Journal of the Canadian Dental Association C L I N I C A L P R A C T I C E 84 February 2003, Vol. 69, No. 2 D entists are often the first health care professionals to diagnose a systemic disease through observation of its oral manifestations. One such condition is gastroesophageal reflux disease (GERD), which may be evidenced by dental erosion. Dental erosion is defined as the progressive loss of hard dental tissues caused by a chem- ical process not involving bacterial action. 1 It has been asso- ciated with ingestion of acidic foods, 2 bulimia, 3 rumination and GERD. 4 In addition to causing dental erosion, undi- agnosed and untreated GERD may also result in esophagi- tis, Barrett’s epithelium, esophageal adenocarcinoma and aspiration pneumonitis of various degrees. It is therefore important that dentists recognize GERD so that timely preventive and treatment measures can be instituted. This paper discusses the relationship between dental erosion and GERD, the prevalence and causes of these conditions, diag- nostic approaches and treatments. Dental Erosion Prevalence In a 5-year longitudinal study, 5 71% of children had erosive lesions of at least grade 1 affecting their primary dentition, and 26% had grade 2 erosions (Table 1). By 16 years of age, 12% had at least one permanent tooth with grade 1 erosion, and up to 0.2% of patients had at least one permanent tooth with grade 2 erosion. 5 Other studies have reported a similar prevalence of erosion in adults (between 5% and 16%). 6,7 It has been our observation, working in the dental department of a tertiary care facility with a catch- ment area of 10 million people, that many causes of dental erosion go unnoticed or undiagnosed in adolescence, and the problems are not identified until early adulthood, when the damage is much more severe and much more difficult to treat. Causes Erosion begins as superficial demineralization of the enamel, which can cause dissolution of the subsurface layers and eventual loss of tooth structure. Any acid with a pH below the critical pH of dental enamel (5.5) can dissolve the hydroxyapatite crystals in enamel. Gastric refluxate has a pH of less than 2.0 and thus has the potential to cause dental erosion. 8 In vitro experimental erosion has been shown to occur at an oral pH of less than 3.7. Causes of dental erosion are classified as extrinsic or intrinsic. Extrinsic causes include carbonated or acidic Dental Erosion in Gastroesophageal Reflux Disease • Robert P. Barron, DMD, BSc, FADSA • • Robert P. Carmichael, BSc, DMD, MSc, FRCD(C) • • Margaret A. Marcon, MD, FRCPC • • George K.B. Sàndor, MD, DDS, FRCD(C), FRCS(C), FACS • A b s t r a c t Dentists are often the first health care professionals to diagnose dental erosion in patients with gastroesophageal reflux disease (GERD). Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus, and GERD is defined as symptoms or complications of GER. Twenty-four-hour monitoring of esophageal pH is helpful in diagnosing GERD.Treatment of dental erosion resulting from GERD involves a multidisciplinary approach among family physician, dentist, prosthodontist, orthodontist and gastroenterologist. When possible, dental erosion should be treated with minimal intervention, and such treatment should include control of microflora, remineralization, adhesive restorations and use of biomimetic materials. MeSH Key Words: dental enamel/pathology; gastroesophageal reflux/complications; tooth erosion/etiology © J Can Dent Assoc 2003; 69(2):84–9 This article has been peer reviewed.