Reflux and Oral Health
While many consumers experience occasional acid reflux (or, as it is more commonly known-heartburn), a more severe, recurrent form of reflux can be of serious damage to teeth and the oral cavity.
Gastroesophageal Reflux Disease (GERD) is characterized by frequent backflow of stomach acid into the esophagus. The upward leeching of stomach contents and acid irritates the lining of the esophagus and may lead to the burping or regurgitation of food and stomach acid and/or vomiting.
Gastroesophageal Reflux Disease may be mild, moderate, or rare, depending upon frequency.
While there are many causes of Gastroesophageal Reflux Disease, the most common include obesity, hiatal hernias, pregnancy, dietary triggers, certain medications, high caffeine consumption, and smoking.
While Gastroesophageal Reflux Disease itself is not terribly dangerous or life-threatening, the complications related to poorly managed GERD can be somewhat severe.
These complications include dental erosion, esophageal scarring and esophageal stricture, esophageal ulcers, and precancerous changes to the esophagus (this is also known as Barrett’s Esophagus) that are associated with an increased risk of esophageal cancer.
Studies have shown that patients with poorly managed Gastroesophageal Reflux Disease are at an increased risk for dental erosion compared to those with GERD, or those with well-managed GERD.
Other complications to the teeth and oral cavity as a side effect of poorly managed GERD include sinus infections, difficulty swallowing, hoarseness, bad breath, and coughing.
While those outside of the dental community may use the terms “dental erosion” and “dental caries” interchangeably, the causes and consequences of dental erosion and dental caries differ.
Dental erosion specifically refers to the loss or wear of hard dental surfaces upon exposure to acids, whereas dental caries is caused by exposure to bacteria.
Dental erosion may be caused by the consumption of an acidic product, or by the presence of acidic properties already present within the body, such as vomit or stomach acid. Soda and carbonated beverages are by far the most common causes of extrinsic erosion, whereas vomit and/or stomach acid are the most common causes of intrinsic erosion.
Although the consumption of soda and carbonated beverages is the most common cause of extrinsic erosion, the degree of erosion caused by intrinsic factors is more severe. Studies have shown that the degree of erosion caused by the intrinsic factors of vomit and/or stomach acid is nearly twice that of soda or acidic beverage consumption.
The degree of acidity for vomit and.or stomach acid is beyond the buffering capacity of saliva, making it of heightened concern with regards to dental erosion and the viability of tooth structure.
While adults are more likely to experience GERD than children, children may also be affected, and the complications are often the same as those for adult patients.
Studies have shown that children with GERD experience significantly greater levels of dental erosion, salivary yeast, and staph colonization than children without Gastroesophageal Reflux Disease.
It is generally agreed upon that dental erosion is irreversible. Therefore, expedient diagnosis and management are key to maintaining the viability of teeth structure.
Over time, poorly managed reflux and subsequent erosion may cause wearing of the enamel, staining, yellowing, tooth decay, tooth fracture, and tooth loss.
Management of GERD is pivotal in protecting the oral cavity from tooth loss and should be a consideration upon diagnosis of GERD.
Although management strategies largely depend on individual GERD triggers, the most common management strategies include weight loss (for overweight or obese patients), hernia repair (for patients with hiatal hernias), lifestyle management during pregnancy, avoidance of carbonated and/or acidic beverages (as these may act as both a trigger for GERD and a factor of extrinsic erosion), smoking cessation, sleeping upright, and medication management.
For dental professionals, the complexity of GERD management requires a multifaceted approach to GERD treatment that typically involves the dental professional, patients (and family members, if applicable, for children or older/vulnerable adults), the patient’s physician, and- if necessary- a nutritionist and/or gastroenterologist.
Patients with GERD should also consider more routine dental exams in order to evaluate the level of erosion and prevent salivary yeast or infection that may cause serious health problems.
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