Triangle Pediatric Dentistry - Wake Forest, NC

GERD grief - my child’s teeth are eroding!

January 14 2011

There is a saying in medicine and dentistry that the mouth can be considered a portal to the rest of the body.   Did you know that the mouth and teeth can often give clues that there can be problems going on in other areas of the body?  Dentists can act as tooth sleuths and find any clues in the mouth that can indicate that something isn’t quite right elsewhere in the body.  As one example, the link between oral health and cardiovascular disease has been in the news a lot in the last few years (link).  Another interesting health condition that has many early warning signs noticed in the mouth is GERD (GastroEsophageal Reflux Disease).    

GERD is a condition in which the stomach contents leak back into the esophagus and sometimes even all the way back into the mouth.   The acidic stomach contents can cause a person to experience frequent heartburn (one of the most common symptoms), frequent belching, chronic coughing, laryngitis, pharyngitis, painful swallowing, and tooth enamel erosion.  If untreated over long periods of time GERD can even lead to other more serious problems including cancer.

With children it is sometimes difficult for parents to even realize that their child may be experiencing GERD. Children can’t always tell you that they are experiencing some of the early symptoms of GERD (heart burn, etc.) and the symptoms may be mistakenly attributed to other problems or disregarded all together.  An early clue that a child may have GERD is the erosion of tooth enamel.  Children with GERD can be subject to acidic stomach contents coming up into the mouth multiple times during the day.  In addition and even more concerning, much of the regurgitation of acidic stomach contents seen in GERD occurs during sleep resulting in several exposures of the teeth to acid at a time when saliva in not being produced to buffer the acid.  Over time these frequent attacks by the acidic stomach contacts will cause the tooth enamel to erode.

Erosion of tooth enamel can often be confused with attrition (wearing away of tooth structure) from grinding the teeth.  Tooth wear from grinding usually wears the teeth out in very flat patterns whereas erosion from GERD tends to cause the loss of tooth structure in more of a reversed architecture formation.  The enamel erosion seen from GERD often manifests as worn craters on the cusps of the molars or in more severe cases “cupping out”  of the chewing surface of the teeth.  This erosion can make the teeth sensitive as well as make them more prone to cavities (and make any existing cavities worse).  Another pretty clear cut sign that the lost tooth structure is from acid erosion is that any filling will appear taller than the surrounding tooth structure (instead of being worn down to the same level as the tooth structure).

          "Raised fillings" due to enamel erosion

When erosion of tooth structure is noted we must first rule out possible sources of enamel erosion in the diet.  These other sources could include acidic drinks (soft drinks, sports drinks, juice, etc.) or acidic candy (sour gummies, sour skittles, sour gummy vitamins, etc.).  If the diet has been ruled out the next step is usually consultation with a physician.  If a child is found to have GERD they can often be treated with medications such as an acid reducer like Zantac or an acid blocker such as Prilosec or Prevacid.  A few other tips to help with reflux are:

• Don’t eat a large meal within 2 hours of bed time (this increases the likelihood of regurgitation during the night)
• Raise the head of the bed by about ½ a foot so the stomach contents are more likely to stay in the stomach
• Follow up with a physician

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