- Can GERD Cause Tooth Decay?
- GERD and Dental Erosion
- 6 Steps to Avoiding Dental Erosion
- First published in the Inside Tract® newsletter issue 187 – 2013
- 1. Farahmand F et al. Gastroesophageal Reflux Disease and Tooth Erosion: A Cross-Sectional Observational Study. Gut and Liver. 2013;7(3):278-281.2. Mulic A et al. Risk indicators for dental erosive wear among 18-yr-old subjects in Oslo, Norway. Oral Sciences. 2012;120:531-538.3. Picos A et al. Dental Erosion in Patients with Gastroesophageal Reflux Disease. Advances in Clinical and Experimental Medicine. 2013;22(3):303-307.
- Acid Reflux: A Dental Disaster in the Making
- Prevent Dental Erosion Due to GERD
- GERD: Acid Reflux and Your Teeth
- Does Acid Reflux Impact Oral Health?
- Is Acid Reflux Eroding Your Tooth Enamel?
Can GERD Cause Tooth Decay?
I do not know what is causing the inflammation in your case, but inflammation, as we all know, is bad for the body as a whole. It is critical that you see an excellent dentist who can give you a proper diagnosis and treatment plan. The diagnosis would likely be a root-canal problem (which would need root-canal treatment), a fracture of the tooth (which would mean it needs to be removed), or a periodontal abscess (in which case the dentist would need to decide whether the tooth is worth saving). If the tooth can be saved, then it would be ideal to go through with one of the above treatments. If the tooth is not able to be saved, then it must be extracted as soon as possible because the infection and bacteria entering your bloodstream from around your tooth will affect the rest of your body, including the brain and heart. Because this seems to be a financial issue, since you mentioned the $3,000 bridge, then my best suggestion is to get an antibiotic prescribed by your dentist and have the tooth removed or fixed at minimal cost: This might even mean seeing someone at a local hospital or a dental school, where dental care is often offered far less expensively than in a private dentist’s office. I would much prefer the tooth either be removed or treated than to have you walk around with an infection in your mouth that will eventually lead to other parts of your body.
Q3. I am going through chemotherapy for breast cancer, and my mouth is very sensitive. I find that regular toothpaste is very irritating. I have been using baking soda to brush my teeth. Is there a toothpaste I could use that has no mint or other irritating substances? I have tried several different toothpastes, but they all have a burning, irritating feeling. Thank you for your help.
I am sorry about your situation. Tooth sensitivity is extremely common in America and usually occurs because of exposure of the root portion of the teeth. Ideally, enamel (the hardest material in your body) covers the portion of your teeth above the gum tissue. However, when gum recession occurs, the root portion gets exposed and sensitivity develops — the root has many dentinal tubules (small channels) with tiny nerve endings that connect to the nerve pulp.
Sensitivity can come from:
- Too much root exposure, which allows the nerve endings to react to temperature (both cold and hot) and sweets
- Brushing too hard with a hard-bristle brush or poor technique, with too much scrubbing action
- Sensitivity from tooth-whitening procedures
- Tooth grinding and clenching, often from stress, in which enamel can be worn away, exposing nerve endings
- Too much exposure to acidic foods such as citrus fruits can cause wearing away (demineralization) of the enamel
- Poor oral hygiene, with plaque buildup and subsequent demineralization of the tooth structure from plaque acid
In your situation, I advise continued excellent oral hygiene so that plaque doesn’t build up and make the sensitivity worse. Try to use toothpastes with no tartar control, whitening agents, or peroxide in them. Opt for gels instead of pastes, and use a toothbrush that has extra-soft bristles. Use toothpaste and mouth rinse that contain fluoride, which helps to remineralize the root surface and block sensitivity. Sensodyne and other sensitivity toothpastes are worth trying, as well as toothpastes made by Tom’s of Maine, which can be found in most supermarkets and health food stores. If these steps don’t work, consult your dentist and physician, who can further evaluate your problem.
Q4. Does decay always begin in or on a tooth and go down into the root? Or is it possible for decay to start below the gum line and not be found with either X-rays or thorough scaling and examination?
