Oral impact of gastro‐oesophageal reflux disease: a case report

Abstract

Background: This case report describes the dental management of a 30-year-old male with cerebral palsy and dyspraxia. Recall examination identified multiple erosive carious lesions despite previous oral hygiene and dietary related instruction. A comprehensive approach to patient management was required to identify the aetiological factors associated with the continued loss of tooth structure. Methods: The identification of the aetiological factors required a detailed medical history and clinical examination, as well as liaison with the patientÕs general medical practitioner. Preventive measures were adopted prior to restorative intervention in order to stabilize and remineralize the dentition. Results: Medical intervention for gastro-oesophageal reflux disease (GORD) and a targeted prevention programme resulted in remineralization of all carious exposed dentine with stabilization of the dentition. Conclusions: Patients with cerebral palsy are known to have a higher incidence of GORD as well as problems with swallowing, vomiting and recurrent chest infections. Long-term gastric acid attacks can contribute to dental erosion, and dental professionals may be the first to diagnose silent GORD. The successful treatment of erosion caused by GORD requires a multidisciplinary and minimal intervention approach.

Three-dimensional profilometric assessment of early enamel erosion simulating gastric regurgitation

“…Concurrent occurrence of GORD and rampant caries is uncommon but such cases can be difficult to manage clinically. 30,31 The pathogenesis of these conditions is not well understood but the resting pH of the oral biofilm is likely to drop close to or below the critical pH of hydroxyapatite or fluorapatite, with the occurrence of little or no remineralization after prolonged phases of demineralization. Erosion of incipient enamel lesions can also result in faster rates of toothbrush abrasion, 32 leading to further demineralization.…”

Temporomandibular joint dislocation in a post-stroke patient with dysphagia caused by gastroesophageal reflux-related vomiting

“…Although oral hygiene is not considered to have any direct effect on the improvement of GER, removal of residual gastric contents from GER strongly contributes to the protection of oral tissues and the prevention of aspiration pneumonia (9). In the present case, since the method of PEG could not be altered, oral hygiene was suggested as the most effective available option for protecting against TMJ dislocation.…”

Links between oral and gastrointestinal health

“…The early identification of GORD and effective management is, therefore, important to minimize these potential complications, particularly when the usual symptoms associated with GORD are absent in the case of silent disease. Aside from undertaking restorative dental treatment necessary to replace the lost of tooth structure caused by erosion [2], dental practitioners may be the first to identify signs that may, in the absence of other exogenous causes of dental erosion, suggest a diagnosis of GORD.…”

“…Dental erosion may, in fact, be the first clinical indication of reflux disease [2,3]. Generally, GORD manifests as symptoms such as belching, an unexpected sour taste and 'heartburn' [1]; silent GORD has also been described when these symptoms are not experienced by patients [1].…”