Introduction
The treatment cost of dental disease is 4.6 percent of global healthcare costs. Dental erosions and dental caries are the predominant dental diseases affecting billions worldwide. Identifying the risk factors helps reduce the economic burden on people and the healthcare system. Laryngopharyngeal reflux, gastroesophageal reflux, and dental disorders are interconnected conditions that can significantly impact oral health.
What Is Gastroesophageal Reflux Disease (GERD)?
GERD is a disorder where stomach acids flow back into the esophagus, causing irritation and inflammation. Many individuals regularly experience a flow back of stomach contents, but the condition is termed GERD when it happens over a chronic period. It develops when the lower esophageal sphincter, a muscular ring, acts as a valve between the esophagus and stomach but does not close properly. The stomach contents sometimes contain excessive acid, which may irritate the esophagus. Patients with GERD develop symptoms like heartburn, regurgitation, chest pain, and difficulty in swallowing. If the patient develops chest pain, seeking medical care is crucial to analyze the cause.
Most people can manage GERD symptoms with lifestyle modification and medications. Rarely, surgery is advised for patients with GERD. If the symptoms of GERD remain untreated, the patients will develop complications like Barrett's esophagus, esophageal strictures, and increased esophageal cancer risk.
What Is Laryngopharyngeal Reflux?
Laryngopharyngeal Reflux (LPR) is a disorder that affects both the throat and pharynx. It is a variant of GERD. The condition is caused by gastroduodenal content reflux's direct or indirect effect, which causes morphological changes in the upper aerodigestive tract.
In Western countries, the incidence of laryngopharyngeal reflux is 10 to 30 percent. There has been a rise in disease incidence due to modern lifestyle and dietary habits. The laryngopharyngeal reflux can cause several otolaryngological diseases due to the deposition of gastroduodenal enzymes into the mucosa and upper aerodigestive tract. Due to gastric enzyme deposition, pepsin can be detected in laryngeal, hypopharyngeal, oral, nasal, tears, Eustachian mucosa, chronic media otitis, and chronic rhinosinusitis.
Individuals with LPR develop symptoms like hoarseness, chronic cough, dysphagia, chronic repetitive throat clearing, throat pain, excessive mucous production, and the sensation of a lump in the throat. Since LPR patients do not develop heartburn like GERD patients, diagnosis becomes challenging.
What Is the Association Between Laryngopharyngeal Reflux, Gastroesophageal Reflux, and Dental Disorders?
For decades, it was suspected that reflux disorder causes dental disorders. GERD and LPR induce dental diseases due to the corrosive effects of stomach acids on enamel. Saliva helps neutralize stomach acid, but when reflux is chronic, it overwhelms the mouth's natural defense. Therefore, reflux disorder increases oral inflammation (gingivitis and periodontitis), dental caries, xerostomia (dry mouth), bruxism (teeth grinding), and erosion. However, the pathological mechanism underlying dental disorder development is poorly understood.
Most studies have used GERD as a criterion to analyze the relationship between reflux disorders and dental diseases. More studies need to analyze the association between laryngopharyngeal reflux and dental diseases. Therefore, it is difficult to conclude that LPR can cause dental disorders.
Reflux Disease, Caries, and Oral Mucosal Disorder
Clinical studies observed a higher incidence of decay and missing teeth in patients with GERD. Some GERD patients even tend to develop periodontitis. The patients with reflux disease have poor oral hygiene.
Reflux Disease and Dental Erosion
Dental erosion is a common issue characterized by tooth enamel wearing. If the dental erosion remains untreated, it causes tooth sensitivity, dental caries, and loss of tooth color. According to studies, individuals with reflux disease had a 16 to 44 percent dental erosion prevalence. Gastroesophageal Reflux Disease (GERD) patients had higher dental erosion incidence than healthy individuals. Dental erosions tend to develop in both maxillary and mandibular teeth. However, the damage in the upper incisors was more significant than in the lower incisors.
Some hypothesize that reducing saliva buffering capacity or modifying oral or pharyngeal microbiota could cause acid reflux episodes. The studies state that low oral pH (potential of hydrogen) and salivary flow rate are additional factors causing dental erosions in GERD patients.
Modifying salivary function aptly describes the mechanism of developing dental disease in reflux diseases. Saliva consists of many protective factors like epidermal growth factor, mucus, and bicarbonate, modified during reflux disease.
The association between dental disease and reflux disorders is bi-directional. Dental disease contributes to reflux symptoms and vice versa. Dental disorders exacerbate the reflux disorder by altering the ability to chew food and swallow and promoting bacterial growth within the oral cavity.
How to Cure Dental Disorders Caused by Gastroesophageal and Laryngopharyngeal Reflux Disease?
Treating gastroesophageal or laryngopharyngeal reflux disease can help reduce dental symptoms. However, oral care is vital for treating the consequences of acid exposure on the teeth.
Individuals suffering from reflux disorders must modify lifestyles to control the disease. The patients are advised to change diet, manage weight, and are asked to avoid lying down after meals. Some patients are prescribed proton pump inhibitors or H2 blockers to reduce stomach acid production. Any damage to the teeth must be treated, and the patients are advised to undergo regular dental check-ups for managing and monitoring oral health.
How Can One Prevent Reflux Disease From Causing Oral Issues?
Reflux disease patients can modify diet, make lifestyle changes, and practice oral hygiene to prevent dental disorders.
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Dietary Modification: Patients must avoid food and drinks that can trigger reflux disease. Commonly avoided foods are citrus fruits, tomatoes, chocolate, caffeine, and spicy foods. Patients are advised to consume smaller and more frequent meals. Larger meals during bedtime must be avoided.
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Lifestyle Changes: Patients must sleep by elevating the head side of the bed to prevent acid from flowing back to the esophagus. Maintaining a healthy weight through exercise and diet can reduce reflux disease incidence.
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Oral Care: Patients with reflux disease must brush and floss daily to prevent cavities. The patients can use toothpaste and mouthwash containing fluoride to strengthen enamel. If the patient notices any sign of dental decay, they must seek dental care at the earliest.
Conclusion
The laryngopharyngeal and gastroesophageal reflux disease are disorders that cause the stomach contents to flow back into the esophagus. The acids from the stomach induce demineralization of the enamel, increasing susceptibility to caries and tooth sensitivity. Although reflux disease is a known risk factor for inducing dental disorders, there is a lack of substantiated research proving the same.
