Almost everyone has experienced heartburn. About 25 million American adults suffer daily from heartburn.
It is that burning sensation felt behind the breastbone and sometimes in the neck and throat. Heartburn is caused by stomach acid refluxing – or splashing upward – into the esophagus, the muscular tube that connects the throat to the stomach. Occasional heartburn is nothing to be concerned about. However, anyone who has heartburn on a regular basis should consult a physician. Constant exposure to stomach acid can irritate the lining of the esophagus, cause sinus infections and erosion of the teeth and gums. Serious heartburn is known as gastro esophageal reflux disease or GERD.
The esophagus carries food and liquid into the stomach. At the lower end of the esophagus where it enters the stomach, there is a strong muscular ring called the lower esophageal sphincter (LES). The LES should remain tightly closed, except to allow food and liquid to pass into the stomach. Reflux occurs when the LES is not working properly.
It may relax for periods of time throughout the day and night, or it may be constantly too weak to function effectively. This allows the stomach’s acid juices to flow into the esophagus. How severe the disease becomes depends on how weakened the LES is, and the amount and duration of acid refluxed into the esophagus.
Treatment for GERD is aimed at reducing acid reflux. Initial treatment can involve changes in lifestyle, such as avoiding eating anything within three hours before bedtime, stopping smoking, avoiding certain foods and alcohol, and maintaining a healthy weight.
Lifestyle changes are often all that is needed to correct mild forms of GERD. When GERD is moderate to severe, the patient’s physician can prescribe medications. Some medications that reduce stomach acid include Tagamet, Zantac, Pepcid and Axid. Certain potent newer drugs, such as Prilosec and Prevacid, can almost eliminate stomach acid entirely. These two drugs are most frequently used when GERD is severe. Other medications, such as Reglan (generic: metoclopramide) tighten the LES. These may be especially useful at night when reflux often occurs.
In extreme cases, surgery can be performed to treat and correct GERD. Working together with your physician, you can develop a good medical program to successfully treat GERD. If you suspect you have GERD, please contact your physician. People often suffer for years, when simple treatment with medication or lifestyle changes can reduce or eliminate symptoms.
GERD and dentistry
Decay from acid erosion of tooth enamel is one of the worst problems from GERD. I have had numerous dental patients who have had severe dental decay directly related to GERD. Their constant regurgitations bathe the teeth in acid, etching away the enamel, leading to decay. GERD patients often have a history of difficult dental visits, often leading to dental fear. Usually the GERD patient cannot lie back in the dental chair without acid reflux discomfort. In many cases, they have a severe gag reflex, which makes dental x-rays difficult and mouth impression nearly impossible. Often GERD patients are depressed and embarrassed by their constant dental decay problems. This contributes to their dental phobia.
Dental treatment for GERD patients
Certain dental procedures can help the GERD patient. Impressions can be made much easier by using smaller side trays to reduce gagging. A digital pantographic radiograph allows full mouth x-rays without putting films in the mouth triggering a gag response. It is also taken in the upright position, so avoiding gastric reflux often found in the reclined position. This procedure also has the added benefit of reduced radiation, one-tenth as much as traditional x-ray films.
I have had great success using conscience sedation on GERD patients. Sedation prevents the gag response in patients and eliminates their fear while allowing long dental appointments. Conscience sedation, often called sleep dentistry, is an extremely safe procedure where the patient is totally relaxed in a sleep-like state, but is responsive when needed to open and close their mouth.
The night before the appointment, the patient takes a pill to help them have a restful night sleep. An hour before their appointment, they take another pill, and then a companion brings them to the office. Vital signs are monitored and more medication is given in the office as needed. The next day they have little or no memory of the visit.
Three years ago I treated a young lady with an extreme gag reflex along with an acid reflux condition that made her past dental treatments difficult and uncomfortable. At the initial appointment, my staff took a digital pantographic radiograph without a problem. We took time with her and determined her treatment and comfort needs. With conscious sedation she was treated comfortably while having an extraction, bone grafting and a dental implant. She was able to lie back farther than usual in a dental chair without acid reflux and have a standard x-ray taken without a gag reflex. Treatment was a success and should last a long time with constant monitoring. She felt great the next day with no memory of the treatment.
Preventable procedures for GERD patients
One of the greatest challenges with GERD patients is preventing future tooth erosion and decay. Brushing with certain toothpastes can trigger the gag response and the accompanying acid reflux. So tooth brushing is often ineffective, leading to dental plaque and decay. Often the medications to reduce GERD cause reduced salivary flow, a condition called dry mouth. Saliva is designed to help clean the teeth, wash away bacterial plaque and fight tooth decay. A number of patients say that sucking on breath mints, candies, or lozenges soothes burning in the mouth. Sucking on lozenges can also stimulate saliva production, which helps to fight dry mouth. Beware of mints or sucking candies that contain sugar, as they will contribute to increased decay.
The GERD patient needs to be extra diligent with brushing, flossing and rinsing, but too often this triggers the gag and acid reflux response. Continual sipping of water can help to reduce dry mouth. Frequent rinsing with water (or ideally, a fluoride rinse if it doesn’t trigger reflux response) is helpful for washing the teeth. Also, frequent brushing, even with just plain water, is extremely helpful for removing acid and plaque from the teeth. Finding fluoride toothpaste that doesn’t trigger acid reflux is ideal; usually non-foaming toothpaste is best. Frequent professional dental examinations and cleaning are vital for health.
If you have GERD, working with your physician and dentist can give you a much improved health and quality of life. If you have had difficulty with dental treatment in the past and particularly if you need extensive dental treatment, I would highly recommend conscious sedation dentistry.
Enjoy life and keep smiling!
George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ malkemusdds.com. Go to Dr. Malkemus’ web site at www.malkemusdds.com.