The Cause of Non-Carious Cervical Lesions (NCCL) May Not Be What You Think
by Dr. V Kim Kutsch
One of the important challenges facing dental professionals today is the rapidly increasing incidence of non-carious cervical lesions (NCCL). These notch-like lesions found at the cervical region of teeth are becoming more common, and there have been a multitude of explanations for why they occur. Malocclusion has been a popular theory; it explains that excessive inappropriate chewing forces account for these abfractive lesions. However, in a study performed by Dr. Terry Tanaka, examining 700 skulls, 150-300 years old, most with enamel completely worn through into the dentin, none had NCCLs.4 In yet another study there was little correlation between the NCCLs and occlusal wear. The authors concluded we have no conclusive evidence that the NCCLs are caused by occlusal loading forces.5 Toothbrush bristles have also been blamed, but the firmness of tooth brush bristles was not a significant factor. In another study, the conclusion was that the abrasiveness of toothpastes was the most significant causative factor.6 And another, more recent study came to the same conclusion: occlusal load did not affect the cervical region but toothpaste abrasivity did.7
So where does that leave us? Toothpaste abrasivity is the recognized cause of cervical tooth wear. So beyond having just enough abrasive to remove typical accumulation of stains from chromogenic foods and drinks, additional abrasive activity runs the risk of unwanted tooth wear. CariFree does not use plastic microbeads for abrasive action, instead using natural silica. CariFree gels also have very low abrasive indices (around 17). These strategies protect both the environment and your precious enamel.
Here is a list from Duke Dental
0-70 = low abrasive
70-100 = medium abrasive
10-150 – highly abrasive
150-250 = regarded as harmful limit
Toothpastes- RDA Value
- Straight Baking Soda- 7
- Arm & Hammer Tooth Powder- 8
- Arm & Hammer Dental Care- 35
- Oxyfresh- 45
- Tom’s of Maine Sensitive- 49
- Arm & Hammer Peroxicare- 49
- Rembrandt Original- 53
- CloSYS- 53
- Tom’s of Maine Children’s- 57
- Colgate Regular- 68
- Colgate Total- 70
- Sensodyne- 79
- Aim- 80
- Colgate Sensitive Max Strength- 83
- Aquafresh Sensitive- 91
- Tom’s of Maine Regular- 93
- Crest Regular- 95
- Mentadent- 103
- Sensodyne Extra Whitening- 104
- Colgate Platinum- 106
- Crest Sensitivity- 107
- Colgate Herbal- 110
- Aquafresh Whitening- 113
- Arm & Hammer Tarter Control- 117
- Arm & Hammer Advance White Gel- 117
- Close-up with Baking Soda- 120
- Colgate Whitening- 124
- Crest Extra Whitening- 130
- Ultra Brite- 133
- Crest MultiCare Whitening- 144
- Colgate Baking Soda Whitening- 145
- Pepsodent- 150
- Colgate Tarter Control- 165
- Colgate 2-in-1 Tarter Control/White- 200
- FDA Recommended Limit- 200
- ADA Recommended Limit- 250