Acid Reflux From Chronic Heartburn May Damage Teeth
Study reveals extent of harm that GERD can cause in the mouth, but some preventive measures exist
Thursday, March 8, 2012
The study, which followed patients over six months, found that almost half of those with the condition suffered much worse tooth wear and erosion than healthy people. The disease can ultimately lead to thin, sharp and pitted teeth.
"We hope we can raise awareness that gastroesophageal reflux disease, a condition quite common in any population, is able to cause tooth damage. Dental professionals are mostly aware of tooth erosion, but the public may not be," said study lead author Dr. Daranee Tantbirojn, an associate professor in the department of restorative dentistry at the University of Tennessee Health Science Center.
GERD, which is also known as acid reflux disease, causes chronic heartburn. The stomach contents, including acid, leak into the esophagus and often work their way back up into the mouth, causing burning pain.
Dentists know that chronic heartburn can damage teeth, Tantbirojn said. The acid from the stomach is strong enough "to dissolve the tooth surface directly, or soften the tooth surface, which is later worn down layer by layer. The damage from acid reflux looks like tooth wear -- the tooth is flattened, thin, sharp or has a crater or cupping."
In the new study, researchers used an optical scanner to measure chronic heartburn's effect on teeth of 12 patients with GERD and compared them to six healthy patients without the disease over six months. The study appears to be the first to follow people for that long, Tantbirojn said.
It's normal to have tooth erosion due to chewing, and about half of those with the condition had about the same or slightly more erosion than healthy people, she said. "However, almost half of the GERD participants had tooth wear and erosion several times higher than the healthy participants."
Several patients with chronic heartburn said they were taking medications, but they still suffered from tooth erosion. "Some patients told us that they still have acid reflux episodes despite the medication, or they might have skipped the medication every now and then," Tantbirojn said.
Dr. David Leader, an associate clinical professor at Tufts University School of Dental Medicine, who's familiar with the study findings, said the research is innovative and uses technology that more dentists will have on hand in the near future so they too can track the progress of tooth erosion.
"Even though a patient wouldn't notice all of a sudden that 'my teeth are different,' a dentist might be able to notice that using this technique in a six-month visit," Leader said.
Once the outer coating of the teeth (known as enamel) is gone, it's gone for good, he noted. "The only thing that you can do is wait for it to become bad enough that we have to put a crown, veneer or filling on the tooth," Leader added.
Tantbirojn discussed what helps prevent tooth damage in patients with heartburn. "Generally speaking, saliva is good as the body's defense mechanism. Saliva has a so-called buffering capacity, meaning it can neutralize acid," she said. "Saliva also contains small amounts of calcium and phosphate ions that can reduce the damage of the tooth."
But there's a limit to what saliva can do, Tantbirojn said. "That's why we saw the erosion."
Here are some tips from Tantbirojn: Don't brush immediately after an acid reflux episode, but a fluoride rinse is a good idea. Dentists may prescribe a special toothpaste for acid reflux patients, and they also may recommend that patients take baking soda or antacids after acid reflux episodes to protect their teeth.
Leader said Xylitol chewing gum, which reduces acid in the mouth, is another good idea.
The study appears in the March issue of the Journal of the American Dental Association.
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