Gastro esophageal Reflux Disease (GERD) and Tooth Erosion; Statistical study of 100 cases
Dental erosion was defined as dissolution of tooth by a solution that is low in pH either after the consumption of extrinsic acidic fluids or when gastric fluids come into the oral cavity. Gastro esophageal reflux (GERD) is a condition defined as an involuntary passage of gastric juice against the normal flow of digestive tract. It can be abnormal phenomena on in newborns and usually disappears with age; however, in some individuals, its maintenance can be considered a pathological condition. (1)
The association between acid reflux and dental erosion was first described by Howden in 1971 and was confirmed in other studies later, both in the adult population and in children. (2, 9, 23)
This association is commonly observed by dentists, but is given very cursory mention or omitted entirely when describing extra esophageal (supra-esophageal) manifestations of GERD. (3)
A recent systematic review found a median prevalence of 24% for tooth erosion in patients with gastro esophageal reflux disease (GERD) and a median prevalence of 32.5% for GERD in adult patients who had tooth erosion Therefore, from their observations of tooth erosion, dentists may be the first persons to diagnose the possibility of GERD, particularly in the case of “silent refluxes.” This diagnosis is important, as GERD has increased in prevalence in many countries, and may have severe health effects if not adequately treated. Consequently, dentists should before aware of the various manifestations of GERD. (4)
The aims of the study were to investigate dental erosion prevalence, location and severity and also to determine the effect of oral hygiene level, dietary behavior, dental behavior and GERD related medication and chronic illness in erosion.
Patients and methods
This study was conducted at the Departments of Oral Medicine and Gastroenterology of Sahloul Hospital, Sousse Tunisia.
The study group consisted of 100 patients with GERD.
All patients with GERD for 6 months with typical symptoms (heartburn and / or acid regurgitation, minimum weekly lasting for six months or more), atypical symptoms (epigastria pain, nausea, belching, halitosis, pseudo-angina pain) or with erosive GERD discovered during endoscopic examination (reflux esophagitis) or at the stage of GERD complications (peptic stenosis of the esophagus, Barrett, hemorrhage digestive).
Were excluded from the study all patients treated surgically for GERD or presenting symptoms of GERD less than once a week or presenting undercurrent factors that can cause dental erosion such as; disorders (bulimia, anorexia), professionals exposure to toxic agents (acid fumes and aerosols used in industry) and pregnant women.
Diagnosis of GERD
All patients of the study group were new patients seen at the Gastroenterology Department because of symptoms ⁄ signs suspicious of GERD. Gastro-esophageal reflux disease was diagnosed by esophagogastroduodenoscopy, 24-h esophageal pH-metry, esophageal manometry.
Oral involvement assessment
Medical history of potential oral symptoms associated with GERD was
carefully collected and the following parameters was evaluated; brushing method, dental erosion, dental sensitivity, loss of dental structure because of abnormal attrition (clenching or bruxing of one tooth surface against another), physical wear by extraneous objects such as toothbrushes, also known as tooth abrasion, alteration of the mucosa.
Thus, dental erosion was assessed in all the patients and by a single investigator under ideal lighting conditions, and to standardize this evaluation, patients were assigned a wear Index according to the classification scale erosion of Eccles and Jenkins (Table 1).
Tooth sensitivity was ranked on a subjective assessment by the dentist in 4 stages: no sensitivity, low sensitivity, moderate, and severe.
Table 1: Repartition of our data according to the classification scale
erosion of Eccles and Jenkins
Data entry and statistical analysis were performed using SPSS (software version 11.0). For the descriptive study, we calculated simple and relative frequencies, means, median and standard deviations for the analytical study, we used the Chi 2 test of Person for the comparison of percentages and the student t test for comparison of means. Only P-values <0.05 were considered statistically significant.
Clinical examination was carried out in 100 patients (Thirty-nine (39%) were men and Sixty-one (61%) were women) with sex’s ratio; 0.63% (mean age: 49.4; range: 20–75). (fig1)
fig. 1: Distribution of patients by age and sex
fig. 2: Prevalence of dental erosion in GERD
Fig. 3a: Dental erosion in palatal surface of maxillary
incisors and molars
Fig. 3b: Dental erosion in palatal surface of maxillary
incisors and molars
Fig. 4: Erosion in occlusal surfaces of lower molars
Fig. 5: Significant associations between dental erosion
related to GERD and the presence of abrasion
Fig. 6: Significant associations between dental erosion
related to GERD and the presence of attrition
Fig. 7: Associations between dental erosion related to
GERD and pathologic attrition (bruxism)
Fig. 8: Significant associations between dental erosion related to
GERD and the use of Beta-blockers
Fig. 9: Significant associations between dental erosion related to
GERD and the use of vitamin C