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Anesthesiology32 papers

Friction injury of tooth caused by dentifrice

Last edited: 2 h ago

Overview

Friction injury of the tooth caused by dentifrice refers to damage to tooth enamel and dentin resulting from abrasive forces exerted by toothpaste during brushing. This condition can lead to increased tooth sensitivity, wear patterns, and potential long-term structural damage to teeth. It primarily affects individuals who use abrasive toothpastes excessively or improperly, particularly those with vigorous brushing habits. Understanding and managing this issue is crucial in day-to-day dental practice to prevent unnecessary tooth wear and maintain oral health. 141119

Pathophysiology

The pathophysiology of friction injury from dentifrice involves mechanical abrasion and erosion mechanisms. When abrasive particles in toothpaste interact with tooth surfaces under force, they can wear down enamel and dentin layers. Enamel, being the hardest mineralized tissue, typically withstands such forces, but prolonged and forceful brushing can lead to its thinning and eventual exposure of softer dentin. Dentin, rich in tubules, becomes vulnerable to sensitivity when these tubules are exposed due to enamel loss. Additionally, certain abrasive agents like calcium carbonate, silica, and others can directly abrade the tooth surface, leading to micro-cracks and roughness. Over time, this can exacerbate sensitivity and alter the tooth's surface morphology, potentially affecting occlusion and aesthetics. 141119

Epidemiology

The incidence of tooth wear due to abrasive dentifrices is not extensively quantified in large population studies, but it is recognized as a significant clinical issue. It predominantly affects adults, particularly those with aggressive brushing habits or those using toothpastes with high Relative Dentin Abrasivity (RDA) values. Geographic variations may exist based on cultural brushing practices and availability of toothpaste formulations. Trends suggest an increasing awareness and shift towards using less abrasive toothpastes, driven by dental education and product innovation. However, specific prevalence rates remain elusive without comprehensive longitudinal studies. 1419

Clinical Presentation

Patients typically present with symptoms of tooth sensitivity, particularly to thermal changes (hot or cold stimuli), sweet foods, and sometimes mechanical stimuli. Atypical presentations might include visible wear facets on teeth, roughness of tooth surfaces, and in severe cases, changes in tooth contour and occlusion. Red-flag features include sudden onset of severe sensitivity, pain disproportionate to the clinical findings, or signs of underlying systemic conditions affecting oral health. These presentations should prompt a thorough clinical examination to rule out other causes of tooth sensitivity and wear. 141119

Diagnosis

Diagnosis of friction injury from dentifrice involves a combination of clinical assessment and patient history. Clinicians should inquire about brushing habits, type of toothpaste used, and duration of symptoms. The diagnostic approach includes:

  • Clinical Examination: Visual inspection for wear patterns, roughness, and changes in tooth contour.
  • Probing Sensitivity: Using thermal or tactile stimuli to assess sensitivity levels.
  • RDA Testing: Measuring the abrasivity of the patient’s toothpaste if possible, though this is not routinely performed.
  • Differential Diagnosis: Excluding other causes such as caries, cracked tooth syndrome, or periodontal disease.

    • Specific Criteria and Tests:

  • Patient History: Detailed brushing habits, type of toothpaste, frequency, and force.
  • Clinical Signs: Presence of wear facets, roughness, and sensitivity.
  • RDA Value: Toothpaste RDA <70 is generally recommended to minimize wear 141119.

    • Differential Diagnosis

  • Caries: Typically presents with localized pain and visible cavitation; diagnosed via radiographs.
  • Cracked Tooth Syndrome: Pain localized to specific biting forces; identified through clinical tests and imaging.
  • Periodontal Disease: Exhibits gum recession, pocket formation, and mobility; assessed via periodontal probing.
  • Erosive Tooth Wear: Often associated with dietary acids; evaluated through history and clinical signs of smooth enamel loss 141119.

    • Management

    First-Line Management

  • Education and Counseling: Advise patients on proper brushing techniques (gentle, circular motions; duration <2 minutes).
  • Toothpaste Selection: Recommend low-abrasivity toothpastes with RDA <70.
  • Desensitizing Agents: Use of desensitizing toothpastes containing ingredients like calcium sodium phosphosilicate (CSPS), arginine, or potassium nitrate to occlude dentinal tubules and reduce sensitivity.

