Dental complications of GORD

Enamel hypoplasia

Formation of tooth enamel can be disrupted by early severe health issues such as OA/TOF repair, premature birth, NICU stay. This is usually most evident on the first permanent molars, which erupt aged 6. These need careful monitoring throughout life, with good diet, brushing twice daily with an electric toothbrush, fluoride toothpaste and fissure sealants.

Tooth wear

Progressive loss of the tooth’s surface due to erosion caused by GORD. Acid reflux causes the enamel to dissolve, initially causing a glassiness of the surface appearance, then leading to stripping of the enamel down to the dentine. It classically affects the back of the upper front teeth as this is where the reflux hits the teeth. In time, if untreated, this can lead to cosmetic changes, chipping and sensitivity, and, if severe, death of the nerve and possible infection. (114) There may also be loss of enamel from the back of posterior teeth, especially molars, and loss of cusps of posterior teeth (molars) exposing yellow dentine and causing visible cupping. (115) Eventually, this can result in tooth loss if not managed.

Dental caries

Acid erosion, tooth wearing and enamel hypoplasia all increase the risk of caries. (116)

Management

• If dental changes are noted by a GP, this should lead to consideration of whether the patient’s GORD is properly managed.
• Lifestyle changes – avoid food that aggravates reflux, avoid fizzy drinks and fruit juices, or use a straw if drinking an acidic drink.
• Avoid toothbrushing for up to 30 minutes after an acidic drink.
• Use fluoride toothpaste, particularly a desensitising one if sensitivity is present.
• Avoid scrubbing with the toothbrush.

Dentine bonding agents and resin composite restorations can all be used to protect teeth against acid damage. Porcelain crowns may also replace individual teeth that are lost or severely damaged. (117) However, long-standing acid reflux can lead to extreme tooth wear and destruction and may need reconstructive dentistry.

If noted by GP, in a patient born with OA/TOF this should lead to consideration of whether GORD is adequately managed and encouragement of patient to seek dental care. (115) Ideally, management of OA/TOF patients’ teeth to protect against reflux damage should start in childhood, but fluoride toothpaste and mouthwash, fissure sealing of teeth, dentine bonding agents and resin composite restorations can all be used to protect teeth against acid damage. (117) However, long-standing acid reflux can lead to extreme tooth wear and destruction and may need reconstructive dentistry.