Here is how Abfractions are caused by Obstructive Sleep Apnea.

This may be used as patient education in your web site or as a hand-out.

(Take the Quiz at the end.)

“Doctor, I always thought these notches are from brushing too hard. They are painful and I have them on my teeth on both sides. What causes them?” 


Here is a simplified explanation:

An abfraction occurs on the lower part of the crown of a tooth, near the gum line as shown in the picture above.

            The enamel covering the crown tapers down to its thinnest there. When the occlusion (bite) is not balanced, there will be uneven pressures on the biting surfaces of teeth. Those pressures cause a torque on the tooth which produces a slight bend at the center where the crown meets the root. As the tooth keeps bending, the thin enamel at the bottom of the crown, near the gum line, chips away. The sensitive “dentin” surface inside the enamel is now exposed. Vigorous, improper teeth brushing will then wear away the unprotected dentin and the notches will grow deeper and larger.

The dentin also becomes vulnerable to acid erosion from foods such as citrus.


The uneven bite pressures also cause a loss of gum and bone attachment around the roots so the roots become progressively exposed adding to the acute sensitivity to touch and cold. Advanced effects can be fracture of the tooth at the crown-root junction, tooth mobility and serious gum disease. 

             Abfractions can resemble other conditions like decay or toothbrush abrasion, but the treatment is more specific. The treatment, after diagnosing the cause as a bite dysfunction, consists of balancing the bite to equally and properly distribute the pressures and then to restore the lost tooth structure. An occlusal guard may be required. About 25% of the population clench or grind their teeth at night (Nocturnal bruxism) and are completely unaware of it!. Obviously, the earlier this condition is discovered, the less damage to the teeth and bone will have occurred. In advanced cases crowns may need to be placed to protect the weakened teeth. There is a convincing connection to Obstructive Sleep Apnea. There are some cases where orthodontic treatment may be necessary. 


Abfractions are non-carious cervical lesions (NCCL) caused by flexural forces; the enamel, especially at the cementoenamel junction (CEJ), undergoes this pattern of destruction by separating and breaking the enamel rods.  

Abfractions are common in patients with OBSTRUCTIVE SLEEP APNEA. Nocturnal bruxism, which is indicative of OSA, plays a major roleThe effective solution requires treatment of the causes. I created this explanation to serve as an aid to educate patients on the need to understand the CAUSES of abfractions- and to treat those causes.



  1. Abfractions are usually caused by improper teeth brushing.                   (F)
  2. Abfractions are a specific type of dental decay.                                       (F)
  3. Correction of an abfraction requires more than just a cervical filling.       (T)
  4. Nutrition plays a role in worsening abfractions.                                         (T)

Multiple Choice

Which are correct?

  1. .Abfractions occur primarily on the facial surfaces of teeth.
  2. A porcelain veneer can have an abfraction.
  3. Abfractions occur only on maxillary teeth.
  4. An abfraction may be able to cause a separation fracture of a tooth crown.
  5. All the above.

The treatment options include all except one of the following:

  1. Orthodontics
  2. Nutritional adjustments
  3. Occlusal adjustment
  4. Periodontal Therapy
  5. Cervical restorations


Dr. Barry Freydberg is a nationally recognized authority on the treatment of sleep disorders. He will share his unique perspective on his very successful Dental Sleep Medicine practice. “Be like Barry.” 
Included in this A to Z presentation is Medical Insurance billing, Codes, Fees and Procedures.  And you will receive 16 CE credits to jump start your new year.
Send us an email and let us know what you’d like Dr. Freydberg to add to the two day course. 
Getting tired yet of the freezing weather?  Join Dr. Freydberg in Fort Lauderdale on Friday and Satuday, February 12 and 13.  The warmest part of the continental U.S. has been here in south Florida. Enjoy Abraham Lincoln’s birthday weekend in sunny Florida.
5-24-15 Lincoln_quote
You will be prepared to do far more as a comprehensive care-giver for your patients and the new ones who seek your services.
Review the course outline and register here:
Sleep Group Solutions



“Satisfied” doesn’t do much for you.  Make them leave you ENTHUSIASTIC and eager to tell the first person they see about their great experience.
Make them want to tell their friends and families that you are caring and professional. Caring enough to be concerned about treating the entire person, not just their teeth, and professional enough to know how the conditions in the oral cavity effect the other systemic organs.
Dentists who perform services like a sleep disorder screening and are able to offer solutions like an intra-oral appliance will “wow” their patients and encourage them to be enthusiastic ambassadors. It’s easy, economical and powerful to develop your patients into a marketing team like that. Simply take a course and learn Dental Sleep Medicine. 
The objective is to have every patient leave the office ENTHUSIASTIC and eager to tell the first person they see about their great dental office experiences. The side benefit of adding Dental Sleep Medicine to your practice is that you will be filling a underserved need and helping a lot of suffering patients.
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