Watch Out for These Four Heartburn-Oral Health Links

15 Mar 2017 Normand Bach, DMD, MS
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Every day we treat patients who come to our offices with not just tooth and gum concerns but overall health issues as well. As good health practitioners, we owe it to ourselves and to our patients to approach dentistry as a general health topic.

One example of taking the broad view is understanding the relationship between heartburn and oral health. To understand why this is an important relationship for dentists to know about, watch out for these 4 heartburn-oral health links.

GERD, AKA Acid Reflux

Heartburn is a burning sensation in the chest that’s quite prevalent among Americans. It can be a symptom of cardiac problems, but the most common cause is gastroesophageal reflux disease (GERD), also known as acid reflux, which has implications for oral health.

Sadly, the percentage of the American population that suffers heartburn is increasing, although scientists aren’t certain why this is happening.1 That may mean GERD is on the rise, too. Currently, about one fifth of the US population is affected by GERD,2 and 7% of Americans experience heartburn symptoms every single day.1

If you suspect your dental patient has GERD, you’ll need to refer him or her to a physician right away for treatment.

Bad News for Tooth Enamel

Heartburn can be a sign of GERD, and it is on the rise. That means a lot of acid entering the oral cavity. For every 100 patients you see, 20 of them have GERD. While not everyone with GERD experiences heartburn, they do suffer acid reflux, and that can wreak havoc on tooth enamel. If a patient indicates heartburn either in conversation or on the screening form, pay particular attention to areas of the mouth prone to enamel erosion, such as the palatal surface of maxillary incisors.

Extreme Stress and Bruxism

Heartburn can be caused by a whole string of daily events and behavior, but one major contributor is stress.3 And as we all know, stress can cause people to begin to inflict major occlusal wear of the teeth. Both forms of bruxism, diurnal bruxism and sleep bruxism, can begin to manifest with any amount of stress. However, the levels of stress associated with heartburn are often even higher.

In any case, if a dental patient has heartburn, preventing bruxism is just another reason to think exhaustively and have a conversation about stress. You may want to evaluate your patient for temporomandibular joint disorders (TMD) while you’re at it, too.

First Responder to a Range of Conditions

Some people don’t suffer from heartburn, but they do have GERD, in which case it’s called “silent GERD.”4 People with silent GERD might not even know they have it. In such a case, you might be the first to diagnose it.

That’s because the first symptom to show up, absent heartburn, might be erosion of tooth enamel. Dentists who’ve discovered erosion on the molars and the lingual of incisors in their patients might want to have a conversation about GERD.

Any sign of extreme occlusal wear is a signal to take action with your patients, but don’t forget the possibility of GERD. Other signs might be found on the cusps. Look for major vertical loss.

GERD is only one health condition signaled by heartburn. Reminding patients to see a primary care physician if they have heartburn can help them with their overall health. 

What You Can Do

Dentists who are trained to identify possible causes of heartburn such as GERD may be able to save their patients from the expensive and inconvenient ordeal of restorations or rehabilitation. They also may provide helpful referrals to their patients who might not otherwise be aware they have health issues like GERD or stress-related conditions like TMD. Keep in mind that for some patients, you are the only healthcare professional they might see on a regular basis.

You also might think about including a question about heartburn on your patient screening forms. It’s one way to open up a conversation about dental health, but it also might remind you to be on the lookout for tooth enamel problems or even extreme wear in the tooth structure itself. It’s all part of viewing your patients from a universal paradigm, helping them lead healthier lives and adding value to your services as well.

References

  1. Carroll L. Heartburn on the rise—and scientists aren’t sure whyToday. Accessed March 8, 2017.
  2. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & facts for GER & GERD. Accessed March 8, 2017.
  3. Understanding heartburn—the basics. WebMD. Accessed March 8, 2017.
  4. Ali DA, Brown RS, Rodriguez LO, et al. Dental erosion caused by silent gastroesophageal reflux disease. J Am Dent Assoc. 2002;133:734-737. Accessed March 8, 2017.

Dr. Bach received his dental degree from the University of Montreal in 2002 and completed a certificate of multidisciplinary residency at Notre-Dame Hospital in 2003. In 2008, He completed a master’s degree of science and a certificate in orthodontics at the University of Montreal. He is currently an associate professor at the University of Montreal and is responsible for the undergraduate orthodontic clinic, in addition to maintaining a private practice limited to orthodontics in Montreal.  

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