Effects of gastroesophageal reflux on the oral cavity.

The effects of chronic exposure of the oral cavity to gastric acid can be many and varied. Soft tissue symptoms (nonspecific burning and sensitivity) have been mentioned in the literature, but pathognomonic soft tissue lesions have not been documented. Dental erosion can be considered to be the predominant oral manifestation of gastroesophageal reflux disease. Erosion begins with subtle changes in the surface enamel and can progress to severe loss of tooth substance. Because the causes of such tooth lesions may be multifactorial, combining the effects of erosion, attrition, and abrasion and because of the subtle changes present in the beginning stages of such lesions, diagnosis may be difficult. Although the basic mechanism of erosion in gastroesophageal reflux patients is the dissolution of enamel and dentin due to acid exposure, a multitude of other factors can modify the effects of gastric acid. Salivary parameters, in particular, may play an important role in affecting oral pH after reflux episodes. Once dental erosion is diagnosed, thorough evaluation is necessary to document the extent of damage and to detect a cause, which may have both intrinsic and extrinsic components. Treatment goals include eliminating the causes of acid exposure, preventing the effects of acid exposure when it is not controllable, treating symptoms of soft tissue irritation and dental erosion, and restoring the dentition to an esthetically and functionally acceptable level.