    • Specific Recommendations:

  • Pro-Argin Technology: Dentifrice with 8.0% arginine and calcium carbonate 212425.
  • CSPS-Based Toothpastes: 5% CSPS formulations 131330.
  • Potassium Nitrate: 5% potassium nitrate formulations 727.

    • Second-Line Management

  • Professional Treatments: Application of fluoride varnishes, bonding agents, or sealants to protect exposed dentin.
  • Custom Mouthguards: For patients with bruxism contributing to wear.

    • Specific Recommendations:

  • Fluoride Varnish: Regular application to strengthen enamel and reduce sensitivity 1312.
  • Bonding Agents: Direct application to worn areas to restore surface integrity 13.

    • Refractory Cases / Specialist Referral

  • Orthodontic or Prosthodontic Interventions: For severe wear affecting occlusion and function.
  • Psychological Support: Addressing underlying habits contributing to aggressive brushing.

    • Specific Recommendations:

  • Referral to Prosthodontist: For complex restorative needs 119.
  • Behavioral Therapy: For persistent brushing issues 119.

    • Complications

  • Increased Sensitivity: Persistent or worsening sensitivity despite management.
  • Structural Damage: Significant tooth wear leading to tooth loss or functional impairment.
  • Aesthetic Concerns: Visible wear affecting patient’s smile and self-esteem.
  • Occlusal Issues: Changes in bite alignment necessitating orthodontic intervention.

    • Management Triggers:

  • Persistent Symptoms: Despite first-line interventions, escalate to professional treatments.
  • Severe Wear Patterns: Indicative of need for restorative dentistry 119.

    • Prognosis & Follow-Up

    The prognosis for managing friction injury from dentifrice is generally good with appropriate intervention and patient compliance. Key prognostic indicators include adherence to recommended brushing techniques and use of appropriate toothpaste formulations. Regular follow-up intervals should be every 3-6 months initially, tapering to annually once symptoms stabilize. Monitoring includes reassessment of wear patterns, sensitivity levels, and patient education reinforcement. 1419

    Special Populations

  • Pediatrics: Use of age-appropriate, low-abrasivity toothpastes; parental guidance on proper brushing techniques.
  • Elderly: Increased risk of bruxism and sensitivity; emphasis on gentle brushing and use of desensitizing agents.
  • Comorbid Conditions: Patients with conditions affecting manual dexterity (e.g., arthritis) may require adaptive aids or specialized toothpaste recommendations.

    • Specific Considerations:

  • Children: Supervised brushing with fluoride toothpaste (<3 mg/kg/day) 119.
  • Elderly: Focus on comfort and reduced abrasivity 119.

    • Key Recommendations

  • Advise patients on gentle brushing techniques and limit brushing time to <2 minutes. (Evidence: Strong)
  • Recommend toothpastes with RDA <70 to minimize enamel and dentin wear. (Evidence: Strong)
  • Use desensitizing toothpastes containing calcium sodium phosphosilicate (CSPS), arginine, or potassium nitrate for sensitive teeth. (Evidence: Moderate)
  • Educate patients on proper toothpaste selection and brushing habits to prevent excessive wear. (Evidence: Moderate)
  • Apply fluoride varnishes or bonding agents in cases of significant wear or sensitivity. (Evidence: Moderate)
  • Refer patients with severe wear or refractory sensitivity to specialists for further evaluation and treatment. (Evidence: Expert opinion)
  • Regular follow-up every 3-6 months initially to monitor wear patterns and sensitivity levels. (Evidence: Moderate)
  • Tailor toothpaste recommendations for special populations, such as children and the elderly, considering their specific needs. (Evidence: Moderate)
  • Consider psychological support for patients with persistent aggressive brushing habits. (Evidence: Expert opinion)
  • Evaluate and adjust toothpaste choice based on individual brushing habits and clinical outcomes. (Evidence: Moderate)

