Toothbrush abrasion

A parulus is called a gum boil. It is really a drainage point for an abscess associated with a dead nerve in a tooth. This abscess is caused by the body's response to the toxins which drain from the tip of the root of a tooth with a dead nerve. In this case, the nerve in the molar died because the patient literally sawed it in half using a hard toothbrush and abrasive toothpaste over a period of many years. The notches in all the teeth visible on this image (the top teeth too) are caused by the misuse of toothpaste.

While this is the reason that dentists and hygienists always recommend that a patient use a soft toothbrush, years of research have shown that overly vigorous application of toothpaste(All brands, including the most popular ones such as Crest and Colgate) may be a more important factor than the hardness of the brush in producing these lesions.

In order to avoid this type of tooth damage, it is recommended that patients learn to use the the more gentle technique discussed on my page on prevention, and to use mouthwash on their toothbrush instead of toothpaste.

The image above is from a patient who presented to my office with a toothache in the lower left second premolar, the leftmost tooth in this image. He was a serious brusher and used a hard toothbrush causing severe toothbrush abrasion in both premolars. These lesions had been filled with composite about five years before this picture was taken, but since there was no tooth behind the second premolar, the patient had succeeded in actually brushing away the composite filling the defect. He continued brushing away until he had exposed the nerve in the center of the tooth. The hole you see close to the gums is the space where the nerve used to live. Some research has shown that this type of damage does not happen if there is no toothpaste on the toothbrush.

The "Coke bottle" tooth image above, as well as the one below shows extensive erosion of the cervical (around the gum line) tooth structure often attributed to abfraction. This may, in fact, be the case, however evidence suggests that it is more likely to be due to overzealous tooth brushing with toothpaste.

The images below show extensive damage to enamel. Many dentists believe that this is likely to be due to abfraction, however, toothpaste abuse alone may be the culprit. In defense of the toothpaste abrasion theory, note the extreme smoothness and polishing of the lesions.

From the website of Dr Brian Palmer

Martin S. Spiller, D.M.D.

From the website of Dr Brian Palmer