Every now and then a dentist sends a kid to our GI practice due to eroded teeth because of concerns about reflux damaging the enamel. While it is recognized that reflux may damage teeth, the exact frequency is unclear. Other questions:
- Which asymptomatic kids with poor dentition require GI evaluation?
- What is the best way to evaluate these children?
- If reflux is identified, how long should they remain on treatment? Forever?
- How effective is reflux treatment in reducing tooth damage?
While none of these questions have been definitely answered, Rosen et al (JPGN 2016; 62: 309-13) show that acid reflux rather than nonacid reflux is predictive of tooth erosion. In this study, the authors used a prospective cohort of 27 children (age ≥3 years)–ALL of them were ON acid suppression (for >1 year) at the time of pH-MII testing. Key findings:
- Prevalence of tooth erosion was 10 or 27 (37%)
- There was correlation with acid reflux episodes (& time in reflux) and tooth erosion, r=0.44, P=0.02
- There was correlation with reflux index as well, r=0.54, P=0.004, In the tooth erosion group, the mean reflux index was 7.3% compared with 1.6% in no dental erosion group.
- There was no correlation with nonacid reflux with tooth erosion
The authors’ discussion highlights many prior relevant studies and indicates that a pH-metry study alone (rather than pH-MII) “may be adequate.” They note some of the limitations of this study which included a small number of patients and potential referral bias, as these children had suspected GERD. In the methods section, the authors state that their standard practice, at the time of the study, was to maintain patients on prior acid suppression medication. It would be useful to acknowledge that many experts, at this time, recommend doing pH-MII studies as well as standard pH studies off all acid suppression due to improved sensitivity/accuracy.
My take: This study shows that in the 10 children with tooth erosion who had suspected GERD, there was correlation with acid reflux but not with nonacid reflux.
Related blog post: Notes from PPI Webinar GutsandGrowth
Unrelated but interesting: Are medical errors really the 3rd leading cause of death in U.S.? Here’s NPR’s summary of a recent BMJ article which makes that claim: Only Heart Disease and Cancer Exceed Medical Errors As Cause of U.S. Death