Attrition is the mechanical wear of tooth structure resulting from direct tooth-to-tooth contact, occurring during normal mastication, swallowing, or parafunctional habits such as clenching and bruxism. Unlike erosion, which involves chemical dissolution of enamel by acids, or abrasion caused by external friction, attrition is a purely tooth-against-tooth frictional process.
Common Causes
Some degree of attrition is considered physiologic with normal aging, but accelerated wear typically signals an underlying issue. The most frequent contributing factors include:
- Bruxism — nocturnal or daytime grinding that amplifies occlusal forces well beyond physiologic limits
- Parafunctional habits — clenching, nail biting, or other repetitive oral contact behaviors
- Malocclusion — improper bite alignment that concentrates stress on specific teeth
- Coarse or abrasive diet — certain foods that compound mechanical wear over time
Clinical Significance
As enamel wears away, the underlying dentin becomes exposed, dramatically accelerating further wear because dentin is far softer than enamel. Patients often report progressive thermal or tactile sensitivity. In advanced cases, continued attrition reduces crown height, alters the occlusal vertical dimension, and places excess stress on the temporomandibular joint and surrounding periodontal structures.
Key clinical findings include:
- Flattened or cupped-out occlusal surfaces
- Loss of incisal edge definition on anterior teeth
- Dentin exposure with or without pulpal sensitivity
- Shortened clinical crowns and reduced lower face height in severe cases
Diagnosis and Management
Diagnosis is primarily clinical, supported by study models, intraoral photographs, and a thorough patient history. Distinguishing attrition from erosion and abrasion is critical, as each condition requires a different management strategy. Where bruxism is the driving factor, a custom occlusal splint can redistribute forces and protect remaining tooth structure. Restorative options — from composite build-ups to full-coverage crowns — are considered when loss of structure compromises function, aesthetics, or pulpal health.
Early identification and addressing the underlying cause remains the most effective strategy for preventing irreversible structural damage to the dentition.