Decay can begin on the top surface of a tooth, beside a tooth, or underneath the gum, mid-root on a tooth. It can most often be seen on X-rays but not always. Decay that starts at the top of a tooth usually has to be probed and explored with a sharp instrument to see if the hole or decay has gone through the enamel into the tooth itself. If it has advanced from the top surface, then sometimes the X-ray will show the decay. Often, decay on a root or in between teeth is obvious on an X-ray. If decay is on the side of the tooth — the outer or inner (tongue) side — then it may not show up on the X-ray as well. There are also times when scaling and root planing can reveal a cavity that would not otherwise be seen on an X-ray or during a routine dental examination.
It is always good policy to see a quality dentist and hygienist who can do bitewing X-rays to check for cavities every year and full-mouth X-rays every two to three years. The X-ray examination is only one part of the picture — the rest is clinical observation, patient reports of sensitivity or pain, and clinical examination by probing and scaling the mouth and evaluating every tooth for surfaces of decay.
Learn more in the Everyday Health Dental Health Center.
GERD and Dental Erosion
Gastroesophageal reflux disease (GERD) occurs when the upper portion of the digestive tract doesn’t function properly, causing stomach contents to regularly flow back into the esophagus, sometimes going all the way up into the mouth. This disease affects 13-29% of Canadians. While the most common symptom of GERD is heartburn, in certain individuals the first sign that they are experiencing this disease can be dental erosion that becomes apparent during a routine dental examination.
Dental erosion is also common in individuals who have a high intake of acidic foods, or repeated vomiting from GI problems or eating disorders. Dental erosion is not the same as the breaking down of carbohydrates by bacteria into acidic components, which is what causes tooth decay and dental caries (cavities).
Dental erosion originates at the enamel, which is the durable, protective coating over our teeth. While tough, it is vulnerable to an overly acidic environment, in which it begins to soften and demineralise, slowly wearing down and leaving the more sensitive parts of the tooth exposed. Our saliva helps to put minerals back into the enamel after we eat acidic foods, but if there is a consistently higher acidity, as is the case with regular reflux, the saliva isn’t able to regulate the pH in the mouth and allow this process. As the enamel erodes, the teeth become discoloured and sensitive to hot, cold, and sweet foods and beverages.
While it might seem odd that reflux can do enough damage to cause dental erosion, especially if you don’t even feel the heartburn, research shows that there is a strong correlation between GERD and dental erosion. One study compared dental erosion in children aged 3 to 12 years who had GERD to children in that age group without GERD. They found that 98% of the children with GERD (53 of 54) had dental erosion, compared to 19% of the control group (11 of 58).1 Another study from Norway found that young adults with GERD were more likely to have symptoms of dental erosion than those without the disease.2 A meta-analysis published in 2013 showed that researchers have acknowledged GERD as a cause of dental erosion since 1937, and the evidence in support of this continues to grow.3
If your dentist notices unusual signs of dental erosion, your next recommended appointment might be with your family physician or gastroenterologist. Clinical evidence suggests that dietary and lifestyle modifications are usually not sufficient to bring chronic GERD under control, so it’s likely that your physician will need to prescribe some medication to help reduce the stomach acid. Fortunately, there are medications that will help keep the dental erosion under control, if used appropriately.
6 Steps to Avoiding Dental Erosion
- Receive treatment for GERD or any other medical problem that causes an increase in reflux or vomiting
- Maintain good oral hygiene by flossing and brushing regularly with fluoride-based toothpaste and a soft-bristled toothbrush; avoid brushing too vigorously
- Reduce food-related risks by eating regular meals rather than grazing throughout the day, rinsing your mouth with water after meals and waiting at least an hour before brushing your teeth
- Avoid swishing or sipping on acidic drinks, or holding them in your mouth for too long, and use straws to prevent the beverages from being in prolonged contact with your teeth
- Drink water throughout the day to combat dry mouth and keep your mouth clean
- Ask your dentist about products or diet modifications that might help re-mineralize your teeth
1. Farahmand F et al. Gastroesophageal Reflux Disease and Tooth Erosion: A Cross-Sectional Observational Study. Gut and Liver. 2013;7(3):278-281.
