In publishing this article, it was our objective to set up a pathodynamic schema that would apply to tooth-surface lesions, both carious and noncarious. We wish to thank Dr. Cohen for his constructive comments on dentifrice abrasion. However, owing to editorial constraints imposed on the length of the article, it was not possible to expand on each mechanism involved in the formation of noncarious cervical lesions, referred to as NCCLs.
The etiologic role of toothbrush and dentifrice had been established by W.D. Miller’s early experiments.1 Surely, as Dr. Cohen points out, the quantity of toothpaste appears to be significant. However, one also must take into account the abrasive index of the particular dentifrice, frequency of brushing, intensity of brushing, method of brushing, reapplication of the dentifrice and/or other abrasives (such as pumice or scouring powder), bristle texture and design, as well as type of brush (for example, manual versus electric).
Numerous studies abound in the literature demonstrating that the dentifrice is more abrasive than the toothbrush per se; however, little attention has been given to the additive and synergistic effects of other factors that coexist. This is complicated by modifying factors such as the presence, composition and amount of saliva, tooth surface remineralization, the composition of teeth, the presence of plaque and various food substances that may act as corrosive agents, as well as stress concentration in the cervical area.
Since various mechanisms may contribute to the formation of NCCLs, we are confronted with a complex multifactorial condition. The relative significance of each factor in the development of NCCLs remains to be elucidated.
It has been our aim that the schema not only facilitate diagnosis by the clinician, but also foster further research into this area of dentistry.
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