Gastroesophageal reflux disease as a risk factor of dental hard tissues erosions

Abstract

Gastroesophageal reflux disease (GERD) is a common chronic disease leading to a spontaneous and regular retrograde flow of gastric and/or duodenal contents into the esophagus. Reflux of the gastric contents into the oral cavity refers to the extraesophageal presentation of the disease, which, in the absence of timely treatment, can result in erosion of dental hard tissue (EDHT) through repeated exposure of the dental tissue to acidic contents. EDHT are non-carious lesions of the dental hard tissues (mainly enamel, and in some cases dentin), induced by a chemical reaction involving acids, which results in demineralization processes. The incidence rates of EDHT in adult patients with GERD are 32.5–51.5%. The EDHT in GERD develops in stages. Initially, the gradual degradation of tooth pelicula happens when it gradually becomes decayed by repeated acidic attacks. The loss of the pelicula results in direct contact of hydrochloric acid refluxate with the enamel surface and initiation of its demineralization at pH < 5.5 with dissolution of hydroxyapatite crystals. Given the high prevalence of GERD in the population, it seems important to update an integrated approach to the treatment of such patients, which involves pharmacotherapy provided by the gastroenterologist, as well as prevention and minimally invasive treatment of presentations in the oral cavity by the dentist. Patients with EDHT due to GERD need to maintain individual oral hygiene (use mouth washes with a neutral pH level, avoid abrasive toothpastes), use remineralization therapy at home applying remogels (Tooth Mousse), and also be observed by a dentist as part of the follow-up care. Minimally invasive treatment by the dentist involves restorations using composite tooth filling materials and ceramic veneers. It is reasonable to empirically use proton pump inhibitors twice a day for 3 months for the direct treatment of GERD in patients with EDHT.