2. Mulic A et al. Risk indicators for dental erosive wear among 18-yr-old subjects in Oslo, Norway. Oral Sciences. 2012;120:531-538.
3. Picos A et al. Dental Erosion in Patients with Gastroesophageal Reflux Disease. Advances in Clinical and Experimental Medicine. 2013;22(3):303-307.
Melvin Heyman, MD
Children who have symptoms of chronic acid reflux are significantly more likely to have dental erosions than those without reflux symptoms, according to a new study led by researchers at the University of California, San Francisco.
The study, which is the first to examine the relationship between acid reflux and dental health in pediatric patients, was presented today, May 4, 2009, at the Pediatric Academic Societies annual meeting in Baltimore, Md.
The research is also among the first to find a conclusive link between chronic acid reflux and dental erosions in any age group, as previous studies have produced inconsistent results, according to Melvin Heyman, MD, chief of pediatric gastroenterology, hepatology and nutrition at UCSF Children’s Hospital and the study’s senior author.
“These findings demonstrate that we really need to start looking for dental erosions in pediatric patients with chronic acid reflux and integrate proper dental care into their treatment regimens,” Heyman said.
Researchers from UCSF Children’s Hospital and the UCSF School of Dentistry compared the dental health of young patients 9 to 17 years old who had symptoms consistent with gastroesophageal reflux disease, or GERD, with a group of healthy controls who had no symptoms and were in the same age group. They found that children with GERD were almost six times more likely to have substantially eroded teeth than children without reflux.
According to Peter Rechmann, DDS, PhD, a professor of dentistry at UCSF and director of the Clinical Sciences Research Group in the Department of Preventive and Restorative Dental Sciences, dental erosions wear away the tooth’s outer covering, the enamel, and leave the weaker underlying tissue, called dentin, exposed. This can lead to a permanent weakening of the teeth, a predisposition to tooth decay, and often a need for major dental work to repair and disguise eroded teeth.
GERD is a chronic form of acid reflux that occurs when the muscular valve at the lower end of the esophagus opens spontaneously, causing stomach acid to seep back up through the esophagus, according to the National Institutes of Health. Children with GERD often experience heartburn, nausea, vomiting, asthma and other respiratory problems.
According to Heyman, GERD can be alleviated by taking certain medications and by adopting better eating habits, like not overeating or losing extra weight. However, if it is not treated properly, GERD can lead to a host of complications, including ulcers and even pre-cancerous changes in the lining of the esophagus.
A total of 80 children participated in the study – 60 had symptoms of GERD and 20 served as controls. Each subject was evaluated for GERD and had a thorough dental examination. In order to eliminate bias, the health care providers who performed the dental exams did not know whether a particular patient had been diagnosed with GERD.
“Having shown that there is a positive correlation between GERD and dental erosions, we must now try to determine exactly what causes children with reflux to develop these erosions,” said Ann Clark, BS, a research assistant in Heyman’s laboratory and co-author who presented the findings at the conference.
Additional co-authors of the study are Beate Rechmann of the Department of Preventive and Restorative Dental Sciences at the UCSF School of Dentistry, and Janet Wojcicki, PhD, MPH, of the Division of Pediatric Gastroenterology, Hepatology and Nutrition at UCSF Children’s Hospital.
The research was supported through a combination of funds from NIH and Takeda Pharmaceuticals North America, Inc.
One of the nation’s top children’s hospitals, UCSF Children’s Hospital creates an environment where children and their families find compassionate care at the healing edge of scientific discovery, with more than 150 experts in 50 medical specialties serving patients throughout Northern California and beyond. The hospital admits about 5,000 children each year, including 2,000 babies born in the hospital.
UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For further information, visit www.ucsf.edu.
Acid Reflux: A Dental Disaster in the Making
You take your child to his dental appointment, expecting smiles all around and a clean bill of health. Instead, you discover that your child’s teeth are in a perilous state of decay, and your child will need thousands of dollars of dental work. You’re a good mom; you brush his teeth and feed him healthy foods. How could this happen?
The answer may be acid reflux. A study from the University of California at San Francisco found that children with reflux are six times more likely to suffer damage to the enamel than healthy children.
