TEETH DAMAGE DUE TO EXTRAESOPHAGEAL REFLUX

Abstract

Introduction, aim: Extraesophageal reflux (EER) is the backflow of gastric fluids (most often acidic) above the level of the upper esophageal sphincter (it differs from gastroesophageal reflux). The symptoms of extraesophageal reflux are non-specific, of varying intensity and depend on the location of the pathological action of the refluxate. In the case of the effect of refluxate on the hard dental tissue, EER can contribute to the formation of dental erosions. In addition to refluxate, other factors such as the composition of saliva and the microbiome of the oral cavity are discussed. In recent years, there has been a significant shift in the understanding of extraesophageal reflux, especially the pathogenesis, and the resulting implications for diagnosis and treatment. The aim of the article is to inform about EER and give an overview of the current possibilities of diagnosis and its treatment, as well as to summarize the results of recent meta-analyses regarding the role of EER in the development of dental diseases.Methods: The basis for the presented article was professional publications obtained in the PubMed, Cochrane Library and Scopus databases from 2002 to 2022. Publications were searched using a combination of keywords in English and Czech languages: extraesophageal reflux, gastroesophageal reflux, dental erosion. A total of 21 studies discussing the association between reflux and dental erosions were analyzed through review, clinical prospective and retrospective studies and meta analyses. The included studies were conducted in the adult population and information on gastroesophageal reflux in relation to the occurrence of dental erosions was used only if it was diagnosed by multichannel intraluminal pH impedance monitoring. The first part of the article presents a current view of the pathophysiology, diagnosis and treatment of EER. The second part summarizes knowledge about dental erosions. In the third part, studies dealing with the effect of EER on dental erosion are presented.Results: The obtained information indicates a higher prevalence of dental erosions in patients with EER compared to the healthy population. The reason is that acids of both exogenous and endogenous origins play an important role in dissolving enamel minerals, which ultimately leads to tooth erosion. Based on the analyzed studies, the relationship between reflux and the development of dental erosions cannot currently be considered causal, mainly due to the low quality of the studies. The authors recommend that further studies investigating the relationship between EER and dental damage should be conducted.Conclusions: Based on the findings, it can be assumed that extraesophageal reflux is involved in the development of dental diseases. A possible link is also supported by the fact that the prevalence of dental erosions in population with reflux or the prevalence of reflux in the population with dental erosions is much higher compared to the healthy population. In the future, however, further studies are needed to investigate the causality of extraesophageal reflux in the occurrence of dental erosions.

Keywords

• extraesophageal reflux
• dental erosion
• pepsin
• oral microbiome
• saliva