Gastroesophageal reflux disease, commonly referred to as GERD, or acid reflux, is a condition in which the liquid content of the stomach regurgitates (backs up, or refluxes) into the esophagus, and often beyond, into the oral cavity. The liquid can inflame and damage the lining of the esophagus, and can gradually erode the enamel surfaces of the teeth. The refluxed contents typically contain acid and pepsin that are produced by the stomach. The regurgitated liquid also may contain bile that has backed up into the stomach from the small intestine. Acid is the most injurious component of the refluxed liquid. and it is the one thing we are concerned with as it relates to the erosion of teeth.
GERD is a chronic condition. Once it begins, it usually is life-long. If there is injury to the lining of the esophagus (esophagitis), this also is a chronic condition. Moreover, after the esophagus has healed with treatment and treatment is stopped, the injury will return in most patients within a few months. Once treatment for GERD is begun, therefore, it usually will need to be continued indefinitely.
Actually, the reflux of the stomach’s liquid contents into the esophagus occurs in most normal individuals. In fact, one study found that reflux occurs as frequently in normal individuals as in patients with GERD. In patients with GERD, however, the refluxed liquid contains acid more often, and the acid remains in the esophagus longer. Sometimes, it reaches the area of the tonsils, and can create ulcerations. As is often the case, the body has mechanisms to protect itself from the harmful effects of reflux acid. For example, most reflux occurs during the day when you are upright. In this position, the refluxed liquid is more likely to flow back down into the stomach due to the effect of gravity. Additionally, while you are awake, you swallow repeatedly, whether or not there is reflux. Each swallow carries any refluxed liquid back into the stomach. Finally, saliva contains bicarbonate. With each swallow, bicarbonate-containing saliva traverses the esophagus. The bicarbonate neutralizes the acid that remains in the esophagus after gravity and swallowing have removed most of the liquid.
Gravity, swallowing, and saliva are important protective mechanisms for the esophagus, but they are effective only when you are in the upright position. At night while sleeping, swallowing stops (for the most part), and the secretion of saliva is reduced. Therefore, reflux that occurs at night is more likely to result in acid remaining in the esophagus longer and causing greater damage to the esophagus, as well as the throat and teeth.
Certain conditions make a person susceptible to GERD. For example, GERD can be a serious problem during pregnancy. The elevated hormone levels of pregnancy can cause reflux by lowering the pressure in the lower esophageal sphincter. At the same time, the growing fetus increases the pressure in the abdomen. Both of these effects can increase reflux.
What many people do not realize, however, and what some physicians fail to recognize, is the role of snoring and sleep apnea in the creation of GERD. If you find yourself taking antacids on a regular basis, please see your physician and let him or her know about the condition. If you are one of our patients, we are specially trained to notice any oral symptoms of this dangerous condition.
