Longitudinal study of gastroesophageal reflux and erosive tooth wear

Clive H Wilder-Smith,Adrian Lussi,Andrea Materna,Lukas Martig

doi:10.1186/s12876-017-0670-1

Abstract

BackgroundApproximately 60% of patients presenting to dentists with erosive tooth wear have significant gastroesophageal reflux (GERD), despite minor reflux symptoms. No longitudinal studies of reflux-associated erosive tooth wear and of reflux characteristics have been reported to date.The aim of this study was to characterize the longitudinal course of GERD and of associated erosive tooth wear, as well as factors predictive of its progression, in a large group of patients.MethodsSeventy-two patients presenting to dentists with clinically significant erosive tooth wear and increased esophageal acid exposure by 24-h multichannel intraluminal pH-impedance measurement (MII-pH) were re-assessed clinically and by MII-pH after 1 year treatment with esomeprazole 20 mg twice-daily. Predictive factors for erosive tooth wear were assessed by logistic regression.ResultsAt follow-up, no further progression in erosive tooth wear was observed in 53 (74%) of patients. The percentage of time with a pH < 4, the number of acid reflux episodes and the percentage of proximal esophageal reflux off-PPI did not change significantly after one year, but the number of weakly acidic reflux episodes decreased significantly in the large subgroup without progression. None of the baseline demographic, clinical, endoscopic or esophageal acid exposure characteristics were significantly associated with progression of erosive tooth wear at follow-up.ConclusionsIn this longitudinal study in patients with erosive tooth wear and oligosymptomatic GERD receiving esomeprazole for one year, erosive tooth wear did not progress further in the majority of patients. Background acidic esophageal reflux exposure appeared stable over time, whereas weakly acidic exposure decreased significantly in patients without erosion progression. MII-pH measurements on-PPI and with healthy controls will be useful in the further elucidation of the causal role of reflux in erosive tooth wear.Trial registrationClinicalTrials.gov, retrospectively registered: NCT02087345.

Highlights

60% of patients presenting to dentists with erosive tooth wear have significant gastroesophageal reflux (GERD), despite minor reflux symptoms
To the best of our knowledge, no systematic study relating to the prevention of progression of erosive tooth wear caused by Gastroesophageal reflux (GERD) has been reported, except a small pilot project examining optical coherence tomography as a tool for quantifying dental reflux damage [6]
In this article we present single-centre, follow-up data regarding GERD characteristics using MII-pH and erosive tooth wear progression in a large cohort of patients receiving standardised pump inhibitor (PPI) treatment, based on the hypothesis that reflux would not significantly change over time and that standard PPI doses would prevent further progression of erosions

Summary

Introduction

60% of patients presenting to dentists with erosive tooth wear have significant gastroesophageal reflux (GERD), despite minor reflux symptoms. The aim of this study was to characterize the longitudinal course of GERD and of associated erosive tooth wear, as well as factors predictive of its progression, in a large group of patients. The chemical dissolution of enamel without bacterial involvement, is considered an established complication of gastroesophageal reflux (GERD) [1] It is caused by repeated episodes of exposure to acid and is influenced by chemical (e.g. salivary buffering effects, pH, fluoride,) and physical (temperature, flow rate) factors [2]. As dental erosion commonly occurs in Wilder-Smith et al BMC Gastroenterology (2017) 17:113 gastroesophageal reflux in the majority [5] This further substantiated the frequent association between GERD and erosive tooth wear, after exclusion of other causes of erosion, such as frequent vomiting, increased ingestion of acidic food or drink and bruxism. Predictive factors for the progression of erosions were investigated

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