Guards: If grinding is the primary cause, a custom-fitted mouthguard can protect your teeth while you sleep.
• Orthodontics: Realignment can help prevent further damage by distributing bite pressure more evenly.
• Desensitizing Toothpaste: For minor lesions, these products can help manage nerve sensitivity and provide relief.

When to See a Dentist

If you notice a lesion starting to form or experience new tooth sensitivity, consult your dentist. Red flag: If you notice a notch that is becoming increasingly sensitive to cold or hot temperatures, or if the area appears to be deepening, schedule an appointment to prevent potential pulp exposure.

Frequently Asked Questions

Are abfraction lesions the same as cavities?

No. Abfractions are classified as NCCLs (non-carious cervical lesions). Unlike cavities, which are caused by bacterial decay, abfractions are primarily caused by physical stress and chemical erosion.

Can I reverse an abfraction lesion?

No. Tooth structure does not regenerate. Once a lesion has formed, it cannot be reversed, but you can prevent it from deepening by addressing the root cause, such as your bite or brushing habits.

Do I need a filling for every abfraction?

Not necessarily. A dentist will usually recommend a filling only when the lesion extends below the gums, becomes decayed, is difficult to clean, or exposes the tooth’s pulp or nerve.

How can I prevent further damage?

Work with your dentist and hygienist to modify risk factors. This may include using a softer toothbrush, addressing acid reflux, or wearing a night guard to mitigate the effects of teeth grinding.