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Introduction
| Much of the information that follows was learned at
a lecture given by Dr. Thomas C. Abrahamsen, DDS.
I present it on my website in my own words using his
outline. Unfortunately, Dr Abrahamsen would not allow me
to use his images, but you can see them by clicking
here. This is
important information since most dentists see severe
wear patterns on teeth, but do not know exactly how they
occur. I have been amazed recently at how accurate the
diagnoses can be when, upon seeing the various types of
wear in a patient's mouth, I have questioned the patient
about his or her particular habit. Since each
habit has specific wear patterns, it becomes possible to
ask such questions and possibly help the patient to
prevent further serious damage to his or her teeth.
As a public service, I am writing this series of
dedicated pages on the subject, and I will eventually
populate them with images of my own. Unfortunately,
outside of very early research by WD Miller in 1907, and
by G Ganges in 1975,
there are few other studies available to back up Dr
Abrahamsen's conclusions, and the theory of Abfraction
currently reigns supreme in explaining many non-carious
lesions. I have no ax to grind and I have
not completely abandoned the theory of abfraction, but
common sense and my own experience has lead me to
believe that Dr. Abrahamsen may, in fact, be
correct in denying that bruxing is the reason for severe
loss of tooth structure on buccal surfaces.
Since I have no means of doing research on this
subject, I will appreciate any observations from
dentists and hygienists who have taken the time to learn
the information presented here and have applied it
clinically.
References: Abrahamsen TC, The worn dentition -
Pathognomonic patterns of abrasion and erosion.
International Dental Journal (2005) 55, 268-276 Miller W.D. 1907
: Experiments and observations on the wasting of
tooth tissue variously designated as erosion, abrasion, chemical abrasion,
denudation, etc. Dent Cosmos 49 vol.1,2,3(1907): 1-23,255-47 Sanges G,
Traumatization of teeth and gingiva related to
habitual tooth cleaning procedures J Clinical Perio
3 (1975): 95-103 |
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If you have been in practice long enough, you will have run into
something like this eventually. This is a 76 year old farmer
who has fairly obviously been "grinding his teeth". In fact,
you would be making a correct assumption. Note that the tooth
wear is much worse anteriorly than it is in the posterior. As
we will eventually see, this is diagnostic of abrasion from bruxism.
But notice a few other less obvious things. You see no
occlusal amalgam fillings in the posterior teeth. You see no
plaque or redness around the gingiva. You see no active decay
anywhere. Furthermore, the patient has no periodontal bone
loss in spite of a serious bruxing habit. On the other hand,
you do see a few buccal composite fillings along with severe
buccal-cervical wear. We can conclude the following from these
observations:
- This patient has probably never used too much sugar.
We conclude this by the lack of amalgam fillings in the intact
molars and the occlusal of #4, the one "surviving" premolar.
- The patient has had good oral hygiene for most of his life.
We conclude this by the lack of periodontal disease, in spite of
severe bruxing, and the current state of health of the gingiva
and supporting structures.
- On the other hand, something has caused cervical erosion on
#s 4,5,6,11 and 12.
The theory of abfraction suggests that the cervical buccal
lesions were caused by the biomechanical "bending" of the teeth due
to severe bruxing forces. But look at the buccal composite on
#6. Note that the filling seems to be raised above the surface
of the enamel. Did abfraction cause this too?
Note the pattern of cervical erosion seen in the
image above. Was this caused by the process of abfraction, or
is this toothbrush abrasion? And why is is so different than
the image below which most dentists and hygienists would not
hesitate to call toothbrush abrasion?
In the following pages, I hope to show that there
are really five major causes of non carious tooth wear, and
abfraction, if it is even a real factor, plays only a minor part in
the drama.
Next page--The theory of abfraction>>>
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Copyright 2000
by Doctor Martin S. Spiller, DMD
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