Dental Abfraction Case Study

A 38-year old patient, whom we will refer to as Kevin, came to the Cosmetic Dentistry Center because his teeth were becoming extremely sensitive to cold water and air. He explained he had first noticed this one night several weeks back while drinking ice tea, and that the condition had become increasingly worse and painful, not only when he drank something cold, but even when he breathed in cold air while running in Memorial Park in the morning. He also said that his wife had woke him up a number of times in the past few weeks, telling him that she had heard him grinding his teeth in his sleep. Kevin was afraid that he might have an abscess and require a root canal. We were more optimistic, because his symptoms sounded more like dental abfraction.

Both sensitivity to cold and the grinding of his teeth (a condition called Bruxism), are symptoms of dental abfraction--an all too common condition where the teeth at or below the gum line become notched. This causes heightened tooth sensitivity and discomfort, and, depending on the degree of dental abfraction, can result in conditions such as bicuspid drop-off, worn anterior teeth that become frayed around the edges, gingival recession, exposed dentin, and bruxism.

Dental abfraction is caused by teeth that are not perfectly aligned. One tooth impacts the opposing row of teeth sooner than the rest, causing too much stress on that individual tooth. This causes enamel to separate from the inner dentin layer and created notches at or below the gumline.

Milder cases of this syndrome can often be treated with something as simple as conservative topical treatments of either fluoride gel or Sensodyne tooth paste. These treatments can be applied with custom, flexible trays to fit the patient's mouth and applied for 20 minutes each day. Other, more severe cases, however, may call for more aggressive forms of treatment. In Kevin's case, we simply would not know until we conducted a thorough case history study and intraoral analysis of his teeth.

When Kevin arrived, the first thing we did was to pull up his medical history on the computer. Each of our dental treatment rooms has one or more computers that allow us to conduct his type of preliminary research. Kevin's medical history revealed that he had been involved in a minor accident where he had been hit in the mouth by a falling object. Although he bled severely enough to require stitches, he had not lost any teeth, so he had assumed it was only his lip that had been cut in the accident. Actually, some of his teeth had been knocked slightly out of alignment. This had not altered the appearance of his smile or caused noticeable pain when he chewed, but over time, it had eroded two of his teeth with severe dental abfraction.

Another advantage that the Cosmetic Dentistry Center offers is the ability to closely examine teeth and gums with an intraoral camera that produces an exceptionally high-resolution, full-color image of the teeth and gums so we can make accurate diagnoses of otherwise mysterious ailments. In Kevin's case, intraoral examination revealed a very acute case of gingival recession and dental abfraction below the receding gum line. Both tooth roots were also exposed, and revealed themselves to be the source of his pain. While it is true that abfraction can result in an exposed nerve that then becomes inflamed, this does not always mean that the root is dying and requires removal. Under close examination, we discovered both tooth roots to be only inflamed, but otherwise alive and healthy.

This level of precise diagnosis would not have been possible without the help of advanced technology, which in turn allowed us to make a precise and accurate diagnosis of the severity of Kevin's dental abfraction. At the end of the day, we were able to circumvent a full root canal in plenty of time, and apply tooth-colored, bonded filling material over the surfaces of both roots.

Since then, Kevin's symptoms have disappeared, and further topical treatments of Sensodyne have successfully reversed much of the gingival recession that resulted from his dental abfraction.

If, after reading Kevin's story, you fear that you may be suffering from dental abfraction because of recent sensitivity, receding gums, or Bruxism, please call us today to schedule an appointment.

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