On patient’s delayed presentation, it is found that GERD occurs in connection with the discovery of demineralization following erosion of enamel due to the acidic pH of the reflux. Dental wearing is the erosion o calcium phosphate (component of carbonated hydroxyapatite) mineral content of the enamel. Normally, carbonated hydroxyapatite is soluble in the acidic medium. The solubility therefore, increases as the pH of the oral cavity decreases by the acid reflux action.
The effect of erosion was earlier noticed when there is a direct contact between the teeth surface and the acid content of foods from outside the body e. g. citrus fruits. This condition should not be compared to the demineralization that occurs in dental caries where acidic environment of the tooth is caused by the acidic toxins released by the bacteria (bacteriodes species). The acid erosion is a direct upward flow from the gastrium or stomach. The erosion in the enamel is usually localized on the palatal side of the teeth around the maxillary region.
These findings are revealed by profilometry scan, spectrophotometry analysis and Magnetic Resonance Imaging of the buccal cavity (Yang, 2005) Management of Dental Complications The awareness of other complications that complicates tooth involvement in GERD helps treatment and protects the high risk of tooth erosion from deteriorating progression. There is remineralization therapy. This treatment is very important to protect long term sparing of dentition during GERD. This could be done by the professionals; it is equally a recommendation as part of patient’s day to day self care therapy.
The primary treatment is the application of “topical fluoride through varnish application, rinses, and one- minute topical gel/foam for use in a disposable tray after completion of the prophylaxis”. In self care aid, patient is advised to increase add fluoride through the use of oral rinses and conc. gels in toothpastes. Market products containing high fluoride content is to be used regularly as dentifrices (Yang 2005). Also products containing soluble calcium and phosphate can help supply same to the content of enamel.
In addition, brushing of teeth is advised to be of high content in sodium bicarbonate to neutralize refluxed acid and their other effect. All these dentifrices prevent erosion of the enamel; hence, patient should be educated to ensure compliance to the fullest. A suggested restorative option involves the use of dentin binding compounds to prevent dentin exposure (Kaltenbach, 2006). Some simple preventive measures also include; i. Affected individual would desist from brushing tooth following immediate acid contact with the tooth in order to prevent aggressive erosion. ii.
The use of highly abrasive tooth paste should be avoided iii. There should be reduction in the frequency of extrinsic acidic food intake; any unavoidable intake should be followed by gentle rinsing. iv. In the presence of erosion, patient is advised to occlude or guard the affected portion to prevent unintentional grinding of this part. v. It is a preventive measure to use agents that aid neutralization of acid after accidental exposure e. g. antacids (containing no sugar). vi. Patient needs increase the presence of saliva in the mouth with the use of high pH candies.Salivary secretion is neutralizing in action.
References Barham CP, Gotley DC, Mills A, Alderson D: Precipitating causes of add reflux episodes in ambulant patients with gastro- oesophageal reflux disease. Gut 36:505, 1995. Jacob R Kahrilas PJ, Vanagunas A: Peristaltic dysfunction associated with nonobstructive dysphagia in reflux disease. Dig Dis Sci 35:939, 1990. Kaltenbach T, Crockett S, Gerson LB (2006). “Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach”. Arch. Intern. Med. 166 (9): 965–71