As children grow, their reflux medication may stop working. Many children go off their medication around age one, just when teeth are popping up. But some older children still have problems with reflux. A child may think that reflux is normal, and forget to mention it to you. Fortunately, there are steps you can take to minimize the consequences of acid reflux.
See the Dentist Early and Often
If your child has a history of reflux, make sure he sees the dentist as soon as he has teeth. A good pediatric dentist can spot reflux damage in its early stages and help you develop a treatment plan. Some children with severe acid reflux may need to see the dentist every three months instead of every six months. When you are dealing with acid damage, prevention is much more economical than waiting for a crisis.
Two, Four, Six, Eight—You Have Got to Fluoridate!
All children need fluoride, but it is especially important for children with acid reflux. Because their teeth are constantly under attack, they need the extra protection fluoride provides. If possible, encourage your child to drink fluoridated water. That way, he will get his fluoride throughout the day. If you have a well or use a water filter that removes fluoride from the water, talk to your dentist or pediatrician. You can get a prescription for liquid fluoride or fluoride pills.
Watch That Diet
For children with reflux, it is not enough to avoid sugary drinks and snacks. If you want to protect your child’s teeth, you need to reduce the flow of acid into the mouth. Avoid typical reflux trigger foods, such as tomatoes and other acidic fruits. Watch your child’s snacking schedule; avoid food right before nap time or bedtime. Finally, talk to your pediatrician to make sure you are doing everything possible to control reflux.
Baby teeth are important. They help your child get adequate nutrition and pave the way for adult teeth. If your child has acid reflux, you need to stay on top of his dental care. Your actions now could impact his future oral health.
Prevent Dental Erosion Due to GERD
Gastroesophageal reflux disease (GERD) occurs when the muscle at the end of your esophagus—the tube that carries food from your mouth to your stomach—randomly opens for a period of time or does not shut properly. Contents in your stomach, including highly acidic digestive juices, can leak back up into your esophagus, resulting in a burning sensation in your chest or throat known as heartburn. You may also taste stomach fluid in the back of your mouth, which is called acid indigestion. GERD occurs when you experience any of these symptoms more than twice a week.
Eventually, GERD can cause a slew of health issues, including ulcers and esophageal cancer. It can also cause dental problems. In fact, dentists are often the first health care professional to identify GERD in patients because one major sign of the disease is dental erosion, or dissolving of tooth surfaces. Dental erosion occurs because the acidic juices in the stomach come into contact with the mouth and, over time, break down your teeth.
A gastroenterologist can diagnose and help treat the condition. In addition, here’s what you can do to protect your teeth:
Avoid brushing your teeth immediately after a reflux episode. Brushing may damage enamel that has already been weakened by acid.
Chew sugar-free gum. Chewing gum stimulates saliva flow, which reduces acid in your mouth.
To reduce the risk of demineralization of your teeth, ask your dentist about mouth rinses and toothpastes containing fluoride.
To dilute the acid in your mouth, rinse vigorously with water.
Rinsing with baking soda in water will neutralize the acid.
“Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD).” National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd. Accessed 2013.
“Preventing Teeth Damage.” Bulimia Help. http://www.bulimiahelp.org/articles/preventing-teeth-damage.Accessed 2013.
GERD: Acid Reflux and Your Teeth
GERD stands for GastroEsophageal Reflux Disease. It’s most commonly referred to as acid reflux.
Acid reflux occurs when the muscles at the lower end of your esophagus that allow food into your stomach relax at the wrong time. This allows your stomach acid to creep back up into your esophagus, causing heart burn. Chronic acid reflux can lead to GERD. GERD is a chronic problem.
What Causes Acid Reflux?
It’s a weak esophageal sphincter that allows for the acids and other contents to back up into the esophagus and your mouth.
There are a few things than can cause this weakness, including:
- An unhealthy weight
- Wearing tight clothing around your midriff
- Smoking (or regular exposure to secondhand smoke)
- Hiatal hernia (part of the stomach protrudes into the diaphragm muscle)
- Certain foods can also trigger acid reflux, including:
- Fried food
- Fatty food
- Spicy food
- Raw onions
- Carbonated beverages
Some medications can also trigger acid reflux.
