Commonly Misdiagnosed Tooth Erosion May Signal Reflux

Knowing what signs of acid damage to look for in your mouth could help you resolve root causes contributing to destruction along the whole digestive tract. 

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Your mouth holds clues to many diseases, including one condition that can sometimes cause damage to your teeth for some time before producing other symptoms.

Acid reflux is the result of stomach acid rising into the esophagus causing burning in the chest, upper abdominal pain, and regurgitation. There’s also another form of acid reflux called laryngopharyngeal reflux, or “silent reflux,” that makes its way into the upper esophagus, throat, and mouth.

Both forms of reflux can leave telltale signs of erosion on the teeth. Dentists can easily mistake erosion for damage caused by bruxism—grinding, gnashing, or clenching the teeth—especially during the night.

“It’s being misdiagnosed as grinding wear versus erosive wear,” Bonnie Ripin, a dental hygienist, told The Epoch Times. “Erosive lesions are more dished out—they have a concavity. If you are grinding your teeth together, you’ll have a flat surface.”

An astute dental professional can tell the difference between the two types of degeneration, she said. Unfortunately, many dentists and hygienists lump both types of wear together, in part because patients can have both types.

Thus dentists often mistreat reflux patients for grinding, giving them a mouthguard and missing an opportunity to resolve the root cause of erosive damage. On the medical side, patients may be treated for reflux by physicians who don’t inform them that acid can deteriorate their teeth.

Patients Can Advocate for Themselves

Patients can do a self-analysis to facilitate optimal dental and medical care. Ms. Ripin said if patients answer yes to any of the following questions, they should talk to both their dentist and doctor about whether reflux could be causing their symptoms:

• Do you suffer from sensitive enamel?
• Have you lost tooth structure or length?
• Have you been told you are grinding your teeth?
• Do you experience burning in your throat or chest?
• Do you have a cough or asthma that is unmanaged?
• Do you snore?
• Have you been diagnosed with sleep apnea?

Patients should also be sure to schedule regular oral examinations.

“Your dentist may find early symptoms of a potentially serious problem before it progresses. In fact, more than 90% of systemic diseases have oral manifestations that may be detected during an oral exam by a dentist,” the dental insurance company Delta Dental stated in an article titled “Your dentist can spot acid reflux.”

Reflux, also called gastroesophageal reflux disease (GERD), and grinding have been connected in medical literature. That’s why some doctors may ask patients if their dentist has told them that they grind their teeth.

Ms. Ripin said she was trained to look for distinguishing signs of reflux erosion in patients’ mouths, explain the cause, and urge them to see a specialist for further testing.

“Bringing it to the attention of the doctors is No. 1,” she said. “If there’s destruction on the teeth—enamel is a hard structure—what’s it doing to their esophagus? If that kind of destruction is happening to teeth, I always tell patients to go talk to a doctor.”

Out-of-Place Acid Creates Problems

The mouth—where saliva has a pH of 6—is the start of the digestion process. Chewing, enzymes, oral microbes, and saliva begin to break down food before it begins its journey through the gastrointestinal tract.

Humans produce large volumes of stomach acid, which helps us digest food faster than other animals. Our stomach’s acidity is 1.5 to 2—near that of battery acid on the pH scale of zero to 14. Seven is “neutral.”

Regurgitated stomach acid alters the pH in the mouth and can lead to oral health problems. When the pH in the mouth drops below a 5, dental decay can begin, according to Ms. Ripin.

Besides noting the pattern of enamel wear related to reflux, dental professionals can also screen patients for snoring, which causes negative pressure in the esophagus and draws up stomach acid, she said.

“This mainly affects the lower posterior [back] teeth and molars. Often we can tell if someone is a side sleeper from the erosion on only one side of the mouth,” Ms. Ripin explained.

As the enamel weakens and wears, teeth may become sensitive. They also become weaker, which puts them at risk for even more damage if patients also grind their teeth. Mouthguards worn at night may slow the process, but they won’t stop the damage.

Surprising, Unexpected Damage

Each patient’s response differs—with some creating no obvious symptoms. That happened in a situation Fairfield Medical Heartburn Center wrote about on its website. One patient discovered at a regular checkup he had a mouthful of cavities resulting from years of acid reflux.

Drew Mace’s primary care doctor had prescribed medication, but it only masked the burning symptoms. Regurgitated acid was still wreaking havoc on his mouth and body.

His dentist referred him to Fairfield Medical Heartburn Center. Obesity, pregnancy, smoking, and certain medications are risk factors for reflux. However, Mr. Mace was fit, showing that anyone can suffer from GERD.

“GERD is very common, and the condition and symptoms affect 20 percent of the U.S. population,” Fairfield Medical Heartburn Center Nurse Coordinator Tonya Mundy said in the article. “People of any age can develop GERD.”

In fact, testing revealed that Mr. Mace had a hiatal hernia, a condition that can cause the stomach to bulge through the diaphragm and into the chest, as well as a weakening of the esophagus. He opted for a hernia surgery that completely resolved his reflux.

Gut–Mouth Connection

Mechanical problems are one of many root causes. A great number of patients suffering from GERD have distinct microbial makeups that are suspected to be causal and are the subject of research.

Stomach acid levels are largely regulated by the gut microbiome, the community of bacteria, viruses, and fungi that reside along the gastrointestinal tract, mostly in the colon. Bacterial overgrowth is suspected to cause an overproduction of acid.

A 2021 study in Surgical Endoscopy noted that intestinal dysbiosis, or unhealthy ratios of good and bad microbes, is associated with GERD. Small intestinal bacterial overgrowth, which causes gas and bloating, may be contributing to reflux, it concluded.

Ms. Ripin worked with one patient who experienced erosion so severe that she required dentures. When Ms. Ripin told her about the role acid may have played in the destruction of her teeth, the patient admitted that she had struggled with her gut health for quite some time.

“Through a combination of specific microbial testing, custom prebiotics and probiotics, and nutritional counseling, she was able to better manage the discomfort she now understood to be from too much stomach acid,” Ms. Ripin said.

Whether patients suspect that they suffer from acid reflux, certain lifestyle behaviors can help limit the likelihood of even occasional bouts of it.

Some tips Ms. Ripin suggested to improve gut microbial balance:

• Eat a variety of foods to increase the variety of gut microbes, which are shown to be protective against many diseases.
• Eat more fermented foods full of probiotics including yogurt, sauerkraut, kombucha, and kimchi. (If you don’t take or eat probiotics, it’s best to start with very small servings.)
• Limit antibiotics when possible, because they wipe out good bacteria and require a rebuilding of the microbiome.
• Consider using digestive enzymes and/or drinking apple cider vinegar diluted in water before meals.
• Don’t eat for three hours before going to bed.
• Raise the head of your bed with wood placed under the feet.
• Limit or quit drinking alcohol and caffeine which relax the lower esophageal sphincter valve that keeps acid out of the esophagus.