Gastroesophageal reflux (shortened as GER) is a phenomenon characterized by the passage of the content of gastric juice into the esophagus of humans. The symptoms and complication associated with the passage of these juices along the esophagus cause the gastroesophageal reflux disease (GERD) (Hyung & Ja Park, 2013). On major occasions, the most common manifestation is the progressive and irreversible loss of the tooth surface characterized by the hard tissue found on the outer surfaces of the teeth. This loss is triggered and maintained by a constant release and flow of chemicals in the gastric juice and not as a result of any bacterial infection (Hyung & Ja Park, 2013). On many occasions, this condition is also referred to as dental erosion and is easily detected. Intensive research has tried to unveil various issues related to the disease and prevent teeth erosion from occurring. His study adds to the existing research to try and unveil the simple connection between GERD and periodontitis (Song, Kim, Cho & Kim, 2014). Various issues have been researched regarding the two conditions with an aim to promote an illustrative understanding of the same. The study reviews a wide array of literature to help unveil these insights discussed in this report.
Jun, Hyung, Eun, & Tae (2014) study attempts to emphasize the obvious fact that the most common factor behind the occurrence of periodontitis is poor hygiene on the oral systems of the affected persons. However, since gastroesophageal reflux disease (GERD) facilitates the proximal transfer of the chemicals-rich gastric juice contents across the esophagus, it is purported to be the major contributor to poor dental maintenance and cleaning systems. As a result, Jun, Hyung, Eun, & Tae (2014) study hypothesized the role of GERD in increasing the risk of chronic periodontitis to be positively correlated and the relationship investigated. The study considered GERD present in an individual based on two criteria: the presence of certain identifiable signs as well as symptoms of the transfer of the gastric juice across the path, the presence of certain etiological agents and persistent and consistent alterations on the anatomic perspectives of the persons. The study adopted a retrospective cross-sectional assessment of a sample of 280 patients in outpatient unit diagnosed with chronic periodontitis and another 280 controls. The study established that GERD has independently increased the risks of occurrence of periodontitis (odds ratio = 2.883 at 95% confidence level). As a result, the study concluded that GERD is a prominent risk factor for the occurrence of chronic periodontitis in individuals.
In their study, Sarbin, John & Roger (2012) reviewed a wide array of articles to establish the various mechanisms associated with the processes involved in the occurrence of gastroesophageal reflux disease and the connection of these processes with the occurrence of periodontitis condition in humans. The study described some of the most common and obviously disastrous processes responsible for causing chronic periodontitis in the affected individuals. The study discussed the channels of transfer of the various chemicals, their impacts on the transfer paths and how these chemicals lead to the development of periodontitis in the affected individuals. According to Sarbin, John & Roger (2012) processes compilation, the excess gastric and duodenal stimulations and reduction in the effectiveness of the protective processes often lead to the occurrence of periodontitis in the persons. For instance, an inadequate saliva production in the oral cavity may result in adverse effects on the esophageal and extraesophageal conditions.
Particularly, the GERD associated with sleep, for instance, is considered insidious to the effects due to its connection with the reduction in the proximal flow of various contents of the gastric juice as well as the saliva juice. Due to these, the gastric juice displaces the saliva from the surfaces of the teeth easily. Following these displacements, the proteolytic pepsin in the juice then acts to remove the protective surface of the teeth known as the dental pellicle. The study further concluded that the insidious production of acids connected to teeth erosion can be managed medically to help prevent and control the occurrence of periodontitis in the affected patients (Song, Kim, Cho & Kim, 2014).
Pace, Pallotta, Tonini Vakil & Bianchi (2008) reviewed the existing literature with an aim to assess the connectivity between dental erosion (periodontitis) and the processes associated with GERD. Relying on the Medline and Cochrane Controlled Trials Register to identify the articles for systematic review, the study identified a total of 17 articles which met the classification criteria sufficiently. The median prevalence of dental erosion in GERD patients reported in the reviewed articles was 24% with a wide range of between 5 and 47.5%. Also, the median prevalence of GERD in patients diagnosed with DE as reported in the literature was 17%, also with a large range of between 14% and 87%. According to the review, children diagnosed with GERD were found to be more at risk of developing dental erosion compared to the adults in the majority of the literature reviewed. Besides, the controls (healthy individuals not diagnosed with the disease-GERD) were found to be at the lowest levels of risks regarding developing DE.
Conclusively, therefore, the review established a strong correlation between GERD and dental erosion in the affected patients. On the other hand, the levels of severity of DE in GERD patients also seemed to differ significantly with the intensity of the symptomatic expression of the disease. In adult samples, for instance, the severity of the DE was associated with the intensity of the acidic pH in the secreted gastric fluids. Owing to these noted correlations, the study recommended a regular and constant inspection of the oral cavity of patients diagnosed with GERD as a means to manage and prevent the occurrence of dental erosion in them.
