I am a retired dentist who has a passion for preventative dentistry and preventive medicine. I recently became painfully aware of the ramifications of acid reflux and GERD (gastroesophageal reflux disease) on the oral cavity.
I developed severe GERD late last year. Unfortunately, complete understanding of the difficulties experienced by patients comes best through direct experience. I look back at many of the patients I worked with throughout my 23 years practicing dentistry and think that I wish I had known then what I understand now.
I have put together this article to help dentists and their patients understand how GERD is creating many dental problems and also the best way to fix them. I hope you will take a few minutes to read this article because I believe the information can help you change patients’ lives and also reduce the frustration of treating patients whose oral health seems to be deteriorating in spite of excellent dental care.
Acid reflux or GERD affects over 50% of adults and 37% of young people. 1 It occurs when the contents of the stomach end up in the esophagus and oral cavity as a result
of inadequate closure of the esophageal sphincters. The pain of heartburn is a symptom in only 10% of cases while others may experience:
• Post-nasal drip
• Sore throat
• Throat clearing
• Chronic cough
• Difficulty swallowing
• Asthma-like wheezing and symptoms
• Chest pain
And many other symptoms….
Nocturnal reflux is very common and extremely damaging since hydrochloric acid and the enzymes of the stomach, especially pepsin, stay in contact with the esophagus and oral cavity for hours. Many people experience silent reflux and do not realize that some of their symptoms are a result of stomach acid.
Medical doctors prescribe Proton pump inhibitors (PPIs) to reduce the amount of acid secreted in the stomach and to eliminate the symptoms of GERD. Although symptoms often improve, PPIs are not able to stop the progression of GERD. A Danish study of 10,000 patients showed that taking PPIs may increase the risk of heart attacks and esophageal cancer. 2 Another study showed that PPIs may increase the risk of dementia. 3 PPIs can be important for a short time (ideally four to eight weeks) but must not be relied on long term to treat GERD.
Diet and lifestyle changes are the best way to reverse the course of this disease.
When I had my first experience of acid reflux, I was shocked by what I felt. I woke up the first morning with a mouth full of sour acid. It took several days of research, trying different suggestions and antacids, and seeing my doctor to begin to improve the problem. By then, my teeth were extremely sensitive, my gums and tongue felt raw and my throat was sore constantly.
I began to think about some of my patients who had constant sensitivies, chalky enamel and rampant decay and I knew that I had missed the diagnosis of GERD. I had also missed helping them to preserve their teeth and heal their disease.
Oral symptoms of GERD may include any of the following:
• Sour taste
• Excess salivation
• Pain on swallowing
• Tooth sensitivies
• Generalized mouth pain and irritation
• Demineralization of enamel (chalky looking first)
• Excessive erosion of enamel – may be located on the palatal surfaces of the maxillary teeth initially
• Chronic decay
“Early recognition of surface changes is essential. Initial signs include the first stages of erosion with chalkiness and loss of lustre.” 4
Dentists must be aware that these symptoms and many others can be indicators of GERD and that patients are not aware of stomach acid contributing to these problems.
There are many ways the dentist can help their patient suffering with GERD to protect their mouth and esophagus. Here are a few suggestions that can make an immediate
• Eliminate all soda pop completely (regular and diet). Pop has been acidified since the 70s and this may be a contributor to the epidemic of GERD 5
• Stop all night time eating. No food or drinks (other than small sips of water) after 7PM or four hours before bedtime
• Eat three meals a day and two snacks. Avoid processed, fatty and acidic foods
• Use a wedge pillow for sleeping and/or raise the head of bed six inches
• Drink Alkaline water. This water neutralizes pepsin which is the enzyme that damages the esophagus 6
• Walk, especially after meals
• Work with a naturopath or nutritionist to identify sensitivities and triggers to establish a diet that works for the person. Problem foods are highly individual and must be determined for optimal health
Suggestions for Patients for the Teeth and Oral Cavity
• Use a baking soda toothpaste with fluoride. Rub a dab over your teeth with your finger and then rinse with water several times a day. Do not brush your teeth when your mouth feels acidic as this contributes to enamel loss
• Rinse with a fluoride mouthwash or use a fluoride gel daily
• Avoid eating acidic and sugary foods- eliminate your triggers and sensitivities to eliminate GERD
• Have regular dental checkups, X-rays and cleanings
• Consider a nightguard to protect teeth from wear due to bruxism
The best long term solution for GERD is a combination of diet and lifestyle changes.
When I saw my doctor and gastroenterologist with my severe symptoms of GERD, I was prescribed medication and sent home with a page of information about the proper diet. The medication helped somewhat but I needed to have support to test and incorporate the lifestyle changes that would lead me to healing my illness. Having a nutrition degree and a great deal of experience in lifestyle changes, I began to read and research the problem of GERD.
Three months later, I was able to eliminate PPI medications and have learned to control my acid problem daily. It has not been easy but the process has helped me to improve my health dramatically.
We as dentists, owe it to our patients to notice the problem and provide the information and support they require to improve their GERD. Dentists are probably in the best position to help patients understand why they are having “teeth problems” related to GERD. As trusted professionals, dentists can recommend medical, nutritional and lifestyle referrals to heal their patients’ stomachs, esophagus and oral health issues caused by acid reflux and GERD.
1. Koufman, Jamie. Dr. Koufman’s Acid Reflux Diet; Katalitix Media; USA, 2015
2. Rodriguez, Jorge E, The Acid Reflux Solution; Ten Speed Press, Berkeley, 2013
3. Gomm W, von Holt K, Thomé F, et al. Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis. JAMA Neurol. 2016;73(4):410-416. doi:10.1001/jamaneurol.2015.4791.
4. Hvid-Jensen, F., Pedersen, L., Funch-Jensen, P. and Drewes, A. M. (2014), Proton pump inhibitor use may not prevent high-grade dysplasia and oesophageal adenocarcinoma in Barrett’s oesophagus: a nationwide study of 9883 patients. Alimentary Pharmacology & Therapeutics, 39: 984–991. doi: 10.1111/apt.12693
5. Ranjitkar, S., Smales, R. J. and Kaidonis, J. A. (2012), Oral manifestations of gastroesophageal reflux disease. Journal of Gastroenterology and Hepatology, 27: 21–27. doi: 10.1111/j.1440-1746.2011. 06945.
6. Roesch-Ramos, Laura; Dental erosion, an extraesophageal manifestation of gastroesophageal reflux disease. Institute for Medical-Biological Research, 2014 http://scielo.isciii.es/pdf/diges/v106n2/original3.pdf
7. Vincent W. Wang, MD, PHD and Mohammad Wehbi, M.D;Understanding Acid Reflux and Its Dental Manifestations; www.dentistryiq.com.
Dr. Gloria Alban graduated from the University of Toronto, Faculty of Dentistry in 1978. She worked in her own dental practice in Toronto until 2001 when she retired due to health issues. As part of her healing, she became a Holistic Nutritionist in 2010. Dr. Alban now works in association with the Spark Institute in Vaughan, Ontario – a clinic devoted to preventive medicine and the natural treatment of digestive disorders, eating disorders, anxiety and depression. In her free time, she volunteers as a grief and crisis counselor with the Toronto Distress Centre and enjoys yoga, hiking and cooking for her family.
RELATED ARTICLE: Prosthodontic Treatment of The Severely Worn Dentition