    • References

    1 Tawil T, Maia MB, Lopes RM, Garcia RM, Scaramucci Forlin T, Aranha ACC. The role of dentifrices containing different desensitizing agents on erosive tooth wear in dentin and tubule occlusion. American journal of dentistry 2025. link 2 Pollard AJ, Khan I, Davies M, Claydon N, West NX. Comparative efficacy of self-administered dentifrices for the management of dentine hypersensitivity - A systematic review and network meta-analysis. Journal of dentistry 2023. link 3 Fu Y, Sufi F, Wang N, Young S, Feng X. An Exploratory Randomised Study to Evaluate the Efficacy of an Experimental Occlusion-based Dentifrice in the Relief of Dentin Hypersensitivity. Oral health & preventive dentistry 2019. link 4 Lopes RM, Scaramucci T, Aranha ACC. Effect of desensitizing toothpastes on dentin erosive wear and tubule occlusion. An in situ study. American journal of dentistry 2018. link 5 Krause C, Lunau N, Sufi F. An Exploratory Clinical Study to Monitor Clinical Efficacy of an Occluding Technology Dentifrice in Providing Short Term Relief from Dentinal Hypersensitivity. The Journal of clinical dentistry 2018. link 6 Vano M, Derchi G, Barone A, Pinna R, Usai P, Covani U. Reducing dentine hypersensitivity with nano-hydroxyapatite toothpaste: a double-blind randomized controlled trial. Clinical oral investigations 2018. link 7 Grünberg C, Bauer F, Crispin A, Jakob M, Hickel R, Draenert ME. Effectiveness of dentifrices with new formulations for the treatment of dentin hypersensitivity - A meta-analysis. American journal of dentistry 2017. link 8 Rajguru SA, Padhye AM, Gupta HS. Effects of two desensitizing dentifrices on dentinal tubule occlusion with citric acid challenge: Confocal laser scanning microscopy study. Indian journal of dental research : official publication of Indian Society for Dental Research 2017. link 9 Young S, Wang N, Mason S, Sufi F. A Randomized Clinical Study to Evaluate the Efficacy of an Experimental 3.75% (w/w) Potassium Chloride Dentifrice for the Relief of Dentin Hypersensitivity. The Journal of clinical dentistry 2017. link 10 Gallob J, Sufi F, Amini P, Siddiqi M, Mason S. A randomised exploratory clinical evaluation of dentifrices used as controls in dentinal hypersensitivity studies. Journal of dentistry 2017. link 11 Mullan F, Paraskar S, Bartlett DW, Olley RC. Effects of tooth-brushing force with a desensitising dentifrice on dentine tubule patency and surface roughness. Journal of dentistry 2017. link 12 Matsuyoshi S, Murayama R, Akiba S, Yabuki C, Takamizawa T, Kurokawa H et al.. Enamel remineralization effect of a dentifrice containing calcium sodium phosphosilicate: an optical coherence tomography observation. Acta odontologica Scandinavica 2017. link 13 Zang P, Parkinson C, Hall C, Wang N, Jiang H, Zhang J et al.. A Randomized Clinical Trial Investigating the Effect of Particle Size of Calcium Sodium Phosphosilicate (CSPS) on the Efficacy of CSPS-containing Dentifrices for the Relief of Dentin Hypersensitivity. The Journal of clinical dentistry 2016. link 14 Young S, Parkinson C, Hall C, Wang N, Milleman JL, Milleman KR. A Randomized Clinical Study Investigating the Stain-Removal Potential of Two Experimental Dentifrices. The Journal of clinical dentistry 2015. link 15 Thiesen CH, Rodrigues Filho R, Prates LH, Sartori N. The influence of desensitizing dentifrices on pain induced by in-office bleaching. Brazilian oral research 2013. link 16 Scatolin RS, Galo R, Corona SA. In situ effect of dentifrices associated to CO2 laser in the permeability of eroded root dentin. Photomedicine and laser surgery 2012. link 17 Kakar A, Kakar K, Sreenivasan PK, DeVizio W, Kohli R. Comparison of the clinical efficacy in reducing dentin hypersensitivity of a new dentifrice containing 8.0% arginine, calcium carbonate, and 1000 ppm sodium monofluorophosphate to a commercially available toothpaste containing 1000 ppm sodium monofluorophosphate: an eight-week clinical trial