Abrasion

Abrasion is a form of pathological tooth wear caused by the mechanical friction of external objects against the tooth surface. Unlike attrition, which results from tooth-to-tooth contact, or erosion, which is caused by chemical acids, abrasion is specifically attributed to habits such as aggressive toothbrushing with stiff bristles, the use of highly abrasive dentifrices, or parafunctional behaviors like nail biting, pen chewing, and opening packages with the teeth. The resulting wear patterns typically present as V-shaped or wedge-shaped notches at the cervical margin of the tooth near the gumline, though abrasion can also flatten incisal edges and occlusal surfaces depending on the causative habit.

Clinically, abrasion is significant because it can progress to the point where dentin is exposed, leading to hypersensitivity, increased susceptibility to caries, and eventual pulp involvement if left untreated. Dentists assess abrasion severity using visual examination and tactile evaluation, often documenting the location, depth, and suspected etiology in the patient record. Identifying the cause is an essential step in the treatment planning process because addressing the underlying habit is necessary to prevent recurrence after restorative intervention. Patients with moderate to severe abrasion may require composite restorations, crowns, or desensitizing treatments depending on the extent of structural loss.

Billing teams should be aware that abrasion-related restorations are typically coded using the appropriate CDT resin-based composite or crown codes based on the tooth and number of surfaces involved. The clinical narrative must clearly document the abrasion diagnosis and its impact on tooth structure to establish medical necessity, particularly when multiple teeth are treated in the same visit. Payers may scrutinize claims for several anterior restorations submitted simultaneously, making thorough documentation of the abrasion pattern and photographic evidence valuable tools for supporting clean claim submission and reducing denial risk.