Do children with acid reflux have more dental problems than other children?

There is some evidence that children with paediatric acid reflux are more likely to experience several types of dental problems including: cavities, bad breath and enamel erosion. Children with acid reflux who experience frequent vomiting (daily, weekly) are especially at risk for tooth decay.

Why do children with acid reflux have more dental problems than other children?

Acid Reflux can cause the teeth to be exposed to acid due to the abnormal backwashing of stomach contents into the oesophagus and mouth. Stomach acid is very caustic and can quickly strip away the outer layer of enamel, especially on the inner surfaces of the teeth next to the tongue.
Some children with acid reflux may experience the following problems:

• Poor nutrition in infancy may lead to soft teeth.
• Frequent meals and snacks may lessen reflux symptoms but cause an increase in tooth decay.
• The child with acid reflux may favour a diet rich in carbohydrates. Unfortunately, starchy foods tend to stick on the teeth and cause decay.
• Multiple medications may be needed to treat reflux and associated complications. However, sugar is frequently added to medications and is known to cause tooth decay.
• Some medications decrease saliva, which helps to “wash” the teeth of food and irritants.
• Some children with acid reflux dislike toothbrushing due to oral sensitivity, a hyperactive gag reflex or negative oral experiences. In addition, enamel erosion can cause sensitivity and make toothbrushing unpleasant.
• Many children report that toothpaste tastes bad and they are less likely to brush their teeth effectively as a result.
• A pacifier may help with the fussiness associated with acid reflux but it can lead to problems with tooth alignment later on.
• Fluoride, a key component of dental health may be lacking.
• Going to the dentist may be traumatic for a child with oral sensitivity, a strong gag reflex, swallowing difficulties, nausea and vomiting.

What can be done to help my child with acid reflux?

There are many things parents can do.

Your child should be seen by a dentist when his/her first tooth erupts or by 12 months of age. The dentist will advise you on proper brushing and preventative dental care. As soon as your child has teeth, begin brushing or wiping the teeth every day. Talk with your pediatrician about nutrition, fluoride, vitamins and minerals to develop healthy teeth.

If your child needs frequent, small meals, minimize the amount of sugar served and wash/rinse or brush teeth after each meal. Remember to have your child rinse his/her mouth with a small amount of water or brush after taking medicine too. Some children with reflux need sealants on the surfaces of the teeth or a fluoride varnish to protect the teeth. Talk with your dentist about the best treatment for your child.

Try several kinds of toothpaste to find a flavour that is acceptable to your child with reflux. Remember, only a small dab of toothpaste is needed. Prescription brand toothpaste contains more fluoride and foams much less than regular toothpaste. Make tooth-brushing fun by providing appealing toothbrushes, cups and a low mirror so your child can see himself/herself brushing. Pretend play may allow a child to act out going to the dentist and lower stress.

Remember

• Schedule an appointment with a paediatric dentist as soon as the first tooth erupts.
• Brush or wipe teeth after meals and reflux episodes.
• Consult your child’s pediatrician about nutrition, diet and vitamins.
• Consult a pediatric dentist about proper toothbrushing and fluoride treatments.

Source: P.A.G.E.R (http://www.reflux.org)

Tooth Decay Article – (Australian Dental Journal 2002)

Children who have gastro-oesophageal reflux are prone to tooth decay and should be targeted for preventive and restorative dental care, Australian researchers say. Researchers from the University of Queensland’s dental school looked at the teeth of 52 children diagnosed with reflux and compared their teeth with those of their brothers or sisters.

The children with reflux were found to more likely have decayed permanent teeth and more severe decay than their siblings.

Sinusitis and Dental Erosions Article – (Medical College of Wisconsin Research 2000)

A review of studies by MCWR physicians suggests that gastric acid refluxed up the oesophagus may damage structures other than the oesophagus and result in various health conditions including sinus infections and eroded teeth and gums.

Recent reports indicate that acid reflux into the pharynx plays a role in the development of sinusitis in both children and adults. There was also a study showing that patients with GERD were less likely to get relief from sinus surgery. In patients with chronic sinusitis (inflammation of the sinuses), a large number of acid reflux events reach the top of the esophagus near the sinuses compared to a control group. While acid reflux probably does not reach all the way to the sinuses, it could induce inflammation of nasal mucous, blocking the sinuses. The exact cause-and-effect mechanism of acid reflux and sinusitis has not yet been established.

Many reports have suggested that regurgitated gastric acid damages the teeth. Recent evidence has strengthened the possible association of reflux and dental erosions. Dental erosions involve the loss of dental enamel by a chemical process that does not involve bacteria (such as occurs in typical teeth cavities). The prevalence of dental erosions in the general population is estimated at 2-18%, but has been reported to range between 20-55% among individuals with GERD.

GERD may also cause globus pharyngeus, a chronic sensation of a lump in the throat—without any physical findings. This can be so serious in some patients that it prevents them from eating on a regular basis, resulting in weight loss. Treatment of mild GERD typically involves over-the-counter anti-acids. More severe cases may require prescription medication, or even surgery. In addition, a new, non-operative endoscopic technique has been tested and may be appropriate for selective patients.