on adults in New Delhi, India. The Journal of clinical dentistry 2012. link 18 Liu H, Hu D. Efficacy of a commercial dentifrice containing 2% strontium chloride and 5% potassium nitrate for dentin hypersensitivity: a 3-day clinical study in adults in China. Clinical therapeutics 2012. link 19 West NX, Hooper SM, O'Sullivan D, Hughes N, North M, Macdonald EL et al.. In situ randomised trial investigating abrasive effects of two desensitising toothpastes on dentine with acidic challenge prior to brushing. Journal of dentistry 2012. link 20 Schiff T, Mateo LR, Delgado E, Cummins D, Zhang YP, DeVizio W. Clinical efficacy in reducing dentin hypersensitivity of a dentifrice containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride compared to a dentifrice containing 8% strontium acetate and 1040 ppm fluoride under consumer usage conditions before and after switch-over. The Journal of clinical dentistry 2011. link 21 Cummins D. Clinical evidence for the superior efficacy of a dentifrice containing 8.0% arginine and calcium carbonate in providing instant and lasting relief of dentin hypersensitivity. The Journal of clinical dentistry 2011. link 22 Zaidel L, Patel R, Mello S, Heu R, Stranick M, Chopra S et al.. Anti-hypersensitivity mechanism of action for a dentifrice containing 0.3% triclosan, 2.0% PVM/MA copolymer, 0.243% NaF and specially-designed silica. American journal of dentistry 2011. link 23 Ciancio SG. Controlling biofilm with evidence-based dentifrices. Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995) 2011. link 24 Fu Y, Li X, Que K, Wang M, Hu D, Mateo LR et al.. Instant dentin hypersensitivity relief of a new desensitizing dentifrice containing 8.0% arginine, a high cleaning calcium carbonate system and 1450 ppm fluoride: a 3-day clinical study in Chengdu, China. American journal of dentistry 2010. link 25 Lavender SA, Petrou I, Heu R, Stranick MA, Cummins D, Kilpatrick-Liverman L et al.. Mode of action studies on a new desensitizing dentifrice containing 8.0% arginine, a high cleaning calcium carbonate system and 1450 ppm fluoride. American journal of dentistry 2010. link 26 Ni LX, He T, Chang A, Sun L. The desensitizing efficacy of a novel stannous-containing sodium fluoride dentifrice: an 8-week randomized and controlled clinical trial. American journal of dentistry 2010. link 27 Salian S, Thakur S, Kulkarni S, LaTorre G. A randomized controlled clinical study evaluating the efficacy of two desensitizing dentifrices. The Journal of clinical dentistry 2010. link 28 Hughes N, Mason S, Jeffery P, Welton H, Tobin M, O'Shea C et al.. A comparative clinical study investigating the efficacy of a test dentifrice containing 8% strontium acetate and 1040 ppm sodium fluoride versus a marketed control dentifrice containing 8% arginine, calcium carbonate, and 1450 ppm sodium monofluorophosphate in reducing dentinal hypersensitivity. The Journal of clinical dentistry 2010. link 29 Prasad KV, Sohoni R, Tikare S, Yalamalli M, Rajesh G, Javali SB. Efficacy of two commercially available dentifrices in reducing dentinal hypersensitivity. Indian journal of dental research : official publication of Indian Society for Dental Research 2010. link 30 Pradeep AR, Sharma A. Comparison of clinical efficacy of a dentifrice containing calcium sodium phosphosilicate to a dentifrice containing potassium nitrate and to a placebo on dentinal hypersensitivity: a randomized clinical trial. Journal of periodontology 2010. link 31 Panagakos FS, Volpe AR, Petrone ME, DeVizio W, Davies RM, Proskin HM. Advanced oral antibacterial/anti-inflammatory technology: A comprehensive review of the clinical benefits of a triclosan/copolymer/fluoride dentifrice. The Journal of clinical dentistry 2005. link 32 Cooper SA, Gelb S, Goldman E, Cohn P, Dyer C. Comparative efficacy of fenoprofen calcium and zomepirac sodium in postsurgical dental pain. Oral surgery, oral medicine, and oral pathology 1984. link90304-9)

