Could the authors of the August JADA article, "Attrition, Abrasion, Corrosion and Abfraction Revisited: A New Perspective On Tooth Surface Lesions," be overlooking something? I appreciated the article by Drs. John Grippo and colleagues and found it very interesting. I wanted to comment about abfraction as mentioned in the article. One thing I have noticed over the years, and perhaps I am missing something, is that I rarely see this on more than one side of teeth, especially buccal and labial surfaces. Why would it be that a flexing tooth would only wear away on one side most of the time?
It would seem more logical that the culprit is toothpaste abuse in the majority of cases. People do brush harder and more efficiently on those sides. I have quizzed many patients about their toothpaste use and brushing habits, and there seems to be a strong relationship between that and the amount of wear seen. It correlates with the amount of tooth-paste used during brushing and the number of brushings daily.
It also correlates to the loss of surface and anatomy on the facial enamel surfaces on crowns. The picture in the article outlines areas of abfraction, yet it seems to me that micro-abrasion from toothpaste is responsible for that kind of wear on both root and crown. It also would appear that the tissue shrinks away from the root areas, because of the abnormal surface created by the micro-abrasion.
Why would the area extend so far up (or down) the root, if the concentration of forces was below the cervical line? The wear frequently appears on teeth that are in buccal-version, compared with others in a more average position. The brush carrying the abrasive-containing paste would contact those areas harder, and naturally would wear them away faster. It also seems that, only after it wears down to a level consistent with their neighbors, do those teeth also develop the same wear pattern, though shallower.
To me, it would seem that microabrasion from toothpaste would be a more reasonable explanation for this condition. We have all seen severe bruxers with no "abfraction." We have all seen teeth in traumatic occlusion too, without buccal grooving. After reading how many repetitions it seemed to take in the experiments, I really wonder if abfraction explains anything. Though the authors mention it in passing, the article seems to minimize tooth-paste in favor of abfraction, and that makes me wonder.
I don’t know the answer myself, and I only ask questions from those I respect as authorities. The question is: Does toothpaste play a bigger role in surface wear than we have previously thought? I leave it to you to help us understand this question.
