Reviews the most common and serious medical conditions that are linked to erosive tooth wear.
Indicates that there is a clear benefit to patients from the dental team picking up on the early signs of these conditions, which may be very subtle and difficult to detect.
Suggests that the dental examination should include the possibility of detecting signs of GORD and eating disorders and if detected appropriate referral and liaison with medical professional instigated.
Discusses how such detection could protect the enamel from erosive wear and more importantly may even lead to saving the patient's life.
There are many reasons why it is vital that dental professionals identify signs and symptoms that suggest that an individual's erosive tooth wear (ETW) may be linked to a broader medical problem than just poor diet. Primarily, spotting an underlying medical cause for ETW increases the likelihood that further deterioration in the individual's oral health will be prevented. However, perhaps more importantly, many of the medical conditions which are commonly related to ETW can have serious and even possibly fatal consequences if left untreated or not diagnosed. This paper reviews the nature of the most common and serious medical conditions related to ETW, such as gastro-oesophageal reflux disease (GORD), laryngo-pharyngeal reflux (LPR) and eating disorders. This article also covers the role of the dental team in the diagnoses, prevention and management of these conditions.
Subscribe to Journal
Get full journal access for 1 year
only $20.79 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Dent J, El-Serag H, Wallander M A, Johansson S . Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2005; 54: 710–717.
Vakil N, Van Zanten S, Kahrilas P, Dent J, Jones R . The Montreal definition and classification of gastroesophageal reflux disease: a global, evidence-based consensus paper. Z Gastroenterol 2007; 45: 1125–1140.
Meyer G, Austin R, Brady III C, Castell D . Muscle anatomy of the human esophagus. J Clin Gastroenterol 1986; 8: 131–134.
Demeester T R, Johnson L F, Joseph G J, Toscano M S, Hall A W, Skinner D B . Patterns of gastroesophageal reflux in health and disease. Annals of surgery. 1976; 184: 459.
Koufman J A, Aviv J E, Casiano R R, Shaw G Y . Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg 2002; 127: 32–35.
Koufman J A . Laryngopharyngeal reflux is different from classic gastroesophageal reflux disease. Ear Nose Throat J 2002; 81: 7.
Chandra A, Moazzez R, Bartlett D, Anggiansah A, Owen W . A review of the atypical manifestations of gastroesophageal reflux disease. Int J Clin Pract 2004; 58: 41–48.
Bennett J . Heartburn and gastro-oesophageal reflux. Br J Clin Pract 1990; 45: 273–277.
Irwin R S, French C L, Curley F J, Zawacki J K, Bennett F M . Chronic cough due to gastroesophageal reflux: clinical, diagnostic, and pathogenetic aspects. Chest 1993; 104: 1511–1517.
Chernow B, Johnson L F, Janowitz W R, Castell D O . Pulmonary aspiration as a consequence of gastroesophageal reflux. Dig Dis Sci 1979; 24: 839–844.
Irwin R S, Madison J M . Anatomical diagnostic protocol in evaluating chronic cough with specific reference to gastroesophageal reflux disease. Am J Med 2000; 108: 126–130.
Field S K . Gastroesophageal reflux and respiratory symptoms. Chest 1999; 116: 843.
Smit C F, van Leeuwen J A, Mathus-Vliegen L M et al. Gastropharyngeal and gastroesophageal reflux in globus and hoarseness. Arch Otolaryngol Head Neck Surg 2000; 126: 827–830.
Bartlett D, Evans D, Smith B . The relationship between gastro-oesophageal reflux disease and dental erosion. J Oral Rehabil 1996; 23: 289–297.
Meurman J H, Toskala J, Nuutinen P, Klemetti E . Oral and dental manifestations in gastroesophageal reflux disease. Oral Surg Oral Med Oral Pathol 1994; 78: 583–589.
Gudmundsson K, Kristleifsson G, Theodors A, Holbrook W P . Tooth erosion, gastroesophageal reflux, and salivary buffer capacity. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 1995; 79: 185–189 Z.
