This document discusses non-carious tooth surface loss including erosion, abrasion, abfraction, and attrition. It defines each type of lesion, describes their causes, clinical features, diagnosis, and treatment options. Erosion is caused by chemical dissolution from acids, while abrasion results from mechanical forces from toothbrushing or habits. Abfraction is microstructural loss from occlusal stresses. Attrition is normal wear from tooth contact. Prevention focuses on diet, oral habits, and correcting occlusal issues. Treatment includes restoration, endodontics, and protecting teeth from further loss.

1. NON CARIOUS
TOOTH SURFACE
LOSS
DR. LAMISA RAHMAN
INTERN DOCTOR , BANGLADESH DENTAL COLLEGE
INTERN ID NO. – 865
T. REG.-12709

2. CONTENT-
 CERVICAL LESION
 TYPES
 EROSION
 ABRASION
 ABFRACTION
 ATTRITION

3. CERVICAL LESION
 Cervical lesions are the loss of hard tooth tissue at
the cemento-enamel junction or in its adjoining one
third portion of the tooth crown / root.
These can affect any surface of the tooth like-
Facial surface , Lingual surface, Proximal surface.

4. TYPES OF CERVICAL LESIONS
 Non – carious lesions :
1. Erosion
2. Abrasion
3. Abfraction
 Carious lesions

5. EROSION
 DEFINITION
It may be defined as the defect
arising because of dissolution of
tooth structure due to subsequent
chemical attack of either endogenous
or exogenous origin or combined
chemo-mechanical attack.

6.  Types
1. Regurgitation erosion:
 caused by frequent exposure of gastric
acid to teeth
Site: palatal surface of maxillary anterior,
occlusal & buccal surface of mandibular
teeth
2.Dietary erosion:
Caused by intake of acidic food & drinks
Site: labial surface of maxillary teeth

7. ABRASION
 Definition
Dental abrasion is the pathological
wearing away of teeth due to
abnormal processes, habits or
abrasive substances.

8. ABFRACTION
 Definition:
it is the microstructural loss of
tooth substance in areas of
stress concentration.

9. ETIOLOGY
EROSION
EXTRINSIC CAUSE INTRINSIC CAUSE
Environmental origin:
Professional wine testers,
battery , chemical
manufacture
Swimmers
Dietary origin:
Citrus food & juices
Carbonated beverages
Pickled foods
Medicinal origin:
Aspirin
Vitamin c, acidic
mouthwash etc.
Gastric disorder:
Gastrointestinal ulcer
Chronic alcoholism
Gastroenteritis
Chronic vomiting
Eating disorder:
Anorexia nervosa
Bulimia nervosa
Pregnancy morning sickness

10. Fig : EXTRINSIC CAUSES OF EROSION

11. Fig : INTRINSIC CAUSES OF EROSION

12. ABRASION
Tooth Brushing -
• Over vigorous brushing with abrasive tooth paste or powder
• Use of hard bristle toothbrush
• Improper brushing technique
Abnormal habits –
• Biting finger nails
• Biting a pipe stem
• Opening bobbypins etc.

13. Fig : CAUSE OF ABRASION

14. ABFRACTION
Excessive occlusal stresses
Parafunctional habits-
• Bruxism
• Clenching

15. CLINICAL FEATURES
FEATURES EROSION ABRASION ABFRACTION
Location Facial or Lingual Facial Facial
Shape Broad , shallow saucer
- shaped
Notched , Wedge –
shaped or V-shaped
Wedge-shaped
Margins Not well defined Sharp & well defined Sharp
Enamel surface Smooth & polished Smooth , may show
scratches.
Initial stage – Rough
Later stage – may
show grooves.
Teeth affected • Palatal surface of
maxillary anterior
• Occlusal & buccal
surface of
mandibular teeth
• Labial surface of
maxillary teeth
• Neck of labial
surface of anterior
tooth
• Neck of buccal
surface of posterior
tooth
• Buccal surface of
the mandibular
tooth.
• Usually single
tooth is affected

17. OTHER NON-CARIOUS LESION
OF TOOTH

18. ATTRITION
 Definition
It may be defined as physiological
wearing of teeth resulting from tooth
to tooth contact or tooth against
restoration or prosthesis.
 Site:
incisal & occlusal surface of teeth

19.  Causes:
 Parafunctional habit like – Bruxism
 Developmental dental defect
 Coarse diet
 Associated with betel nut & pan chewing
 Associated with hypersensitive patients
 Associated with poor restorations
 Natural teeth opposing coarse porcelain
 Attrition of anterior tooth due to lack of posterior
support

20.  CLINICAL FEATURES :
The first manifestation is the appearance of a small
polished facet on a cusp tip or ridge or an incisal
Severe attrition can result in dentinal exposure , which
may increase the rate of wear.

