Effects of gastroesophageal reflux on the oral cavity.

The effects of chronic exposure of the oral cavity to gastric acid can be many and varied. Soft tissue symptoms (nonspecific burning and sensitivity) have been mentioned in the literature, but pathognomonic soft tissue lesions have not been documented. Dental erosion can be considered to be the predominant oral manifestation of gastroesophageal reflux disease. Erosion begins with subtle changes in the surface enamel and can progress to severe loss of tooth substance. Because the causes of such tooth lesions may be multifactorial, combining the effects of erosion, attrition, and abrasion and because of the subtle changes present in the beginning stages of such lesions, diagnosis may be difficult. Although the basic mechanism of erosion in gastroesophageal reflux patients is the dissolution of enamel and dentin due to acid exposure, a multitude of other factors can modify the effects of gastric acid. Salivary parameters, in particular, may play an important role in affecting oral pH after reflux episodes. Once dental erosion is diagnosed, thorough evaluation is necessary to document the extent of damage and to detect a cause, which may have both intrinsic and extrinsic components. Treatment goals include eliminating the causes of acid exposure, preventing the effects of acid exposure when it is not controllable, treating symptoms of soft tissue irritation and dental erosion, and restoring the dentition to an esthetically and functionally acceptable level.

Dental evaluation in bone marrow transplantation.

In the case presented, thorough radiographic and clinical examinations would have precluded misinforming the patient and prevented a six-week delay of the bone marrow transplant. The patient's ill feeling was generated because of confusion about the recommended dental treatment. This was unfortunate, given the considerable physical and emotional stress that these patients endure under the best of circumstances. Because of the severity of immunosuppression before and (for three months) after transplantation, and the life-threatening nature of oral infection, elimination of oral infection is paramount for successful BMT. This can only be achieved by adequate diagnosis and prompt, aggressive dental treatment.

Dental erosion and acid reflux disease.

OBJECTIVE: To determine the relation between gastroesophageal reflux disease and dental erosion using ambulatory 24-hour esophageal pH testing. DESIGN: Cross-sectional observational study. SETTING: Tertiary referral center. PATIENTS: The dental group consisted of 12 patients with idiopathic dental erosion who were identified by dentists and screened for gastroesophageal reflux disease using 24-hour pH testing. The gastroenterology group consisted of 30 patients who had 24-hour pH testing in the esophageal laboratory and who were referred for dental evaluation (10 did not have reflux, 10 had distal reflux, and 10 had proximal reflux). MEASUREMENTS: 24-hour esophageal pH monitoring using a pH probe in the distal and proximal esophagus. Complete dental examination with particular attention to the presence and severity of dental erosion; plaque; gingival damage; and decayed, missing, and filled teeth. Analysis of saliva for pH, flow rates, buffering capacity, and calcium and phosphorus levels. Standardized questionnaire to ascertain possible causes of dental erosion and presence of reflux symptoms. RESULTS: Ten of the 12 patients in the dental group (83% [95% CI, 52% to 98%]) had gastroesophageal reflux on esophageal pH monitoring. Nine had distal and 7 had proximal reflux. Seven had reflux in the upright position only, 1 had reflux in the supine position only, and 2 had both upright and supine reflux. No saliva abnormalities were found. Ten patients had typical symptoms of gastroesophageal reflux, but dietary or mechanical problems that may have been causing dental erosion were not identified. In the gastroenterology group, upright reflux was seen in 5 of the 10 patients with distal reflux and in all 10 patients with proximal reflux. In addition, 40% of patients in the gastroenterology group (12 of 30) had dental erosion (4 of the 10 with distal reflux [40%], 7 of the 10 with proximal reflux [70%], and only 1 of the 10 without reflux [10%]; P = 0.02 for those with reflux compared with those without reflux). The cumulative dental erosion score correlated with proximal upright reflux when all 24 study patients with erosion were analyzed (r = 0.55 [P < 0.01]); this correlation was even stronger in the subgroup of 12 patients with abnormal amounts of proximal upright reflux (r = 0.84 [P = 0.001]). CONCLUSION: Dental erosion is a common finding in patients with gastroesophageal reflux disease and should be considered an atypical manifestation of this disease.

Radiographic evaluation of occlusal caries: effect of training and experience.

The purpose of this study was to investigate what effect differing levels of didactic education and clinical experience have on the ability to diagnose occlusal caries from radiographs. Freshman and senior dental students and dental school faculty were asked to evaluate bitewing radiographs for the presence of occlusal caries and for a recommendation for restorative treatment. The agreement between histologic and radiographic diagnosis was assessed by calculating sensitivity, specificity, accuracy, and interexaminer agreement. It was concluded that dental students and faculty did differ in their abilities to evaluate radiographs for occlusal caries, and that education and clinical experience especially affected interexaminer agreement.

Shear bond strengths of composite to chlorhexidine-treated enamel.

This study determined the shear bond strength (SBS) of composite bonded to chlorhexidine-treated enamel and untreated enamel. Fifty human molars were mounted in cold- cure acrylic and the superficial enamel of the buccal or lingual surface was exposed using 600-grit silicon carbide paper. During the experimental protocol, the control group (n = 25) and the experimental group (n = 25) were stored in distilled water at 37 degrees C. The experimental group was immersed in 0.12% chlorhexidine gluconate for 1 minute, 4 times daily, for 7 days. Prisma APH composite was then bonded to all samples following acid etching for 30 seconds, and the SBS was determined. Shear bond strengths for the control (13.23 +/- 3.22 MPa) and the experimental (13.67 +/- 4.59 MPa) groups were not significantly different using a t-test. The result may be attributed to either a lack of effect of chlorhexidine or to the acid etch which dissolves the affected superficial enamel leaving an unaffected substrate for bonding.

Tooth erosion: an unusual case.

A case of tooth erosion due to prolonged exposure to acidic pool water has been presented. Dentists and swimmers must be aware of the detrimental dental effects associated with prolonged exposure to improperly maintained pool water, and what measures can be taken to prevent such effects.