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Abfraction

Diagnosis And Treatment

Chief Complaint and History
Dentists diagnose an abfraction by asking you about the acute or chronic problems and symptoms you are experiencing. The dentist will also take a detailed history of the problem: For example, if you have tooth sensitivity and/or pain, or jaw pain, the dentist will ask you about the location, duration, type and intensity of your pain, as well as what stimulates/causes the pain and what, if anything, relieves the pain.

Extraoral Exam:
The dentist will examine the tissues of the head/face and neck, as well as the jaw joints (TMJ) and jaw muscles for any abnormality such as tenderness, pain, stiffness, spasm, limited range of motion, swelling, bruising, and lumps.

Intraoral Exam:
The dentist will examine the teeth to determine if an abfraction is present and will also look for the following symptoms and conditions that may contribute to abfractions:

  • Inspecting each individual tooth for signs of crazing/stress lines, enamel fracture, restoration fracture, erosion/corrosion, abrasion and abfraction.

  • Percussion: tapping on each tooth to determine if teeth are sensitive to percussion and to determine the sound of each tooth when tapped.

  • Evaluating your gum (periodontal) health and inspecting the gum tissues around the teeth for signs of recession that may be caused by toothbrush abrasion.

  • Examining and evaluating your occlusion (bite) to determine if your teeth are functioning properly or abnormally. First, the dentist will determine if you have a correct, or normal (“Class I”) occlusion, or if you have a malocclusion such as an “overbite” (Class II occlusion) or “underbite” (Class III occlusion). The dentist will also determine if only your teeth are out of alignment, or if your teeth and jaws are both misaligned.

  • As part of examining your occlusion, the dentist will also look for signs of abnormal wear on the teeth, such as wear facets, as well as signs of abnormal or excessive forces being placed on one or more teeth, known as occlusal trauma. For example, the dentist will have you bite on special dental marking paper called articulating paper to help determine if the teeth are in proper occlusion, or if certain teeth are being subjected to improper or excessive chewing/biting forces. Some dentists will also use a computerized device that can evaluate how the teeth contact one another as well as the biting forces on each tooth.

  • The dentist will also determine if any teeth are loose or mobile, or if any teeth have moved or migrated away from their original position, as this could be an indication of bite problems, where teeth may have improper or excessive chewing/biting forces continually placed on them. Teeth that are mobile or that have migrated may be a sign of occlusal trauma.

  • Inspecting the jaw bone on the inside of the mouth for exostoses, which are areas of excess bone growth or bony protuberances that may indicate bruxism.

  • Taking radiographs (X-rays) of the teeth and jaws to assess signs of traumatic occlusion and assess the bone support of each tooth.


  • Treatments Available for Abfractions and Associated Conditions

    For Acid Reflux Disease (GERD)
    If acid reflux disease (GERD) is suspected, the dentist will refer you to your physician or to a gastroenterologist for treatment. Once the acid reflux disease has been treated, the dentist can restore the teeth affected by abfraction.

    Occlusal Trauma
    If any teeth are affected by occlusal trauma, the dentist can adjust your bite to relieve and correct the excess and/or improper forces on individual teeth. If necessary, the dentist can more comprehensively “equilibrate your occlusion” in order to help distribute the forces evenly on all the teeth and allow the teeth and jaw joints to function properly while biting or chewing.

    Niteguard
    An occlusal guard, commonly called a “niteguard” can be prescribed and fitted by your dentist. This hard acrylic occlusal splint is made to fit on either all the upper or lower teeth and is commonly worn at night while sleeping. Niteguards can protect the teeth and jaw joints from further wear and trauma caused by grinding and clenching, and may also serve as a device to help the jaw joints function under less strain.

    Physical Therapy
    Physical therapy may be prescribed for jaw, neck and shoulder muscle discomfort or muscle spasm related to clenching and grinding habits.

    Restorative Dentistry
    Any teeth that have lost smaller amounts of enamel or dentin due to abfraction can be restored with tooth-colored materials to correct the damage and return the tooth to a normal appearance.

    If larger parts of the tooth have been lost due to enamel or enamel/dentin fracture, a restoration such as a porcelain veneer or crown may be needed to correct the problem.

    If any teeth remain mobile following bite adjustment, these teeth can be splinted to help retain the teeth and make them more stable and usable when chewing.

    If any teeth are lost due to abfraction or occlusal trauma, they may be able to be replaced by dental implants, or a fixed bridge, or a removable partial denture.

    Cracked Tooth Syndrome and Root Canal Therapy
    If any teeth affected by abfraction remain hypersensitive following standard treatment, the tooth may have “cracked tooth syndrome.” In this case, further restorative treatment may be required to save the tooth, such as a crown or endodontic (root canal) therapy.

    TMJ and Facial Pain Problems
    If you have minor TMJ problems, your dentist may help relieve them through adjusting your bite and making a niteguard for you to wear. Physical therapy may also be prescribed. This conservative treatment can help protect your teeth from nighttime grinding and clenching forces that can be harmful to the teeth and jaws, and help the jaw joints and muscles become comfortable again.

    If your dentist does not treat TMJ or facial pain problems or you have a more complex TMJ/facial pain problem, your dentist can refer you to a dental specialist who is trained in oral-facial pain and temporomandibular disorders (TMD). The specialist, alone or in collaboration with other dental and medical specialists, will diagnose and treat your problem.

    Orthodontic Treatment
    Teeth that are misaligned (malocclusion) can be corrected with orthodontic treatment. Benefits of orthodontic treatment are a corrected bite (occlusion) as well as an improved appearance of your smile (i.e., having straight teeth).

    Last updated: Aug-17-06

     
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