17/08/2026
🦷 Non-Carious Tooth Surface Loss — Quick Notes
Definition
Non-carious tooth surface loss (NCTSL) is the loss of tooth structure not caused by dental caries. It may be physiological or pathological.
The 4 Main Types — ABEF
🅰️ A — Attrition → tooth-to-tooth
🅱️ B — Abrasion → tooth-to-substance
🅴 E — Erosion → chemical dissolution
🅵 F — Abfraction → cervical defect; proposed occlusal-stress mechanism
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1. Attrition
Tooth-to-tooth wear caused by functional or parafunctional contact.
Features
Wear facets on incisal/occlusal surfaces
Smooth, well-defined, shiny surfaces
Often bilateral and generalized
Common associations
Bruxism
Clenching
Parafunction
Physiological aging
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2. Abrasion
Mechanical wear caused by an external substance.
Features
Frequently affects cervical areas
Notched, grooved, V-shaped or saucer-shaped defects
Often related to habits and brushing technique
Common causes
Vigorous/horizontal tooth brushing
Abrasive toothpaste
To***co chewing/pipe use
Nail or object biting
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3. Erosion
Chemical loss of tooth structure caused by acids without bacterial involvement.
Features
Smooth, glazed or rounded depressions
Cupping may occur on occlusal surfaces
Enamel may appear thin/translucent
Can involve enamel and dentin
Sources of acid
Citrus fruits and acidic drinks
Gastric reflux
Recurrent vomiting
Occupational acid exposure
Certain acidic medications
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4. Abfraction
A cervical wedge-shaped lesion that has traditionally been associated with occlusal stress and tooth flexure.
Features
Usually cervical
Wedge-shaped defect
Often sharply defined
May occur near the cemento-enamel junction
Important: The mechanism of abfraction is controversial. Current understanding recognizes that cervical lesions are often multifactorial, with abrasion, erosion and mechanical stress potentially interacting.
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Other Tooth-Surface Defects
These should be distinguished from the four major mechanisms above:
Developmental enamel/dentin defects
Traumatic fractures and cracks
Structural defects
Risk Factors
Acidic diet
Reflux/vomiting
Aggressive brushing
Parafunction
To***co habits
Occupational exposure
Reduced salivary flow
Age-related changes
Diagnosis
Diagnosis should consider:
1. History — diet, brushing, habits, reflux, occupation
2. Clinical examination — location, shape, surface texture and distribution
3. Radiographs when indicated
4. Differential diagnosis from caries, abrasion, erosion, abfraction, fractures and other cervical lesions
Management
Identify the cause → control the cause → protect the tooth → restore when necessary → monitor
Modify acidic diet
Manage reflux or relevant medical conditions
Improve brushing technique
Control parafunctional habits
Address occupational exposures
Use desensitizing/preventive measures when indicated
Restore lesions when there is sensitivity, functional/aesthetic need, or progression
Regular follow-up
⭐ Exam Pearls
Attrition = tooth ↔ tooth
Abrasion = tooth ↔ external substance
Erosion = acid
Abfraction = proposed stress-related cervical lesion; multifactorial
NCTSL ≠ caries
A cervical lesion may have more than one contributing mechanism.
