A 45-year-old lawyer who reports significant work-related stress presents with wedge-shaped notches at the cervical aspect of multiple teeth. There is no evidence of caries or erosion. What is the most likely cause?

Correct answer: B. Abfraction (stress-related tooth flexure causing cervical enamel loss)

• A. Attrition (tooth-to-tooth wear) affects the INCISAL and OCCLUSAL surfaces, not the CERVICAL area.
• B. CORRECT. Abfraction refers to non-carious cervical lesions caused by biomechanical stress (occlusal loading, bruxism, clenching). Compressive and tensile stresses from excessive occlusal forces cause fatigue of the enamel at the cervical flexure point (the CEJ area is the thinnest and most vulnerable), resulting in wedge-shaped (V-notch) lesions. In a stressed patient with likely clenching, abfraction is the primary diagnosis.
• C. Abrasion (toothbrushing trauma) can cause wedge-shaped cervical lesions but these are typically unilateral (dominant hand side) and associated with overzealous brushing technique — less likely as the primary cause across multiple teeth in a stress patient.
• D. Erosion causes saucer-shaped (concave) cervical lesions from acid dissolution — classically from acidic foods, beverages, or GERD. It lacks the distinct V-notch shape and has no connection to stress.