Bartlett D, Evans D, Anggiansah A, Smith B . A study of the association between gastro-oesophageal reflux and palatal dental erosion. Br Dent J 1996; 181: 125–131.
Moazzez R, Bartlett D, Anggiansah A . Dental erosion, gastro-oesophageal reflux disease and saliva: how are they related? J Dent 2004; 32: 489–494.
Schroeder P L, Filler S J, Ramirez B, Lazarchik D A, Vaezi M F, Richter J E . Dental erosion and acid reflux disease. Ann Intern Med 1995; 122: 809–815.
O'Sullivan E A, Curzon M E, Roberts G J, Milla P J, Stringer M D . Gastroesophageal reflux in children and its relationship to erosion of primary and permanent teeth. Eur J Oral Sci 1998; 106: 765–769.
Gregory-Head B, Curtis D A . Erosion caused by gastroesophageal reflux: diagnostic considerations. J Prosthodont 1997; 6: 278–285.
Barrett N . Chronic peptic ulcer of the œophagus and œsophagitis. Br J Surg 1950; 38: 175–182.
Naini B V, Souza R F, Odze R D . Barrett's esophagus: a comprehensive and contemporary review for pathologists. Am J Surg Pathol 2016; 40: e45–e66.
Choi J Y, Jung H-K, Song E M, Shim K-N, Jung S-A . Determinants of symptoms in gastroesophageal reflux disease: nonerosive reflux disease, symptomatic, and silent erosive reflux disease. Eur J Gastroenterol Hepatol 2013; 25: 764–771.
Klauser A G, Heinrich C, Schindlbeck N E, Müller-Lissner S A . Is long-term esophageal pH monitoring of clinical value? Am J Gastroenterol 1989; 84: 362–366.
Blondeau K, Tack J . Usefulness of impedance testing in the management of GERD. Am J Gastroenterol 2009; 104: 2664–2666.
Sweis R, Fox M, Anggiansah A, Wong T . Prolonged, wireless pH-studies have a high diagnostic yield in patients with reflux symptoms and negative 24-h catheter-based pH-studies. Neurogastroenterol Motil 2011; 23: 419–426.
Dent J, Vakil N, Jones R, Bytzer P et al. Accuracy of the diagnosis of GORD by questionnaire, physicians and a trial of proton pump inhibitor treatment: the Diamond Study. Gut 2010; 59: 714–721.
Bardhan K D, Strugala V, Dettmar P W . Reflux revisited: advancing the role of pepsin. Int J Otolaryngol 2011; 646901.
Reulbach T R, Belafsky P C, Blalock P D, Koufman J A, Postma G N . Occult laryngeal pathology in a community-based cohort. Otolaryngol Head Neck Surg 2001; 124: 448–450.
Marshall R E, Anggiansah A, Owen W A, Manifold D K, Owen W J . The extent of duodenogastric reflux in gastro-oesophageal reflux disease. Eur J Gastroenterol Hepatol 2001; 13: 5–10.
Chapman D B, Rees C J, Lippert D, Sataloff R T, Wright S C . Adverse effects of long-term proton pump inhibitor use: a review for the otolaryngologist. J Voice 2011; 25: 236–240.
Dunbar K B, Agoston A T, Odze R D et al. Association of acute gastroesophageal reflux disease with esophageal histologic changes. JAMA 2016; 315: 2104–2112.
Lazarus B, Chen Y, Wilson F P et al. Proton pump inhibitor use and the risk of chronic kidney disease. JAMA Intern Med 2016; 176: 238–246.
Moazzez R, Bartlett D, Anggiansah A . The effect of chewing sugar-free gum on gastro-esophageal reflux. J Dent Res 2005; 84: 1062–1065.
Smoak B R, Koufman J A . Effects of gum chewing on pharyngeal and esophageal pH. Ann Otol Rhinol Laryngol 2001; 110: 1117–1119.
