Prevalence of Erosive Tooth Sensitivity in Patients with GERD

 

Hiba Farooq¹, Syeda Humal Bukhari², Munaza Riaz³

Lahore College for Women University near Wapda Flats, Jail Road, Lahore 54000

 

ABSTRACT:

Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus, and GERD is symptom or complication of GER. The most common extra oral manifestation of GERD is a progressive, irreversible loss of dental hard tissues due to a chemical process not involving bacteria. Tooth sensitivity is a common complaint in local population. Because of dietary habits, GERD is a prevalent condition in local region as well. To study the prevalence of dental wear and sensitivity in patients with gastric problems, an observational study was conducted. Sample size was 210 patients examined in different dental clinics and hospitals of Lahore. A questionnaire was used to collect data covering various aspects. Out of recruited subjects showing symptoms of GERD, only 38% people were diagnosed with GERD. All the recruited subjects were having dental problems and out of them 38% considered visiting dentist. The study showed that many respondents used to consume citrus fruits, carbonated drinks; tea/coffee frequently. Effective outcome of dental erosion treatment requires counseling and oral hygiene information. This study determined the GERD patients were at higher risk of developing dental erosion com­pared to the healthy individuals in a sample of Pakistani population

 

 

 

INTRODUCTION:

The retrograde or forward gush of gastric food that in general occurs one hour after meals called Gastro esophageal reflux. Gastro esophageal reflux disease is a disorder that may develop from it.^[1]. Dental erosion is a disease linked with bad hygiene/nutritional habits, but chiefly with contact to destructive agents, like acids. The incidence of Dental Erosion in patient with GERD is variable i.e. from 5.00 % to 58.41 %^[2]. Two types of risk factors for dental erosion include intrinsic and extrinsic types^[3]. Intrinsic factors are based on presence of stomach acids, and may present intra-orally following vomiting, regurgitation, gastro-esophageal reflux disease (GERD) or rumination^[4],[5]. Direct contact of regurgitated gastric acid is considered to be the main mechanism of dental erosion in the patients with    GERD ^[6].

 

Strong relation is known to be found between Tooth wear and GERD. To remove acid from esophagus, saliva plays a major role, accurate for healthy persons and patients with GERD both ^[7]. Dietary counseling has a major role in management of Dental Erosion. Counseling can only be given after careful dietary analysis. Avoidance of acidic food and drink between meals, at bedtime and during the night is recommended ^[8]. Avoidance of direct contact with acids, mainly through fluoride therapy is one the important strategies regarding prevention of Dental Erosion ^[9].

 

The primary principle of this study to evaluate the prevalence of erosive tooth sensitivity in patients with reflux disease and also the dietary habits in a group of pa­tients showing symptoms of gastro-esophageal reflux disease.

 

METHDOLOGY:

A descriptive/ observational study was conducted to study the prevalence of dental wear and sensitivity in patients with gastric problems in different dental clinics and hospitals of Lahore, Pakistan. The study was also carried out to know the influence of dietary habits in causing erosive tooth sensitivity. Two hundred and ten subjects both male and female between 15-60 years of age, who have been diagnosed with GERD or received any treatment for erosive tooth sensitivity, formed the study group. Duration of the study was two months. Various public and private sector clinical settings were visited for the purpose of this study.

 

A structurally designed data collection form was filled by face to face interview with people. It covered all aspects of prevalence, treatment, and counseling trends regarding erosive tooth sensitivity in studied population. The results have been interpreted and presented graphically and in tabular form using Microsoft Excel.

 

RESULTS:

The study was conducted to find out the prevalence of Dental Erosion in patients having gastric problems. Out of recruited subjects, 43.8% showed signs and symptoms of GERD (Fig no. 1) but only 28% of them were diagnosed and received proper treatment of GERD (Fig no 2). The recruited subjects showed symptoms which have been aggravated by having spicy foods and carbonated beverages. The respondents have frequent consumptions of acidic food and drinks. (Fig no 3) The studied population was also found to consume fast food, spicy food, pickles and eggs frequently which contribute for increased incidence of GERD, which ultimately leads to high risk of erosive tooth sensitivity. 52% people used desensitizing toothpaste as a home remedy for the treatment of symptoms of dental erosion. 28% used floride gel and 14% subjects used warm rinse water. Counseling trends are moderately appreciated in public settings and use of mouth washes along with use of desensitizing tooth paste for prevention of future recurrence of dental erosion is highly recommended (Fig no 4)

 

Fig no 1: Respondents experiencing sign and symptoms of GERD (n=200)

 

Fig no 2: People diagnosed with GERD (n=200)

 

Fig no 3: Routinely dietary habits (n=200)

 

Fig no. 4: Preventive measures recommended by Dentist (n=200)

 

DISCUSSION:

GERD is a relatively frequent condition which involves a leaky valve causing acid regurgitation from stomach back to esophagus. Acid reflux leading to stomach acid leaking into the oral cavity can be very damaging to teeth.  The damage and wear on the teeth from acid reflux can cause toothache and sensitivity. From this study it was noted that erosive tooth sensitivity is more prevalent in patients showing gastric problems. Dental erosion prevalence in patients with GERD is variable i.e. from 5.00% to 65% which was comparable to the present study having a prevalence of 43.8% ^[10]. The studied population experienced most of the symptoms of dental erosion including teeth discoloration, cracked tooth, bad breath, difficulty in chewing and gum bleeding. Due to exposure of tooth dentine during erosive tooth sensitivity, teeth may become yellowish or become discolored. The continuation of Dental Erosion leads to cracks or rough texture of teeth. The ends of front teeth may also appear transparent. Questionnaire items on dental visits showed that 50% of respondents attended dental check-ups. Many respondents from this study misunderstood that destructing effects of Dental Erosion would be prevented by brushing right after consuming acidic foods and drinks. Brushing should be done by soft toothbrush and any toothpaste containing fluoride. To prevent damaging effects on enamel and dentine, it is advantageous to wait for an hour before brushing ^[11]. Regarding dietary habits, the study showed that many respondents have frequent meals and frequently consume fruits juices, citrus fruits, soft drinks, tea/coffee. All carbonated drinks quickly dissolve enamel on teeth. Owens concluded that due to strong buffering capacity, carbonated drinks have more damaging potential for teeth. Permanent teeth of adolescents are more vulnerable to acid attack by the soft drinks because of immature enamel^[12] Study showed that 60% of the individuals used to consume milk on daily basis. However, there is found to be a negative link between frequency of Dental Erosion and consumption of milk. It has been reported that occurrence of tooth erosion was less in subjects with greater milk consumption.^[13] Counseling and oral hygiene information are some effective strategies fr prevention of Dental Erosion. A dentist can develop a healthy relationship with the patients over the longer term which is based on seeing the patients not just when they are ill, and need to be counseled to provide support and encouragement^{. [14]} There is a lack of awareness on the part of general physicians regarding the association between GERD and dental erosions. So there is a need to disseminate this information through medical education.

 

CONCLUSION:

GERD is an increasingly common and potentially serious condition, with various extra esophageal adverse health effects. From this study it was concluded that Erosive Tooth Sensitivity is highly prevalent in patients with GERD. Encouraging patients to improve their life style would be beneficial. Most of the people had frequent consumption of acidic foods and drinks, which may need to be reduced or even eliminated because of the erosion they may cause. Counseling trends should be appreciated in public settings and patients must be counseled about how to prevent GERD.  Thus, diagnosis and prevention of both conditions need good association between dental professionals and gastro­enterologists

 

REFERENCES:

1.        Prasad GA, etal. Predictors of pro­gression in Barrett’s esophagus: current knowledge and future directions. American journal of Gastroenterol 2010; 105(7): 1490 - 5021.

2.        Laura R, etal. Dental erosion, an extraesophageal manifestation of gastroesophageal reflux disease. The experience of a center for digestive physiology in Southeastern Mexico. Rev Esp Enferm Dig 2014; 106(2): 92-7.

3.        Hicks J, etal. Biological factors in dental caries enamel structure and the caries process in the dynamic process of demineralization and remineralization (part 2). J Clin Pediatr Dent 2005; 29(2): 119-24.

4.         Jain P, etal. Commercial soft drinks: pH and in vitro dissolution of enamel. Gen Dent. 2007; 55(2): 150-54.

5.        Vakil N, et al. The Montreal defi­nition and classification of gastroesophageal reflux disease. A global evidence-based consensus. Am J Gastroenterol 2006; 101(8): 1900-943.

6.        Alavi G et al, Dental Erosion in Patients with Gastroesophageal Reflux Disease (GERD) in a Sample of Patients Referred to the Motahari Clinic, Shiraz, Iran. J Dent. 2014; 15(1): 33-8.

7.        Roesch-Ramos L, et al. Dental erosion, an extraesophageal man­ifestation of gastroesophageal reflux disease. The experience of a center for digestive physiology in Southeastern Mexico. Rev Esp Enferm Dig 2014; 106(2): 92-7.

8.        Lazarchik DA, Filler SJ. Effects of gastroesophageal reflux on the oral cavity. American Journal of Medicine. 2003; 103( 103): 107S–113S

9.        Ganss C, Schlueter N, Friedrich D, Klimek J. Efficacy of waiting periods and topical fluoride treatment on toothbrush abrasion of eroded enamel in situ. Caries Res. 2007;41(2):146-5

10.     Ramos LR, Dietlen FR, Troche RMJ et al. Dental erosion, an extraesophageal manifestation of gastroesophageal reflux disease. The experience of a center for digestive physiology in Southeastern Mexico. Rev Esp Enferm Dig (Madrid) 2014; 106 (2): 92-7.

11.     Wiegand A, Egert S, Attin T: Toothbrushing before or after an acidic challenge to minimize tooth wear? An in situ/ex vivo study. American Journal of Dentistry 2008; 21: 13-16.

12.     Owens BM: The potential effects of pH and buffering capacity on dental erosion. Gen Dent. 2007, 55: 527-531.

13.     Abdul manaf Z, Muhammad ali H, Lee mee T, Ismail nor H, etal: Relationship between food habits and tooth erosion occurrence in Malaysian university students. The Malaysian Journal Of Medical Sciences 2012; 19(2): 56-65

14.     Nicki k. Erin K. Management of Dental Erosion. Newzealand Dental Journal 2004; 100(2): 44-47

 

 

 

 

Accepted on 28.02.2017           © RJPT All right reserved