What are Symptoms of Acid Reflux?
The most common symptoms are acid indigestion and heartburn. These are going to hit everybody from time to time. But if it’s happening more than twice a week, you might have acid reflux.
Other symptoms include:
- Nausea and vomiting
- Tooth erosion and bad breath
- Difficulty swallowing (dysphagia)
- Respiratory problems
- Abdominal pain
Does Acid Reflux Impact Oral Health?
As noted above, tooth erosion is a symptom of acid reflux. So what’s happening is that the enamel on the inside surfaces of your teeth and the chewing surfaces of your teeth are getting worn away. That’s a huge problem because tooth erosion is permanent.
When the enamel goes, you have to deal with these:
- Pain or sensitivity when drinking hot, cold, or sweet beverages
- A yellowish discoloration of the teeth.
- Fillings that have changed.
- Greater risk for cavities over time.
- The development of an abscess (in extreme cases)
- Tooth loss (in extreme cases)
How Do You Treat Acid Reflux?
Good news. It’s usually pretty simple to manage acid reflux with antacids and over-the-counter meds. Plus, you can make some lifestyle changes as part of the management process:
- Quit smoking
- Eat smaller meals
- Maintain a healthy weight
- Avoid trigger foods (like the ones listed above)
- Avoid wearing tight clothing around your midriff
- Move around after you eat
Specifically, for your oral care, you can chew gum. Chewing sugar-free gum can encourage saliva production, which helps neutralize and wash away the acids in your mouth. Choose gum that has the ADA Seal of Acceptance.
If medications and lifestyle changes don’t do the trick, surgery may be an option. Surgery for acid reflux involves the reinforcing of the lower esophageal sphincter.
And, as always, keep up those regular dental visits. It’s your dentist who may be the first to identify your acid reflux based on how any tooth erosion is manifesting.
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Is Acid Reflux Eroding Your Tooth Enamel?
Ten percent of Americans experience daily burning and discomfort associated with heartburn. While heartburn may be a common condition, it certainly isn’t normal and is a frequent symptom of chronic acid reflux, also called gastro esophageal reflux disease (GERD).
Chronic acid reflux affects the body in many ways, one that is often overlooked is how teeth are affected by acid. Acid reflux can cause dental erosion, a condition where the tooth enamel dissolves, making them susceptible to damage, discoloration and decay.
What is Acid Reflux and GERD?
Normally, when you swallow, food travels down the esophagus into the stomach where it is digested. A muscle connecting the stomach and esophagus closes to keep food in the stomach and acid out of the esophagus. In someone suffering from acid reflux or GERD, the muscle is weakened, allowing food and stomach acid to travel back into the esophagus. This causes burning in the chest, neck and throat and often leaves an acidic or bitter taste.
How Does Acid Reflux Affect Teeth?
Teeth are covered by a thin layer of tooth enamel, which is highly sensitive to changes in the pH of saliva. Over time, stomach acid can cause tooth enamel to dissolve and erode. Most patients don’t notice damage caused by acid reflux until advanced stages. This is an alarming issue because once tooth enamel is lost, it will not grow back.
Sandra came to Dr. Doray with severe acid erosion damaging nearly all of her teeth. The loss of tooth enamel was significant, dramatically reducing the size of her teeth. Dr. Doray restored Sandra’s smile using porcelain dental crowns.
“I’m so much more confident. No more hand over my mouth when I smile!” – Sandra
Signs that Acid Reflux is Causing Tooth Enamel Loss
Common symptoms of tooth erosion include:
- Tooth sensitivity, especially to hot, cold or sweet food and drinks
- Chipped teeth or sharp tooth edges
- Tooth discoloration or darkening of the teeth
- Thinning or shortened teeth, may be recognized as changes in the bite
- Pain or irritation in the mouth
GERD and Acid Reflux Treatment
Acid reflux and GERD should be diagnosed by your physician. Though these are chronic conditions, they can be managed through a combination of medication and lifestyle changes. The following treatments may be helpful:
- Dietary changes to remove trigger foods which often include fried or greasy food, tomato based food, chocolate, carbonated beverages, citrus fruits, coffee and alcohol
- Quit smoking
- Lose weight, acid reflux and GERD are more common in patients who are overweight or obese
- Drink plenty of water
- Elevate the head of your bed at least 6 inches higher than the foot
While antacids can help to relieve the burning sensation caused by acid reflux, be sure not to overuse these medications as they can also cause dental problems.
