ACQUIRED DEFECTS OF THE

TEETH
 ATTRITION
Wearing away of teeth caused by tooth-to-
tooth friction as caused by the action of
chewing or clenching of teeth.
Attrition is the loss of teeth structure by
mechanical forces from opposing teeth.
According to the classic definition, attrition
was considered to be a physiologic process
occurring primarily from tooth contact
during mastication.
Predisposing factors:
• The most common cause of attrition
is bruxism.
• Functional habits are those such as
chewing and swallowing, which usually
puts very little force on opposing teeth.
•  
Parafunctional habits, such as clenching and
clicking the teeth together nervously, place
greater amounts of forces on opposing teeth
and begin to wear the teeth.
As expected, wear usually begins on the
incisal or occlusal surfaces.
Characteristic Features:
The wear from attrition may be seen on
the occlusal surfaces of posterior teeth,
the incisal edges of anterior teeth, the
palatal surfaces of maxillary anterior
teeth, and the labial surfaces of
mandibular anterior teeth.
The affected surfaces are usually hard,
smooth, and shiny.
The areas of attrition may exhibit a
yellowish-brown discoloration if the wear
has penetrated the dentin.
 ABRASION
Abrasion is the loss of tooth structure by
mechanical forces from a foreign element.
Predisposing factors:
1- Vigorous horizontal tooth brushing. The
most common cause of abrasion, we can see
notching teeth at the cervical area ( the
thinnest part of enamel)
2- nail biting, pen biting and pipe smoking.
3- denture clasps in RPD.
4- Abrasive tooth pasts and powders. Some
smokers use a whitening abrasive powder or
pastes to remove stains but it is very abrasive.
5- Hard tooth brushes
Clinical appearance:
It can be angular “V” shaped at the cervical
area or can be rounded, dish shape .
Usually it affects teeth in the left quadrant of
right handed patients and vice versa.
Affect labial surfaces of prominent teeth ,
canines and premolars(most pronounced
teeth in the jaw) at the cervical area bec of
brushing.
 ABFRACTION
Abfraction is a wedge-shaped/ usually V-
shaped cervical lesion that results from
repeated tooth flexure caused by occlusal
loading.
It is non carious cervical lesions and it is not
caused by tooth brushing only but there is
occlusal force and tensile stress so we expect
abrasion lesion to become more severe in
bruxist patients and that may cause
microfracture of cervical enamel rods.
Mechanism (Stress corrosion theory):

Force on occlusal surface will cause

flexure at the pivot (fulcrum at the
CEJ), it is away from initial contact (the
contact at the occlusal surface but the
lesion at the CEJ).
So the difference between abrasion and
abfraction :
Abrasion is the loss of tooth structure by
mechanical forces from a foreign element.
Abfraction is the loss of tooth structure
from flexural forces.
-The loss of tooth substance may depend
on the direction, magnitude, frequency,
duration and location of the force on the
teeth.
Abfraction lesion is located
subgingivally away from tooth brush
which support another factors.
If it is abrasion we expect the lesion to
be higher at the cervical margin.
EROSION
 irreversible loss of tooth structure due to chemical
dissolution by acids not of bacterial origin.
CAUSES:
Regurgitation
Reflex of acidic contents from the stomach,
we have to type of regurgitation:
Involuntary regurgitation:
related to disease, surgical problem or
pathology in GIT
 1- gastrointestinal problems, like esophagus
regurgitation.
 2- Chronic alcoholism: not the alcohol it
self that attack the tooth but alcoholism
cause damage to the lining of stomach which
will cause regurgitation or reflex of acidic
contents to attack the teeth as well so it is
indirectly affecting the tooth structure.
Voluntary regurgitation
Voluntary vomiting caused by some
psychological diseases and eating disorders:

serious fatal psychological diseases with

high mortality rate, western disease between
models, singers and actresses due to
exaggerated concern of body image and how
they look, it affects female more than male.
they induce vomiting to loss their weight
bec they think that they are fat.
1- Anorexia nervosa
 2- Bulimia nervosa
Environmental
Flow of Saliva
• It is secondary cause of tooth wear,
• Saliva has:
- a buffering effect: it will buffer the acid we ingest bec most drinks have a
pH less than 4
- lubricating effect reduce the effect of rubbing the teeth against each other
• so if you have a reduced salivary flow that mean the same amount of acid
will be more effective in weakening the teeth.
• That happens usually with cancer patients or in salivary
glands disease. Reduced flow and rate: Xerostomia,
Sogren syndrome, radiotherapy( those patient with radiotherapy have a
very weak teeth and they get a new carious lesion every week)
 Clinical Apperance of Erosion
• Enamel has matted appearance.
• Dentine may be exposed with continuous erosion which will
cause (Capping: cavity within dentine with raised enamel
margins bec dentine is softer than enamel)
• palatal erosion related to intrinsic and extrinsic acids.
• Outstanding restorations. in some patients we find the
margins of the amalgam restoration are above the cavity
preparation that bec the surrounding tooth structure is
being eroded while amalgam is resistant to acid so we will
see this filling is outstanding of the cavity margins.
• Increase in translucency of anterior teeth.
• Cervical surfaces may be more prone to erosion because
these areas close to the gingiva are less self-cleaning and
food and beverages may be harboured on the tooth surface
for longer periods of time.