Shahzad (2015) study assessed the relationship between GERD and DE in patients diagnosed with the disease to surge a means for a collaborative approach between the dentists and gastroenterologists in preventing and combating the occurrence of the two conditions. Using a patients section from the Punjab Dental Hospital in Lahore, Pakistan, the study examined the permanent incisors and permanent molars of the patients to derive the effects of GERD on them. The patients were classified into three main categories depending on their ages (6-12, 13-18 and 19-90 for groups I to III respectively) to unveil the prevalence of the conditions in patients of different age-groups. The surfaces of each tooth described previously were examined, and the correlations described using the SPSS software. The results affirmed the correlation between GERD and DE thus asserting the purported derivation that the dentists and gastroenterologists ought to work together to help diagnose prevent and manage the occurrence and persistence of DE in GERD patients.
Other studies have also investigated different aspects relating the occurrence of DE in patients diagnosed with GERD under various circumstances. For instance, Munoz et al. (2003) effects of gastro-oesophageal reflux disease on dental as well as periodontal lesions. Noting the prevalence of dental erosion, an extraesophageal expression of the GERD, in children and adults, Munoz et al. (2003) investigated the prevalence of the periodontal and dental lesions as expressed in patients diagnosed with GERD. The study assessed some 253 patients. The study sample group consisted of 181 patients and a control group consisting of 72 volunteers not diagnosed with the condition. Like in the previous studies Munoz et al (2003) evaluated the presence as well as the number of dental erosion occurrence in the individuals, the location of the erosion and their severity, assessment of the samples’ dental conditions using CAO index and status of the periodontal determined by observing the plaque index, the gingival recessions and the plaque index. To contrast the occurrence of these conditions in relation to other causative agents, the study also assessed other factors such as the victims, body mass indices, and alcohol and tobacco consumption levels. The goal of investigating these effects was to determine the differences in expressional characteristics of dental erosion in the examined patients. Unlike the previous studies, this study concluded otherwise, asserting to the fact that owing to the similarities between the expressional characteristics of the dental erosion in patients with GERD and those with a history of smoking and alcoholism, there was no evidence that GERD would possibly have resulted to the occurrence of dental erosion in the individuals.
To conclude, it is good to reiterate at this point that gastroesophageal reflux (GER) is a normally occurring condition in humans and which occurs for about one hour following completion of eating as a postprandial process. The process involves a smooth and efficient flow of gastric juice contents right into the human esophagus. An episode of the GER is evident when the pH of the esophagus drops below 4.0 for about 30 minutes. The GER process can advance to a clinical disorder referred to as the gastroesophageal reflux disorder (GERD) characterized by symptoms such as heartburns as well as a regurgitation of acid. In the event of the GERD occurrence, the chemical content of the GER often results in erosion of the outer surfaces of the teeth, thereby leading to a condition referred to as periodontitis. Even though some studies finds no connection between periodontitis caused as a result of GERD and those caused as a result of other causative agents such as smoking, alcoholism, etc., research points to the association between the two. A collaborative treatment between the dentists and the gastroenterologists is therefore recommended regarding diagnosis, management, and treatment of the disease.
Hyung, H.K., & Ja Park, S., (2013). Tu1192 Correlation between Gastroesophageal Reflux Disease and Chronic Periodontitis. American Gastroenterological Association, 114(5): S-786.
Jun, Y.S., Hyung, H.K., Eun, J.C., & Tae, Y.K., (2014). The Relationship between Gastroesophageal Reflux Disease and Chronic Periodontitis. Gut and Liver, 8(1): 35-40.
Munoz, J.V., et al. (2003). Dental and periodontal lesions in patients with gastro-oesophageal reflux disease. Digestive and Liver Disease, 35(2003): 461-467
Pace, F., Pallotta, S., Tonini, M., Vakil, N., & Bianchi, P.G., (2008). Systematic review: gastro-oesophageal reﬂux disease and dental lesions. Alimentary Pharmacology & Therapeutics, 27, 1179–1186. Doi:10.1111/j.1365-2036.2008.03694.x
Sarbin, R., John, A.K., & Roger, J.S., (2012). Gastroesophageal Reﬂux Disease and Tooth Erosion. Review Article. International Journal of Dentistry, 2012, 1-11. Doi:10.1155/2012/479850.
Shahzad, A.S., (2015). Gastroesophageal Reflex Disease (GERD) and Dental Erosion. Pakistan Oral & Dental Journal, 35(1): 135- 139.
Song, J. Y., Kim, H. H., Cho, E. J., & Kim, T. Y. (2014). The Relationship between Gastroesophageal Reflux Disease and Chronic Periodontitis. Gut and Liver, 8(1), 35–40. http://doi.org/10.5009/gnl.2014.8.1.35