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Regressive Alterations of Teeth

Published on May 25, 2021 and last reviewed on Jun 03, 2022   -  4 min read


Regressive alteration is a condition that has a multifactorial origin dentally, causing the loss of the tooth layers, enamel, and dentin. Have a look into what are the causes, symptoms, and management of these regressive alterations.

Regressive Alterations of Teeth


Attrition, abrasion, and erosion are the three main regressive alterations of the teeth seen in the permanent dentition. Although tooth wear is a part of the normal aging process, it remains a major cause of concern to many patients. Most dental surveys carried out, especially amongst middle-aged and elderly individuals, show an increased tooth wear rate, mainly because of the two layers of the teeth that are the dentin and the superficial but strong enamel wearing out. This tooth wear is part of a group of regressive changes mainly due to non-bacterial causes (unlike dental caries, which have a bacterial origin).

The affected teeth by these alterations in tooth structure cause not only sensitivity but also an impairment of normal tooth function. Mechanical microfractures and loss of tooth structure in specific areas accumulate a stress load upon the remaining portion of the affected tooth (especially the masticatory or chewing forces that determine the tooth functionality).

What Are the Effects of Regressive Alterations?

The effects of regressive alterations are:

  1. Irregular tooth surface leading to plaque retention and deposit accumulation.

  2. Loss of masticatory efficiency or chewing and biting efficiency (as the stress load is unevenly distributed onto the tooth surface affected by alterations).

  3. Pulpal exposure and weakened tooth structure, causing sensitivity and pain.

  4. Compromised esthetics due to irregular appearance caused by alterations.

What Are the Regressive Alterations of the Teeth?

1) Attrition:

Derived from the Latin word attritium, which means the action of rubbing against something, and well-shaped wear facets can be seen on the functional surfaces of the teeth. This is predominantly a cause of esthetic concern in the upper and lower front incisors as it gives a cup-shaped edge to the incisal surfaces of the front teeth. As the dentin is less prone to any regressive alteration compared to the superficial enamel, these defects are visualized clearly. In addition, attrition on ten proximal surfaces of the teeth leads to shortening of the dental arch.

Causes of Attrition:

Radiographic View:

2) Abrasion:

This condition is a pathologic wearing out of tooth enamel and dentin due to forces created by an abnormal mechanical process. Abrasion that is specifically caused by masticatory or chewing stress (by the friction of the food bolus) is termed masticatory abrasion, whereas the abrasion by aggressive or improperly aligned toothbrushing is termed toothbrush abrasion. In the case of toothbrush abrasion, studies indicate the friction is more; that is, the wear facets are seen on the left side in a right-handed person and vice versa because of the toothbrush holding hand’s alignment. The abrasion lesion presents as v-shaped notches on the cervical margins of the tooth surface.

Causes of Abrasion:

Radiographic View:

3) Erosion:

It is a non-bacterial wear-out of a tooth substance by a chemical process. Erosion would be either extrinsic or intrinsic. The lesions found on the labial or buccal surfaces of ten teeth (front surface of the front and back teeth) have a smooth surface without any chalky appearance. If the lesion is palatal (surface of the tooth facing the palate), the teeth are decalcified (pyrolysis, which means the surface is eroded due to gastric regurgitation in the mouth).

Causes of Erosion:

The duration of exposure to the acidic environment by either diet or vomiting influences the extent of the abrasion on the tooth surface. The causes are,

Radiographic View:

The other possible consequences of stress and pathology are abfraction and resorption.

4) Abfraction:

Wedge-shaped lesions are usually more occlusal (on the biting surface of the tooth) or cervical areas too because of mechanical stress. This occurs as a result of biting stress that can produce eccentric forces on the tooth surface. An abfraction lesion occurs at the area of greatest tensile stress application at or near the fulcrum of force.

5) Resorption:

This is a process in which tooth structure is progressively lost and damaged because of the resorbing cells called odontoclasts. It would be physiologic in the primary dentition in the children or pathologic in the permanent dentition in adults. Resorption mainly affects the maxillary incisors and the maxillary or mandibular (upper or lower) bicuspids or premolars.

How Does the Dentist Manage These Regressive Alterations?

When your dentist diagnoses these regressive tooth structure changes will mainly suggest procedures ranging from preventive night guards and splints to dietary modifications. However, when the lesions are moderate to large and require restorative fillings, then the dentist will prefer to fill the lesion with restorative glass ionomer cement or resin-based composites. Occlusal adjustments can be made either with or without restoration (based upon the extent and severity of the lesion and by increasing the vertical dimension at occlusion or VDO).


To conclude, though, the regressive alterations of teeth are not reversible once they occur; however, their progression can be prevented by the lesions treated timely by the dental surgeon. An orderly evaluation process and treatment protocol by the dentist is needed to restore the patient’s function and aesthetics correctly again.


Last reviewed at:
03 Jun 2022  -  4 min read




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