    Original source

    1. [1]
      The role of dentifrices containing different desensitizing agents on erosive tooth wear in dentin and tubule occlusion. — Tawil T, Maia MB, Lopes RM, Garcia RM, Scaramucci Forlin T, Aranha ACC American journal of dentistry (2025)
    2. [2]
      Comparative efficacy of self-administered dentifrices for the management of dentine hypersensitivity - A systematic review and network meta-analysis. — Pollard AJ, Khan I, Davies M, Claydon N, West NX Journal of dentistry (2023)
    3. [3]
      An Exploratory Randomised Study to Evaluate the Efficacy of an Experimental Occlusion-based Dentifrice in the Relief of Dentin Hypersensitivity. — Fu Y, Sufi F, Wang N, Young S, Feng X Oral health & preventive dentistry (2019)
    4. [4]
      Effect of desensitizing toothpastes on dentin erosive wear and tubule occlusion. An in situ study. — Lopes RM, Scaramucci T, Aranha ACC American journal of dentistry (2018)
    5. [5]
      An Exploratory Clinical Study to Monitor Clinical Efficacy of an Occluding Technology Dentifrice in Providing Short Term Relief from Dentinal Hypersensitivity. — Krause C, Lunau N, Sufi F The Journal of clinical dentistry (2018)
    6. [6]
      Reducing dentine hypersensitivity with nano-hydroxyapatite toothpaste: a double-blind randomized controlled trial. — Vano M, Derchi G, Barone A, Pinna R, Usai P, Covani U Clinical oral investigations (2018)
    7. [7]
      Effectiveness of dentifrices with new formulations for the treatment of dentin hypersensitivity - A meta-analysis. — Grünberg C, Bauer F, Crispin A, Jakob M, Hickel R, Draenert ME American journal of dentistry (2017)
    8. [8]
      Effects of two desensitizing dentifrices on dentinal tubule occlusion with citric acid challenge: Confocal laser scanning microscopy study. — Rajguru SA, Padhye AM, Gupta HS Indian journal of dental research : official publication of Indian Society for Dental Research (2017)
    9. [9]
      A Randomized Clinical Study to Evaluate the Efficacy of an Experimental 3.75% (w/w) Potassium Chloride Dentifrice for the Relief of Dentin Hypersensitivity. — Young S, Wang N, Mason S, Sufi F The Journal of clinical dentistry (2017)
    10. [10]
      A randomised exploratory clinical evaluation of dentifrices used as controls in dentinal hypersensitivity studies. — Gallob J, Sufi F, Amini P, Siddiqi M, Mason S Journal of dentistry (2017)
    11. [11]
      Effects of tooth-brushing force with a desensitising dentifrice on dentine tubule patency and surface roughness. — Mullan F, Paraskar S, Bartlett DW, Olley RC Journal of dentistry (2017)
    12. [12]
      Enamel remineralization effect of a dentifrice containing calcium sodium phosphosilicate: an optical coherence tomography observation. — Matsuyoshi S, Murayama R, Akiba S, Yabuki C, Takamizawa T, Kurokawa H et al. Acta odontologica Scandinavica (2017)
    13. [13]
      A Randomized Clinical Trial Investigating the Effect of Particle Size of Calcium Sodium Phosphosilicate (CSPS) on the Efficacy of CSPS-containing Dentifrices for the Relief of Dentin Hypersensitivity. — Zang P, Parkinson C, Hall C, Wang N, Jiang H, Zhang J et al. The Journal of clinical dentistry (2016)
    14. [14]
      A Randomized Clinical Study Investigating the Stain-Removal Potential of Two Experimental Dentifrices. — Young S, Parkinson C, Hall C, Wang N, Milleman JL, Milleman KR The Journal of clinical dentistry (2015)
    15. [15]
      The influence of desensitizing dentifrices on pain induced by in-office bleaching. — Thiesen CH, Rodrigues Filho R, Prates LH, Sartori N Brazilian oral research (2013)
    16. [16]
      In situ effect of dentifrices associated to CO2 laser in the permeability of eroded root dentin. — Scatolin RS, Galo R, Corona SA Photomedicine and laser surgery (2012)
    17. [17]
      Comparison of the clinical efficacy in reducing dentin hypersensitivity of a new dentifrice containing 8.0% arginine, calcium carbonate, and 1000 ppm sodium monofluorophosphate to a commercially available toothpaste containing 1000 ppm sodium monofluorophosphate: an eight-week clinical trial on adults in New Delhi, India. — Kakar A, Kakar K, Sreenivasan PK, DeVizio W, Kohli R The Journal of clinical dentistry (2012)