Carpenter G, Cotroneo E, Moazzez R et al. Composition of enamel pellicle from dental erosion patients. Caries Res 2014; 48: 361–367.
Wang G-R, Zhang H, Wang Z-G, Jiang G-S, Guo C-H . Relationship between dental erosion and respiratory symptoms in patients with gastro-oesophageal reflux disease. J Dent 2010; 38: 892–898.
Gregory-Head B L, Curtis D A, Kim L, Cello J . Evaluation of dental erosion in patients with gastroesophageal reflux disease. J Prosthetic Dent 2000; 83: 675–680.
Bartlett D, Evans D, Anggiansah A, Smith B . The role of the esophagus in dental erosion. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 2000; 89: 312–315.
Marsicano J A, de Moura-Grec P G, Bonato R C, de Carvalho Sales-Peres M, Sales-Peres A, de Carvalho Sales-Peres S H . Gastroesophageal reflux, dental erosion, and halitosis in epidemiological surveys: a systematic review. Eur J Gastroenterol Hepatol 2013; 25: 135–141.
O'Toole S, Bartlett D, Moazzez R . Efficacy of sodium and stannous fluoride mouthrinses when used before single and multiple erosive challenges. Aus Dent J 2016; 61: 497–501.
O'Toole S, Mistry M, Mutahar M, Moazzez R, Bartlett D . Sequence of stannous and sodium fluoride solutions to prevent enamel erosion. J Dent 2015; 43: 1498–1503.
Dahl B L, Krogstad O, Karlsen K . An alternative treatment in cases with advanced localized attrition. J Oral Rehabil 1975; 2: 209–214.
Dahl B, Krogstad O . Long-term observations of an increased occlusal face height obtained by a combined orthodontic/prosthetic approach. J Oral Rehabil 1985; 12: 173–176.
Robb N, Smith B, Geidrys-Leeper E . The distribution of erosion in the dentitions of patients with eating disorders. Br Dent J 1995; 178: 171–175.
Milosevic A . Tooth surface loss: Eating disorders and the dentist. Br Dent J 1999; 186: 109–113.
Williamson D A, Martin C K, Stewart T . Psychological aspects of eating disorders. Best Pract Res Clin Gastroenterol 2004; 18: 1073–1088.
UK Government. Eating disorders: Types, causes, who's affected, treatment. NHS Choices Your health, your choices. Available online at http://www.nhs.uk/conditions/eating-disorders/pages/introduction.aspx (accessed Feb 2018).
Russell G . Bulimia nervosa: an ominous variant of anorexia nervosa. Psychol Med 1979; 9: 429–448.
PricewaterhouseCoopers. The costs of eating disorders: Social, health and economic impacts. Assessing the impact of eating disorders across the UK on behalf of BEAT. PricewaterhouseCoopers LLP, 2015.
National Institute for Health and Care Excellence. Eating disorders: recognition and treatment (NG69). 2017.
Scheutzel P . Etiology of dental erosion – intrinsic factors. Eur J Oral Sci 1996; 104: 178–190.
Hellström I . Oral complications in anorexia nervosa. Eur J Oral Sci 1977; 85: 71–86.
Rytomaa I, Jarvinen V, Kanerva R, Heinonen O P . Bulimia and tooth erosion. Acta Odontol Scand 1998; 56: 36–40.
Moazzez R V, Austin R S, Rojas-Serrano M et al. Comparison of the possible protective effect of the salivary pellicle of individuals with and without erosion. Caries Res 2014; 48: 57–62.
Gilmour A, Beckett H . The voluntary reflux phenomenon. Br Dent J 1993; 175: 368–372.
About this article
Cite this article
Moazzez, R., Austin, R. Medical conditions and erosive tooth wear. Br Dent J 224, 326–332 (2018). https://doi.org/10.1038/sj.bdj.2018.166
Acta Odontologica Scandinavica (2020)
Clinical Oral Investigations (2019)
Journal of Dentistry (2019)
High serum ferritin levels are associated with a reduced periodontium in women with anorexia nervosa
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity (2019)