The December JADA article by Dr. Luiz Pegoraro and colleagues, "Noncarious Cervical Lesions in Adults: Prevalence and Occlusal Aspects" (
JADA 2005;136:1694–1700
), is an excellent article on abfractions.1 I applaud the authors for addressing the long-standing mystery and myth about abfractions and for finally obtaining the scientific data linking abfractions to occlusal forces.
Based on evaluating thousands of patients over 35 years of clinical private practice and extensive article research, I can state with confidence that this article answers most of the questions about abfractions.
As demonstrated by the scientific data in this article, abfractions are caused by traumatic lateral forces that result in wear facets. All traumatic lateral forces in the mouth, however, are not caused by occlusal forces. The tongue also can generate traumatic lateral forces during abnormal swallowing.
Newborns are born with a naturally correct swallowing pattern designed for breast-feeding. Bottle-feeding, pacifier use, ankyloglossia and excessive noxious infant habits interfere with this swallowing pattern and can cause an abnormal swallowing pattern generically called a "tongue-thrust."
Based on my research, abfractions on teeth that do not have wear facets are due to the traumatic lateral forces generated by a tongue-thrust or by not meeting the key requirements of occlusion. Three key works on the topic by Mannerberg,1 Grippo2 and Lee and Eakle3 also are discussed in these articles and presentation.
Teeth that have wear facets but do not have abfractions simply have responded differently to that force. The response depends on the local environment, including the health of the individual and surrounding periodontium. Other possible responses to traumatic lateral forces include sensitive teeth, mobile teeth, bone loss, broken restorations, alignment change, open contacts and nonbacterial/ nonplaque-related gingival recession.
The authors can refine their article by simply recalling the same 70 patients and performing two actions. First, they can add the following two questions to their questionnaire:
- – How long was the individual exclusively breast-fed as an infant?
- – Did the individual have any excessive noxious infant habits such as digit-sucking, lip-sucking, arm-sucking or blanket-sucking?
Second, they can re-evaluate the patients for the following:
- – the presence of tongue-thrusting;
- – the presence of tight lingual or labial frenums;
- – the presence of other possible responses to traumatic lateral forces.
This article greatly enhances the understanding of abfractions. With a little more evaluation of the same 70 individuals, the authors can come even closer to answering all the questions about these "elusive lesions."
In conclusion, traumatic lateral forces are the cause of abfractions—be it either from traumatic lateral forces of occlusion or traumatic lateral forces of a tongue-thrust.
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