Longitudinal study of gastroesophageal reflux and erosive tooth wear

Clive H Wilder-Smith, Andrea Materna, Lukas Martig, Adrian Lussi, Clive H Wilder-Smith, Andrea Materna, Lukas Martig, Adrian Lussi

Abstract

Background: Approximately 60% of patients presenting to dentists with erosive tooth wear have significant gastroesophageal reflux (GERD), despite minor reflux symptoms. No longitudinal studies of reflux-associated erosive tooth wear and of reflux characteristics have been reported to date. The aim of this study was to characterize the longitudinal course of GERD and of associated erosive tooth wear, as well as factors predictive of its progression, in a large group of patients.

Methods: Seventy-two patients presenting to dentists with clinically significant erosive tooth wear and increased esophageal acid exposure by 24-h multichannel intraluminal pH-impedance measurement (MII-pH) were re-assessed clinically and by MII-pH after 1 year treatment with esomeprazole 20 mg twice-daily. Predictive factors for erosive tooth wear were assessed by logistic regression.

Results: At follow-up, no further progression in erosive tooth wear was observed in 53 (74%) of patients. The percentage of time with a pH < 4, the number of acid reflux episodes and the percentage of proximal esophageal reflux off-PPI did not change significantly after one year, but the number of weakly acidic reflux episodes decreased significantly in the large subgroup without progression. None of the baseline demographic, clinical, endoscopic or esophageal acid exposure characteristics were significantly associated with progression of erosive tooth wear at follow-up.

Conclusions: In this longitudinal study in patients with erosive tooth wear and oligosymptomatic GERD receiving esomeprazole for one year, erosive tooth wear did not progress further in the majority of patients. Background acidic esophageal reflux exposure appeared stable over time, whereas weakly acidic exposure decreased significantly in patients without erosion progression. MII-pH measurements on-PPI and with healthy controls will be useful in the further elucidation of the causal role of reflux in erosive tooth wear.

Trial registration: ClinicalTrials.gov , retrospectively registered: NCT02087345 .

Keywords: Dental erosion; Esomeprazole; GERD; Gastroesophageal reflux; Proton pump inhibitor; pH-impedance.

Conflict of interest statement

Ethics approval and consent to participate

As this was a study analyzing coded clinical data with no additional research-related procedures, no Institutional Ethics Board approval was required in Switzerland at the time. The study was conducted according to the principles of the latest version of the Declaration of Helsinki and its later amendments and patients provided informed consent.

Consent for publication

Not applicable.

Competing interests

Clive Wilder-Smith received research funding for unrelated studies from Astra Zeneca until 2008. None of the other authors have a conflict of interest or disclosure.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Typical high-resolution photographs of dental erosions secondary to gastroesophageal reflux. a Oral (BEWE 3). b Occlusal (BEWE 3). BEWE = basal erosive wear examination [7]

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