Laryngopharyngeal reflux, gastroesophageal reflux and dental disorders: A systematic review.

Jerome R Lechien,Christian Calvo Henriquez,Cyril Bouland,Maria Rosaria Barillari,Andrea Nacci,Sven Saussez,Antonio Schindler,Francois Mouawad,Carlos M Chiesa-Estomba,Luigi Laino,Cyrielle Ristagno,Giovanni Cammaroto

doi:10.1371/journal.pone.0237581

Abstract

To investigate the role of gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) in the development of dental disorders. The first outcome was review of the role of reflux in the development of dental disorders in adults. The second outcome was review of the potential pathophysiological mechanisms underlying the association between reflux and dental disorders. Three investigators screened publications for eligibility and exclusion based on predetermined criteria through a literature search conducted on PubMed, Cochrane Library, and Scopus according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). From 386 publications, 24 studies were kept for analysis. Objective approaches were used in 16 studies to confirm GERD diagnosis. Pharyngeal reflux episodes (LPR) were considered in 2 studies. No study considered nonacid reflux. The study results supported a higher prevalence of dental erosion and caries in reflux patients compared with healthy individuals. Patients with dental erosion have a higher prevalence of reflux than controls. The pathophysiological mechanisms would involve changes in the saliva physiology. No study investigated the microbiota modifications related to reflux although the findings are supporting the critical role of microbiota change in the development of dental disorders. There is an important heterogeneity between studies about diagnostic methods and clinical outcome evaluation. The involvement of reflux in the development of dental disorders is not formally demonstrated and requires future investigations considering pharyngeal acid and nonacid reflux episodes and in particular their potential impact on oral microbiota.

Highlights

Laryngopharyngeal reflux (LPR) is an inflammatory condition of the upper aerodigestive tract tissues related to direct and indirect effect of gastroduodenal content reflux, which induces morphological changes in the upper aerodigestive tract [1]
Objective approaches were used in 16 studies to confirm gastroesophageal reflux disease (GERD) diagnosis
The study results supported a higher prevalence of dental erosion and caries in reflux patients compared with healthy individuals

Summary

Introduction

Laryngopharyngeal reflux (LPR) is an inflammatory condition of the upper aerodigestive tract tissues related to direct and indirect effect of gastroduodenal content reflux, which induces morphological changes in the upper aerodigestive tract [1]. The LPR is involved in the development of many otolaryngological diseases through the deposit of gastroduodenal enzymes into the mucosa of the upper aerodigestive tract. The involvement of reflux in the development of dental disorders has been suspected for several decades. Reflux would be responsible for increasing risk of oral mucosa inflammation [11], dental caries [11] and erosion [12]. The pathophysiological mechanisms underlying the development of dental disorders related to reflux are still poorly understood. Many hypotheses have been proposed including the reduction of the salivary buffering capacity or the modification of the pharyngeal/oral microbiota by acid reflux episodes [13]

Objectives

Methods

Conclusion