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Fenton, M. Terry, K. Galloway, C. Smith, J. Hunter, and J. View at: Google Scholar. More related articles. These include. TLESRs are normal and occur spontaneously throughout the day, like when burping, and can allow acid to escape the stomach. A weak lower esophageal sphincter. It may not close tightly enough, allowing acid upward.
Stomach pressure, either from wearing too-tight clothing or from excess stomach fat, can put pressure on the stomach and force acid upwards. With respect to conservative dental restorations fillings, endodontic treatment or fixed prosthetic dental reconstructions, there was no significant difference between the ERD and NERD patients. Study participants in both groups consisted in all cases of Caucasian individuals. With respect to the number of teeth and smoking habits, there were no significant differences Table 1.
All smokers in this study used to smoke cigarettes. No other forms of tobacco such as spit tobacco, cigars and pipes were consumed. No statistical significance between the two groups detectable. With respect to medical care, all study patricipants had provided name and address of their family doctors and family dentists and had confirmed to see them regularely.
However, three of them in the NERD group were classified as non-responders. In addition, medical history of the 71 patients revealed no impact on oral mucosa. In both groups, erythemas were localized equally on the palatal and buccal mucosa and the mucosa of the tongue.
No patient demonstrated ulcer of the mucosa. Statistical analysis failed to demonstrate significant differences between scores and groups Table 2. No statistical significance between scores and groups. With regard to the oral plaque index, similar levels of oral hygiene were found in both groups.
Similarly, mean CAL values showed no significant differences. Periodontal findings. Significantly more patients suffering from severe periodontitis in the ERD group. Recent literature has pointed out that, with respect to GERD patients, only controversial epidemiological data on the prevalence of acidic oral mucosa lesions are available [ 9 ]. Moreover, most recent literature demonstrated that GERD is independently associated with an increased incidence of chronic periodontits.
Therefore, clinical studies are urgently necessary to find out if there is an association between the main two subgroups of GERD and acidic oral mucosal lesions erythema or ulcer and periodontal conditions with respect to PPI medication.
Several studies on oral findings in GERD patients provide only limited information if or how GERD was diagnosed endoscopy solely [ 19 ], esophageal pH monitoring in combination with impedance measurement [ 20 ] or treated before the study was carried out [ 19 , 21 — 23 ], which hampers reliable comparison with the present results. Moreover, in this study, both groups of GERD patients were treated with PPI for at least 1 year which allows conclusions on the clinical impact on oral conditions of PPI in this sample of patients.
With respect to the dental status, patients with removable dentures were not excluded in all studies, which, again, hampers comparison of the present results with the literature. In a recent study [ 13 ], three patients with GERD were completely edentulous; however, one participant, a year old woman in the GERD group, was found to have a mucosal lesion, a small ulcer-like lesion associated with redness on the dorsal tongue.
Accordingly, it remains unclear if ulcer was attributable to the prosthodontic construction or to GERD. In this study, none of the subjects had removable dentures to eliminate bias if mucosal alterations were caused by the prosthodontic construction. Although GERD affects all age groups [ 21 ], the incidence of this disease increases considerably after 40 years of age [ 19 ]. Similarly, in this study, the mean age of patients was In accordance with the literature, among all 71 GERD patients, a total of 41 Also in previously published studies, a higher incidence of GERD in women has been reported [ 23 ].
With respect to ethnicity, number of teeth and smoking habits, no differences were found. Therefore, due to the fact that the aforementioned characteristics were very similar in both groups, the results of this study seem not to be compromised by these general factors. Due to the fact that all study participants had confirmed to attend regularely medical and dental care, it seems unlikely that periodontal findings in this study may be attributed to lack of accessing routine dental care including dental prophylaxis.
However, three patients of the NERD group were classified as non responders. Clinical efficacy of PPI medication has been documented by Wang and coworkers who collected gastric fluid during routine endoscopy in patients on PPIs, on H2-receptor blockers and on no acid suppression therapy [ 24 ]. The mean pH values were 5. However, a recent study has PPI even proved to be ineffective in a number of patients [ 2 ].
Data from a meta analysis have shown that a high-dose proton pump inhibitor is no more effective than placebo in producing symptomatic improvement or resolution of laryngo-pharyngeal symptoms [ 25 ]. Accordingly, the three non responders found in this study are in accordance with the literature. Many investigators have proposed an association between GERD and laryngo-pharyngeal symptoms such as hoarseness, globus pharyngeus, vocal fatigue, frequent sore throat, frequent throat clearing, chronic cough [ 26 — 30 ].
Moreover, oral mucosal lesions may result from GERD by direct acid or acidic vapor contact in the oral cavity [ 9 ]. It has been demonstrated histopathologically in the rat model that reflux affects the soft palate, which suggests that these pathological changes may reflect the relationship between laryngopharyngeal reflux and airway obstruction [ 5 ]. One clinical large case-controlled study observed a significant association of GERD with erythema of the palatal mucosa and uvula [ 7 ].
In another study, histologic examination of palatal mucosa found a greater prevalence of epithelial atrophy, deepening of epithelial crests in connective tissue and a higher prevalence of fibroblasts in 31 GERD patients compared with 14 control subjects [ 6 ]. But, these changes were not visible to the naked eye, unlike the mucosal changes that may be more readily observed in esophagitis and laryngitis where the pH of the gastric reflux at these sites is lower than in the mouth [ 31 , 32 ].
Other studies have not found any abnormal appearances of the oral mucosa or associated oral symptoms in patients with confirmed GERD [ 8 , 11 ]. Also in this study, there was no statistical significant difference with regard to the total number of oral mucosal lesions and their localization when the ERD and the NERD group were compared. Acid regurgitation may exacerbate oral mucosal changes associated with co-existing hyposalivation, which can arise from systemic conditions, local salivary gland conditions and intake of drugs including PPIs [ 9 ].
Altman and coworkers have demonstrated the presence of this pump in laryngeal seromucinous glands [ 34 ]. In addition, there is evidence that systemic medication may enter saliva through diffusion [ 35 ]. Thus, it is possible for the pH of the seromucinous secretions to be affected by PPI use, and this could alter the oral mucosa, and, in addition, the bacteria growth environment in the oropharynx [ 33 ].
Especially, patients with diabetes and a history of recent PPI use are more likely to have abnormal oral flora [ 33 ]. However, due to the fact that lesions of the oral mucosa did not differ significantly between the ERD and the NERD group in the current study it may be assumed that PPI medication had no adverse impact on oral mucosal health in both groups.
Periodontal evaluation consisted of clinical three dimensional evaluation by probing due to the fact that two dimensional radiographs are not highly reflective of the real periodontal situation [ 36 ]. With respect to the oral plaque index, bleeding index and clinical attachment loss, similar levels were found in both groups Table 3.
This is, in part, in accordance with the most recent literature. Erosive esophagitis is a severe form of gastroesophageal reflux disease GERD, or acid reflux in which the lining of the esophagus is damaged by the backup of reflux, or stomach acid. Once the esophagus is eroded, it can take 6 to 9 months of treatment for it to fully heal. Erosive esophagitis is caused by acid reflux, which is the biggest thing to look out for.
Other signs and symptoms of erosive esophagitis include:. If you have erosive esophagitis, a clinical trial might be able to help. Learn more by entering your information:. Who qualifies for this research study?
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