Gastrointestinal conditions related to tooth wear

Abstract

Gastro-oesophageal reflux disease (GORD) is a relatively common condition that occurs in adults and less commonly in children. It develops when the reflux of stomach contents into the oesophagus causes troublesome symptoms and/or complications. Signs and symptoms include heartburn, retrosternal discomfort, epigastric pain and hoarseness, dental erosion, chronic cough, burning mouth syndrome, halitosis and laryngitis. A proportion of patients will, however, have silent reflux. Strongly associated risk factors include family history, age, hiatus hernia, obesity and neurological conditions, such as cerebral palsy. There are different treatment options which may be considered for GORD, consisting of conservative, medical and surgical therapy. Dentists should be aware of the symptoms of GORD and dental signs of intrinsic erosion indicative of possible GORD so that they can question patients about this and, if appropriate, initiate a referral to a general medical practitioner.

Fig. 1

Showing incisal edge wear and buccal wear exposing yellow dentine, with lack of dento-alveolar compensation likely due to the rapid onset

Fig. 2

Showing maxillary wear on palatal surfaces, change in occlusal morphology, proud restoration, exposure of dentine with enamel peripheral ring and visualisation of pulp chamber

Fig. 3

Mandibular wear, showing change in occlusal morphology, hollows and concavities, proud restorations and exposure of dentine

Fig. 4

A closed lower oesophageal sphincter, retaining gastric contents in situ

Fig. 5

An open lower oesophageal sphincter, allowing retrograde passage of gastric contents

Fig. 6

A tight peptic stricture (caused by long-term acid exposure) at the lower oesophageal sphincter region

Fig. 7

Barrett's oesophagus of the lower oesophagus, a premalignant condition caused by long-term acid exposure

Fig. 8

Grade A oesophagitis caused by excess acid exposure within the lower oesophagus