Attrition, Abrasion, Erosion, and Abfraction: The Four Types of Tooth Wear Compared

Attrition refers to tooth wear resulting from direct tooth-to-tooth contact, most commonly from teeth grinding or clenching, causing the biting surfaces of teeth to gradually flatten or wear down over time.

Abrasion refers to tooth wear caused by an external mechanical source rubbing against the tooth, most classically overly aggressive toothbrushing technique, though it can also result from other habits like holding objects between the teeth repeatedly.

Erosion refers to tooth wear caused by chemical acid exposure dissolving enamel, whether from dietary sources like soda and citrus, or from internal sources like acid reflux or frequent vomiting.

Abfraction refers to a proposed mechanism where bite force causes mechanical flexing and stress specifically at the neck of the tooth near the gumline, contributing to notched tooth structure loss in that specific area, though as discussed elsewhere, some debate remains about the precise contribution of this specific mechanism.

Attrition typically affects the biting surfaces of teeth. Abrasion commonly affects the areas near the gumline where a toothbrush or other object makes repeated contact. Erosion can affect broader tooth surfaces more generally, depending on how the acid contacts the teeth. Abfraction specifically affects the neck of the tooth at the gumline, sometimes overlapping in location with abrasion.

Yes, this is genuinely common — a tooth can experience combined wear from multiple mechanisms simultaneously, such as someone who grinds their teeth (attrition), brushes aggressively (abrasion), and also has some dietary acid exposure (erosion), all contributing to overall wear in overlapping or adjacent areas.

Yes, genuinely — identifying the primary contributing mechanism or mechanisms guides the most effective prevention strategy, whether that's a nightguard for grinding-related attrition, adjusted brushing technique for abrasion, dietary and timing changes for erosion, or addressing bite force concerns for abfraction.

Your dentist considers the specific pattern, location, and appearance of the wear, combined with your history, including habits like grinding, brushing technique, and diet, to identify the most likely contributing mechanism or combination of mechanisms.

No, once enamel or dentin structure has been lost through any of these mechanisms, it doesn't regenerate, meaning the focus is on stopping further progression and, if needed, restoring the affected area through restorative treatment like bonding or a crown, rather than expecting natural reversal.

Yes, some gradual, mild wear, particularly attrition, is a normal, expected part of a lifetime of chewing, and your dentist distinguishes between this typical, age-appropriate wear and more significant, potentially problematic wear requiring specific intervention.

Yes, since all four mechanisms can eventually expose the dentin layer beneath the enamel, which is more sensitive, temperature and touch sensitivity is a commonly shared symptom across all four categories, even though the underlying causes differ.

Depending on severity, treatment ranges from desensitizing products for milder cases, to bonding or bite adjustment for moderate cases, to crowns for more significant structural loss, with addressing the underlying causative habit or exposure, like grinding, brushing technique, or diet, being equally important alongside any restorative treatment.