Here's the updated Markdown with caries and erosion added to the differential diagnosis table, along with additional relevant information:

Dental Diagnosis Guide

Clinical Signs

Abfraction (Caused by occlusal stress and flexural forces)

• Wedge-shaped lesions at the cervical third of the tooth
• Sharply defined margins
• Common on buccal/labial surfaces of premolars and canines
• No signs of bacterial involvement (unlike caries)

Abrasion (Caused by external mechanical forces like brushing)

• V-shaped or notched wear on cervical areas of teeth
• Smooth and shiny lesion surfaces
• Associated with aggressive tooth brushing or using a hard-bristled brush
• Often found on buccal/labial surfaces

Caries (Bacterial demineralization of enamel and dentin)

• Chalky white spots (early demineralization)
• Brown or black cavitations
• Soft, sticky texture inside the lesion
• May cause pain or sensitivity to sweet, hot, or cold stimuli

Attrition (Tooth wear due to tooth-to-tooth contact)

• Flattened occlusal or incisal surfaces
• Loss of enamel and exposure of dentin
• Matching wear facets on opposing teeth
• Possible dentin hypersensitivity

Erosion (Chemical dissolution by acids)

• Smooth, shiny, scooped-out lesions
• Cupping of occlusal surfaces
• Preservation of enamel at restoration margins ("raised margins")
• Often affects palatal surfaces of maxillary teeth
• Associated with acid reflux, bulimia, or frequent acidic beverage consumption

Hypersensitivity (Exposed dentin leading to pain)

• Sharp, transient pain triggered by cold, sweet, or acidic foods
• No visible cavitation or decay
• Common in cases of gingival recession, abfraction, or erosion
• Pain disappears when the stimulus is removed

Fracture (Breakage due to trauma or excessive force)

• Visible crack or break in enamel, dentin, or pulp
• May cause sharp pain during chewing
• Sensitivity to temperature changes
• Can range from craze lines to complete tooth splitting

Differential Diagnosis of Tooth Surface Lesions

Feature	Abfraction	Abrasion	Attrition	Erosion	Caries	Fracture
Primary Cause	Occlusal stress	Mechanical wear	Tooth-to-tooth contact	Acid dissolution	Bacterial acids	Trauma/excessive force
Mechanism	Enamel microfractures	Frictional wear	Chronic grinding	Chemical demineralization	Bacterial demineralization	Structural breakage
Appearance	Wedge-shaped cervical	V-shaped cervical	Flat occlusal surfaces	Smooth, scooped concavities	Brown/black cavities	Visible cracks/chips
Margins	Sharp, defined	Smooth, rounded	Matching facets	Undermined enamel	Soft, irregular	Jagged edges
Surface	Hard, clean	Shiny, polished	Glossy wear facets	Glossy, dissolved	Sticky, rough	Fresh fracture lines
Color	Normal tooth	Normal tooth	Yellowish dentin exposure	Translucent/thinned	Discolored	Variable
Location	Cervical (buccal)	Cervical (buccal)	Incisal/occlusal	All surfaces	Pits/fissures/proximal	Any surface
Pain	Cervical sensitivity	Brushing sensitivity	Possible dentin pain	Temperature sensitivity	Late-stage pain	Sharp chewing pain
Progression	Stress-dependent	Brush technique-dependent	Bruxism-dependent	Acid exposure frequency	Plaque accumulation	Force-dependent
Key Features	Non-carious cervical lesion	Toothbrush/dentifrice marks	Matching opposing teeth wear	Preserved restoration margins	Soft to probe	Visible fracture line
Management	Occlusal adjustment	Improve brushing technique	Occlusal guard	Reduce acid exposure	Restorative treatment	Bonding/crown/RCT