30 One systematic review determined that the mean prevalence of erosion in adult patients with GERD was 32.5% (range: 21-83%) and 17% among children with GERD (range: 14-87%). Prevalence rates of GERD across all age groups reportedly ranges from 9% to 33%, with some evidence suggesting an increase in GERD prevalence in the United States since 1995. 24-27 Dysregulation of gastrointestinal enzymes and hormones and impaired reflux clearance have been identified as two potentially important contributors to GERD development. Two common symptoms of GERD are heartburn and/or acid regurgitation, and additional manifestations of GERD include dysphagia, dyspepsia, hoarseness of voice, abdominal pain, or an acidic taste (or burning sensation) in the mouth or throat. 4 Increases in intra-abdominal pressure (i.e., from obesity or pregnancy) may also increase reflux, 7 and GERD has been found to be a common comorbidity of several chronic respiratory conditions. 4 However, in people with GERD, the passage of gastric acids into the oral cavity during sleep is especially damaging to the teeth, as salivation and swallowing are reduced, and, in a supine position, the lower molars can be bathed in the acids. 18-20 Occasional regurgitation of stomach acids following meals, especially after overeating, is considered normal 7, 13 for up to about one hour a day. Some systematic reviews report that severity of erosive tooth wear may be associated with the frequency and/or intensity of acid regurgitation. Gastroesophageal reflux. Gastroesophageal reflux disease is considered a predisposing factor for dental erosion due to chronic regurgitation of gastric contents.Other erosive challenges from gastric acid occur from recurrent vomiting, such as occurs in bulimia nervosa, chronic alcoholism, and pregnancy, when it is referred to as hyperemesis gravidarum. 7, 13 Stomach acid may reach the oral cavity in cases of gastroesophageal reflux disease (GERD), a common condition in which gastric contents reflux back up into the esophagus and/or the mouth. Intrinsic erosion results from the introduction of gastric acids into the oral cavity at a frequency, duration and/or intensity that exceed the ability of the buffering capacity of saliva or other oral health measures to minimize an erosive challenge, usually several times a week for an extended period of time. In the U.S., an analysis of data from the National Health and Nutrition Examination Survey (NHANES, 2003-2004) estimated an erosive tooth wear prevalence of 45.9% among children 15 and up to 80% among adults. 14 A 2015 meta-analysis 13 indicated that 34.1% of 16,661 children and adolescents worldwide exhibited dental erosion. 14 The same study also reported selective and highly variable data on erosion prevalence in children, adolescents and adults, due to variation in erosion indices, populations examined, regional diets/customs and study design. 13, 14 One global prevalence study estimated that the mean prevalence of erosion in deciduous teeth ranges between 30% and 50%, and the mean prevalence of erosion in permanent teeth in adults ranges between 20% and 45%. 9-12ĭental erosion can occur in individuals of any age. 3, 4, 7, 8 Beyond aesthetic consequences and associated oral health issues, severe erosive activity can lead to exposed dentin, hypersensitivity, and eventual loss of affected teeth. The primary etiologic factors of dental erosion are acids of intrinsic (often due to acid reflux) or extrinsic origin (diet, particularly carbonated/soft drinks or acidic fruit-juice consumption exposure to industrial or environmental chemicals). 1 Erosive demineralization is a chemical process characterized by acid dissolution of dental hard tissue, and its etiology is multifactorial. Dental erosion, also known as tooth erosion, is the chemical loss of mineralized tooth substance caused by exposure to acids not derived from oral bacteria.
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