Saturday, March 29, 2008

Reflux patients at increased risk of dental problems

F. PACE, S. PALLOTTA, M. TONINI, N. VAKIL, G. BIANCHI PORRO (2008)
Systematic review; gastroesophageal reflux disease and dental lesions.
doi:10.1111/j.1365-2036.2008.03694.x

Background: Dental erosion (DE), which is the irreversible loss of tooth substance that does not involve bacteria ranging from a minimal loss of surface enamel to the partial or complete exposure of dentin by a chemical process, is acknowledged as an established extraesophageal manifestation of Gastroesophageal reflux (GERD). However, the real impact of GERD in the genesis of this lesion is unclear.

Aims: To review the existing literature in order to assess the relationship between DE and GERD.

Methods: Studies that assessed the prevalence of DE in individuals with GERD or viceversa were identified in Medline and the Cochrane Controlled Trials Register via a systematic research strategy

Results: 17 studies met the selection criteria. Studies however differed greatly as far as design, population methods of diagnosing GERD, duration of follow-up and consequently findings. The median prevalence of DE in GERD patients was 24%, with a large range (5% - 47.5%), and the median prevalence of GERD in DE adults patients was 32.5% (range: 21%-83%) and in pediatric population 17% (range: 14%-87%).

Children with GERD are found by the majority of studies at increased risk of developing dental erosions in comparison with healthy subjects, as are intellectually disabled people.

Conclusion: This systematic review shows that there is a strong association between GERD and DE. The severity of dental erosions seems to be correlated with the presence of GERD symptoms, and also, at least in adults, with the severity of proximal esophageal or oral exposure to an acidic pH. The inspection of the oral cavity in search for dental erosions should become a routine manoeuvre in patients with GERD.

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