22. DIAGNOSIS
 HISTORY-
Before any intervention or any restorative treatment the nature
& duration of patient’s chief complain & expectations must be
ascertained.
Apart from using a routine medical questionnaire , emphasis
may be placed on medical conditions predisposing to erosion
due to gastro-esophageal reflux or reduced salivary flow.
Evalualtion of the family & social history can reveal if the patient
is under unusal stress , which may be related to bruxism ,
changes of diet etc.

23.  CLINICAL EXAMINATION –
Clinical signs of occlusal problems-
• Tooth mobility
• Open contacts
• Tilted or drifted teeth
• Atypical occlusal wear
• Overerupted teeth
• Cross bites , deep bites & open bites
• Fewer number of occluding teeth

24. Other signs –
• Tooth sensitivity
• Compromised esthetics
• Risk of tooth fracture
• Pulpal damage
• Poor periodontal health

25.  Radiographic Findings-
They may be useful in identifying the following
changes-
• Altered lamina dura & periodontal space
• Evidence of resorption
• Pulpal calcification

26. TREATMENT
 Dentine desensitization:
 Fluoride varnishes or fluoride iontophoresis
 Dentine bonding agents
 Use of desensitizing tooth paste
 Restoration:
 Light cure composite filling
 Glass ionomer cements
 Endodontic therapy
 Periodontal therapy

27. • Appearance is satisfactory-
 Counselling is required to patients with parafunctional habit.
 Conventional treatment like- exposed pits are filled, occlusal disharmony is
corrected etc.
• Appearance is unsatisfactory but no need to raise the vertical height-
 Teeth are restored preferably with all ceramic crowns or laminates
 Occlusal guard for protection against nocturnal clenching
• Appearance is unsatisfactory & need to raise vertical height-
 Orthodontic tooth movement can be used for over eruption of posterior teeth
creating space for anterior teeth

28. ATTRITION
• Normal attrition –
Requires no treatment because of formation of secondary dentin, tooth
eruption & alveolar bone growth compensates for occlusal attrition.
• Severe attrition –
Treatment options include use of adhesive materials to replace lost
tooth structure or extraction of affected teeth & replacement with
conventional dentures , overdentures , overlay prosthesis , amalgam or
composite buildups & fixed or removable prosthesis.
• Pathological attrition –
Occlusal adjustment & splint therapy may be indicated for the
dentition.

29. PREVENTIVE MEASURES
EROSION
1. Diet counselling –
• Advice patients to reduce intake of erosive products such as acidic food &
• Always finish meal by food that are alkaline in nature like cheese
• Forbade them to brush their teeth immediately after taking any citrus food
2. Psychiatric counselling-
For suspected anorectics & bulimics.
3. Use of sodium bicarbonate mouthrinse –
In patients with gastric acid regurgitation sodium bicarbonate mouth rinse should be
prescribed to neutralize the effect of the acid.
4. Use of fluoride mouthrinse & xylitol-
Gum exposed to fluorides will reduce the softening effect of acids.

30. ABRASION
1. Correct brushing technique-
Advice patients to modify their brushing technique &
recommend use of soft bristle toothbrush & less
abrasive toothpaste or toothpowder.
2. Correct abnormal oral habit-
Abnormal oral habits like nailbiting, holding objects
pins , pipes etc. in the mouth should be corrected .

31. ABFRACTION
1. Correct occlusal stresses-
In patients with traumatic occlusion or abnormal
occlusal stresses , correction of these occlusal
should be done by occlusal adjustments.
2.Provide mouthguard-
In patients with clenching & bruxism provide
mouthguard to prevent tooth flexure