GERD, gastroesophageal reflux disease, is more commonly known as acid reflux disease. It happens to children, adolescents, and adults. In this condition, common in American patients, acid from the stomach leaks up past the valve that’s supposed to keep it inside the stomach and into the esophagus, throat, and mouth. It travels with a host of unpleasant companions, including chronic bad breath, pain, increased cancer risk, and tooth decay.
When we look at tooth decay caused by GERD, we usually look at the primary culprit, acid. After all, it’s called acid reflux, and we know that acid can dissolve tooth enamel and pave the way for dental caries. Usually, the acid that demineralizes teeth comes from bacteria in the mouth and, to a lesser degree, acidic foods in the diet, but GERD can complicate the acid process in the mouth. Stomach acid can have a pH as low as 1.2, much lower than necessary to start demineralizing teeth and beyond the regular capacity of saliva to counteract the acid attack. When a person suffers from GERD, stomach acid regularly has a chance to come in contact with tooth surfaces. It can do considerable damage if left untreated.
Regular dental checkups are an important part of a GERD management plan, along with medications to manage the overproduction of acid. Still, as dangerous as the stomach acid can be for enamel health, acid splashing up onto enamel surfaces is not the only way GERD can stress your teeth. The surprising way that it can endanger your teeth is….
Dry mouth is a major risk factor for dental caries—cavities. Saliva is the primary natural defense your mouth uses to get rid of threats to oral health. Saliva washes away contaminants and retains minerals so the minerals can be redeposited in the enamel when high pH conditions allow for it. In this way, it both acts as a tooth protector and a tooth strengthener.
When dry mouth occurs, there can be too little saliva or none at all, or the saliva is thick and stringy. The mouth is left without its protective mechanism.
Dry mouth and GERD, unfortunately, have medication in common. GERD usually causes sufferers to use medication to manage their disorder. Medications for GERD frequently cause dry mouth in those who need medication daily. In fact, one small study found that a particular PPI, one of the most commonly prescribed types of medication for GERD sufferers, causes dry mouth that resolves when the medication is discontinued. The dry mouth in these was also found with other opportunistic oral infections of fungus or bacteria.
What’s to Be Done?
Managing dry mouth is vital to the success of managing dental stress caused by GERD. This can be difficult because some of the front-line techniques frequently used to treat dry mouth can aggravate reflux symptoms. For example, sipping water all day can help alleviate dry mouth, but it also can cause reflux to worsen by filling the stomach with extra fluids and putting extra pressure on the leaky valve. Discontinuing medication can eliminate the side effect of dry mouth, but it’s not often possible for a patient to go without the medication. If a patient stops using medication to treat GERD, the direct acid attack on the teeth can resume, as can damage to the esophagus and the throat.
In the case of GERD related dry mouth, saliva substitutes, available over the counter and at your dentist’s office, can provide protection for your teeth that the medication strips away. Oral sprays can also help keep symptoms of dry mouth at bay without aggravating symptoms of GERD. Some people find strong mint flavor will worsen GERD, so other flavors, like CTx2 Spray in grape, may be more helpful. Chewing gum can frequently help dry mouth sufferers alleviate dry mouth symptoms by stimulating saliva production. It also has shown some promise in studies helping manage GERD symptoms if the GERD patient chews a sugar-free gum for 30 minutes after meals. Be careful using hard candy to alleviate dryness; sugar candy can worsen both dental decay and GERD symptoms.
It’s important to talk to your dentist about your GERD and be sure dry mouth management is part of your overall management plan and cavity prevention plan. You can manage GERD and dry mouth and keep your teeth healthy, all at the same time.