Acid Reflux and Dental Implications - GERD
Acid Reflux causes Dental Problems
What is Acid Reflux?
Acid reflux, also known as gastro-oesophageal reflux disease or GERD, is a somewhat common condition where the acid from the stomach is able to leak up into your oesophagus. For some people, there are symptoms such as heartburn or regurgitation. For others, it can be symptom-free and go completely unnoticed.
GERD is caused by a combination of conditions that increase the presence of acid reflux in the oesophagus. Factors that weaken or relax the lower oesophageal sphincter and make reflux worse are:
Lifestyle – Use of alcohol or cigarettes, obesity and poor posture (slouching).
Medications – Calcium channel blockers, beta-blockers, theophylline (Tedral, Hydrophed, Marax, Quibron), nitrates and antihistamines.
Diet – Fatty and fried foods, drinks with caffeine
Eating habits – Eating large meals and/or eating just before bedtime.
Other medical conditions – Hiatus hernia, pregnancy, diabetes and rapid weight gain
Typical Symptoms of GERD
Persistent heartburn, sometimes referred to as acid indigestion, is the most common symptom of GERD.
Heartburn is a burning, painful sensation in the center of the chest, behind the sternum (breastbone). It often starts in the upper abdomen and spreads up into the neck. It is usually worse after eating and can last as long as two hours. The pain usually does not start or get worse with physical activity. Exacerbating factors, include lying down or bending over.
The absence of heartburn does not rule out GERD.
Other symptoms include:
- Regurgitation – a sour or bitter-tasting acid backing up into your throat or mouth
- Bloody or black stools or bloody vomiting
- Dysphagia – a narrowing of your oesophagus, which creates the sensation of food being stuck in your throat
- Hiccups that don’t stop
- Weight loss for no known reason
- Wheezing, dry cough, hoarseness or chronic sore throat
Treatment for Dental Complications
There are several levels of therapy:
- Recognition of tooth surface changes: Early detection of tooth wear by our team is important in early diagnosis. It is important to be aware of the various medical conditions that increase the risks of tooth wear. These include diseases that affect salivary glands or medications that decrease salivary function. Low salivary flow reduces its buffering and clearance effect, predisposing teeth to demineralisation. Early recognition of surface changes is essential. It is the most important step in management of GERD-related risk. Initial signs include the first stages of erosion with chalkiness and loss of lustre. More advanced erosion follows, with a corresponding increase in lustre and transparency.
- Remineralisation therapy is an important part of protecting the long-term health of the dentition and may be recommended to you as a part of your self-care routine. Not only will these treatments help you reduce erosion due to acid reflux, they will also help to control damage to the enamel from other demineralisation factors, such as excessive ingestion of acidic foods and beverages (e.g., soft drinks, sports drinks, citric acid in foods and drinks).
- Restorative treatments usually follow the early stabilisation phase. The nature of rehabilitation is dependent on the extent of the tooth destruction, but our goal is the restoration of your teeth for improved function and aesthetics. With early diagnosis and intervention of GERD, the unnecessary destruction of tooth structure can be avoided. This preventative approach reduces the progressive destruction and minimises future costs for you and most importantly, it improves your well-being.
Self Assessment for GERD:
- Are you taking prescription medication for acid reflux?
- Do you often get a burning feeling behind your breastbone (heartburn)?
- Do you often feel stomach contents (liquid or food) moving upwards to your throat or mouth (regurgitation)?
- Do you often have a pain in the centre of the stomach?
- Do you often have difficulty getting a good night’s sleep because of your heartburn and/or regurgitation?
- Do you often take OTC medication for your heartburn and/or regurgitation?
Sleep Apnoea episodes are often implicated as a contributing aetiology of GERD. Increased negative pressure in intra thoracic space during apnoeic episode causes gastric acid to expel into the oesophagus. This triggers micro arousals leading to Sleep Bruxism.
- Pain or irritation in your mouth
- Sensitivity to certain foods and drinks, especially hot, cold or sweet
- Sharp tooth edges
- Thinning or shortened darkening teeth
Patients with acid reflux are at greater risk of tooth erosion and periodontal problems. The enamel of the teeth begins dissolving at a pH of 5.5, and the pH of stomach acid is two or less. Prolonged exposure to the acid begins to thin and dissolve away the protective coating of the teeth, leaving them noticeably weakened. When the enamel wears away, the sensitive inner dentin layer of the tooth is exposed, and this can lead to additional, serious complications with the health of your teeth and mouth. Often your dentist or hygienists will be the first to notice these changes. It is important to note that just because a person does not feel the burning symptoms does not mean they do not have acid reflux.