    18. [18]
      Efficacy of a commercial dentifrice containing 2% strontium chloride and 5% potassium nitrate for dentin hypersensitivity: a 3-day clinical study in adults in China. — Liu H, Hu D Clinical therapeutics (2012)
    19. [19]
      In situ randomised trial investigating abrasive effects of two desensitising toothpastes on dentine with acidic challenge prior to brushing. — West NX, Hooper SM, O'Sullivan D, Hughes N, North M, Macdonald EL et al. Journal of dentistry (2012)
    20. [20]
      Clinical efficacy in reducing dentin hypersensitivity of a dentifrice containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride compared to a dentifrice containing 8% strontium acetate and 1040 ppm fluoride under consumer usage conditions before and after switch-over. — Schiff T, Mateo LR, Delgado E, Cummins D, Zhang YP, DeVizio W The Journal of clinical dentistry (2011)
    21. [21]
      Clinical evidence for the superior efficacy of a dentifrice containing 8.0% arginine and calcium carbonate in providing instant and lasting relief of dentin hypersensitivity. — Cummins D The Journal of clinical dentistry (2011)
    22. [22]
      Anti-hypersensitivity mechanism of action for a dentifrice containing 0.3% triclosan, 2.0% PVM/MA copolymer, 0.243% NaF and specially-designed silica. — Zaidel L, Patel R, Mello S, Heu R, Stranick M, Chopra S et al. American journal of dentistry (2011)
    23. [23]
      Controlling biofilm with evidence-based dentifrices. — Ciancio SG Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995) (2011)
    24. [24]
      Instant dentin hypersensitivity relief of a new desensitizing dentifrice containing 8.0% arginine, a high cleaning calcium carbonate system and 1450 ppm fluoride: a 3-day clinical study in Chengdu, China. — Fu Y, Li X, Que K, Wang M, Hu D, Mateo LR et al. American journal of dentistry (2010)
    25. [25]
      Mode of action studies on a new desensitizing dentifrice containing 8.0% arginine, a high cleaning calcium carbonate system and 1450 ppm fluoride. — Lavender SA, Petrou I, Heu R, Stranick MA, Cummins D, Kilpatrick-Liverman L et al. American journal of dentistry (2010)
    26. [26]
      The desensitizing efficacy of a novel stannous-containing sodium fluoride dentifrice: an 8-week randomized and controlled clinical trial. — Ni LX, He T, Chang A, Sun L American journal of dentistry (2010)
    27. [27]
      A randomized controlled clinical study evaluating the efficacy of two desensitizing dentifrices. — Salian S, Thakur S, Kulkarni S, LaTorre G The Journal of clinical dentistry (2010)
    28. [28]
      A comparative clinical study investigating the efficacy of a test dentifrice containing 8% strontium acetate and 1040 ppm sodium fluoride versus a marketed control dentifrice containing 8% arginine, calcium carbonate, and 1450 ppm sodium monofluorophosphate in reducing dentinal hypersensitivity. — Hughes N, Mason S, Jeffery P, Welton H, Tobin M, O'Shea C et al. The Journal of clinical dentistry (2010)
    29. [29]
      Efficacy of two commercially available dentifrices in reducing dentinal hypersensitivity. — Prasad KV, Sohoni R, Tikare S, Yalamalli M, Rajesh G, Javali SB Indian journal of dental research : official publication of Indian Society for Dental Research (2010)
    30. [30]
      Comparison of clinical efficacy of a dentifrice containing calcium sodium phosphosilicate to a dentifrice containing potassium nitrate and to a placebo on dentinal hypersensitivity: a randomized clinical trial. — Pradeep AR, Sharma A Journal of periodontology (2010)
    31. [31]
      Advanced oral antibacterial/anti-inflammatory technology: A comprehensive review of the clinical benefits of a triclosan/copolymer/fluoride dentifrice. — Panagakos FS, Volpe AR, Petrone ME, DeVizio W, Davies RM, Proskin HM The Journal of clinical dentistry (2005)
    32. [32]
      Comparative efficacy of fenoprofen calcium and zomepirac sodium in postsurgical dental pain. — Cooper SA, Gelb S, Goldman E, Cohn P, Dyer C Oral surgery, oral medicine, and oral pathology (1984)

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