How to Prevent Tooth Erosion
One of the best ways to prevent tooth erosion is to practice healthy dental habits. This should include regular visits to the dentist along with brushing twice daily using a dentin-sensitive toothpaste.
Tooth Erosion Treatment
If your teeth are already affected by dental erosion, your dentist will offer a range of treatment options to repair damage and restore teeth to their optimal health and appearance. Dr. Doray treats patients who have been affected by tooth erosion using porcelain veneers, dental crowns, cosmetic bonding.
If you are suffering from acid reflux or dental erosion as a result of acid reflux and GERD, contact Philadelphia dentist Dr. Doray for a consultation.
Few people are aware of the damage acid reflux can cause to their teeth. Acid reflux is a common problem, which develops when the acid in the stomach begins to leak into the esophagus. Regurgitation and heartburn are both indicators of acid reflux, but sometimes, no symptoms appear and the disease goes unnoticed. According to research, acid reflux is not only burning your insides, but it is also affecting your oral health and increasing your probability of developing periodontal disease.
Symptoms of Acid Reflux Damaging Your Teeth
The most common symptom of acid reflux causing enamel erosion is persistent pain in the mouth. People may also find that they are unable to eat or drink certain things, specifically food and drinks that are sweet, hot, and cold. If they feel the inside of their mouth with their tongue, they may notice sharp edges. In addition, the color of their teeth may also change from white to a darkish tone.
The U.S. Department of Health and Human Services reported that over seven million people suffer from acid reflux. Moreover, what is even more startling is the fact that people fail to realize the damage their disease is causing to their teeth. It is gradually destroying the tooth enamel. If they do not find a dentist in their area to visit, there will be nothing left of the enamel, leaving you with a toothless grin, which a dentist can easily fix if you make an appointment with one on time.
Looking at the Science behind Acid Reflux
If you recall from science class, you measure the acidity of material by its pH level. If the pH is lower, the material contains higher levels of acid. If the pH is higher, the material contains lower levels of acid. The acid produced by the disease has a pH level of 2.0, which is extremely low and deadly to your teeth.
How Can People Decrease the Occurrence of Acid Reflux?
People who have acid reflux disease should take preventive measures to maintain their diet. They should not consume fatty, spicy, and fired foods. Furthermore, dairy products, beverages, and citric fruits can also trigger acid reflux in some individuals. If that is true in your case, you should refrain from eating them. Dentists also recommend patients not to brush their teeth after an episode of acid reflux, at least not for sixty minutes.
Most importantly, you should alert your dentist about any medical condition you have such as diabetes, heart disease, and acid reflux disease. If the dentist does encounter enamel erosion in their examination of your mouth in its early stages, they may be able to save your teeth and restore your smile.
If you are an acid reflux suffer, visit Spring Cypress Dental. One of our dentists will inspect your mouth to ensure everything is in order. If something looks amiss, they will gladly let you know of a solution you can select to have your smile back.
In addition to your dentist, you’ll also want to talk to your doctor about fixing the real problem down in your stomach. Oftentimes, medication and a change in diet can rectify the problem. Avoiding foods or exercise that trigger heartburn symptoms can help. Drinking lots of water can also neutralize the acid that escapes the stomach. Alcohol can further irritate the esophagus due to its acidic nature, so it should be avoided along with spicy foods. Smoking is also a problem, as nicotine has been show to further weaken the lower esophageal sphincter whose malfunction creates acid reflux. (Source: Webmd.com.)
Your doctor can prescribe histamine blocker to reduce the production of gastric acid or, in more extreme cases, a member of the proton pump inhibitors medication family. PPIs are even more effective at reducing stomach acid production than histamine blockers and also give the esophagus the break it needs to heal inflammation from reflux. (Source: Webmd.com.)
In some cases surgery may be necessary to correct your stomach’s glitch, but your esophagus, throat, and oral health will be the better for it.