Pediatric Abstract Update: Oral Motor, Oral Health ini Gastrooesephageal Refluks

ABSTRACT I: Oral health of children with gastro-esophageal reflux disease: a controlled study.

Linnett V, et al.

Aust Dent J. 2002 Jun;47(2):156-62.

Affiliation
The University of Queensland, School of Dentistry, Brisbane, Australia.

Abstract
BACKGROUND: The aim of this study was to compare the dental health of children with gastro-esophageal reflux disease (GERD) with a healthy control group.

METHODS: Dental examinations were conducted for 52 children (31 boys and 21 girls) with a definitive history of GERD. For every subject enrolled in the study, a healthy control sibling without the condition was recruited. Medical histories were obtained from medical records, and dental and dietary histories were obtained from parents. The teeth were examined for erosion, dental caries, and enamel hypoplasia, and sampled for Streptococcus mutans.

RESULTS: The prevalence of erosion by teeth was found to be statistically significant between GERD patients (14 per cent) and controls (10 per cent) (p<0.05). GERD patients had erosion in more permanent teeth compared to controls (4 per cent vs 0.8 per cent, p<0.05), and more severe erosion (p<0.05). Caries experience was also higher in GERD patients compared to controls (p<0.05). Although there were more subjects with Streptococcus mutans in the GERD group compared to the control group (42 per cent vs 25 per cent), the difference was not statistically significant.

CONCLUSIONS: Children with GERD have more erosion and dental caries compared to healthy controls and should be targeted for increased preventive and restorative care.

ABSTRACT II: Oral and dental manifestations of gastroesophageal reflux disease in children: a preliminary study.

Ersin NK, et al.

Pediatr Dent. 2006 May-Jun;28(3):279-84.

Source: Department of Pedodontics, Dental Faculty, Ege University, Bornova-Izmir, Turkey. nazan.ersin@ege.edu.tr

Abstract
PURPOSE: The aim of this study was to investigate the effects of gastroeophageal reflux disease (GERD) on: (1) erosion; (2) caries formation; (3) salivary function; and (4) salivary microbiological counts.

METHODS: Thirty-eight GERD patients with a mean age of 6 1/2 years and 42 healthy children of the same age and gender and social background comprised the study group. All subjects answered a detailed frequency questionnaire related to acidic drinks, foods, and sugar consumption and participated in a clinical dental examination. The caries experience of the children was recorded according to World Health Organization criteria, and erosion was scored according to the Eccles and Jenkins grading scale. The children were also investigated for stimulated salivary flow rate, buffer capacity, and salivary mutans streptococci (MS), lactobacilli, and yeast colonization.

RESULTS: The prevalence of dental erosion and the salivary yeast and MS colonization in GERD children was found to be significantly higher than for healthy subjects (P<.05). The caries experience, salivary flow rate, buffering capacities of the children, and frequency of acidic drinks, foods, and sugar consumption were found to be similar in both groups.

CONCLUSION: This current investigation has shown that GERD children were at an increased risk of developing erosion and caries compared with healthy subjects.

ABSTRACT III: Oral symptoms including dental erosion in gastroesophageal reflux disease are associated with decreased salivary flow volume and swallowing function.

Yoshikawa H, et al.

J Gastroenterol. 2011 Dec 27.

Source:Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.

Abstract
BACKGROUND: This preliminary clinical study aimed to evaluate the effects of salivary flow volume and swallowing function on oral symptoms including dental erosion in gastroesophageal reflux disease (GERD).

METHODS: The subjects were 40 GERD patients and 30 (15 younger, 15 older) healthy controls. Detailed medical, dietary, and dental histories were obtained to identify individual behavioral habits potentially associated with dental erosion. Oral examination evaluated dental erosion and determined scores for the decayed, missing, filled (DMF) index, the papillary, marginal, attached (PMA) index for gingivitis, and the Simplified Oral Hygiene Index (OHI-S). Salivary flow volume and swallowing function were evaluated by the Saxon test and repetitive saliva swallowing test, respectively.

RESULTS: The DMF index and OHI-S scores differed significantly between all 3 groups. The PMA index was significantly different between the GERD group and the two control groups. The prevalence of dental erosion was 24.3% in the GERD group (0% in the control groups). No specific relationship was found between the incidence of dental erosion and dietary history or behavioral habits. The Saxon test results were significantly lower in the GERD group than in both the control groups. Frequency of swallowing was significantly lower and time to first swallow was significantly longer in the GERD group than in the two control groups.

CONCLUSIONS: Oral symptoms in GERD are likely to be associated with impaired salivary flow volume or swallowing function. Treatment for the oral dryness induced by reduced salivary flow volume and rehabilitation for swallowing function could be indicated in patients with GERD.

ABSTRACT IV: Evaluation of dental erosion in patients with gastroesophageal reflux disease.

Gregory-Head BL, et al.

J Prosthet Dent. 2000 Jun;83(6):675-80.

Source: University of the Pacific School of Dentistry, and University of California, San Francisco, California, USA.

Abstract
STATEMENT OF PROBLEM: The cause of dental erosion may be difficult to establish because of its many presentations. Determination of the cause is an important aspect of diagnosis before extensive prosthodontic rehabilitation.

PURPOSE: This cross-sectional study evaluated the association between loss of tooth structure as a result of dental erosion and gastroesophageal reflux disease.

MATERIAL AND METHODS: Twenty consecutive adult dentate subjects referred to the Division of Gastroenterology for investigation of gastroesophageal tract disease were also evaluated for signs of dental erosion. All subjects underwent a dental evaluation that included a patient history to determine potential etiologic factors responsible for dental erosion. Subjects were examined clinically to quantify loss of tooth structure using a Tooth Wear Index (TWI). Endoscopic examination and 24-hour pH manometry were carried out to determine which subjects met the criteria for gastroesophageal reflux disease (GERD). Scores for maxillary versus mandibular dentition and anterior versus posterior dentition were also compared. Data were analyzed with the Kruskal-Wallis test (P =.004).

RESULTS: Ten subjects were diagnosed with GERD and 10 subjects had manometry scores below the level indicating GERD. Overall, subjects diagnosed with GERD had significantly higher TWI scores compared with control subjects (mean difference = 0.6554; P =.004). GERD subjects had higher TWI scores in all quadrants, except in the mandibular anterior region where there was no difference.

CONCLUSION: The results indicated that a relationship exists between loss of tooth structure, as measured by the TWI index, and the occurrence of GERD in this group of subjects.

ABSTRACT IV: Dental erosion and acid reflux disease.

Schroeder PL, et al.

Ann Intern Med. 1995 Jun 1;122(11):809-15.

Source: Division of Gastroenterology, University of Alabama at Birmingham 35294-0007, USA.

Abstract
OBJECTIVE: To determine the relation between gastroesophageal reflux disease and dental erosion using ambulatory 24-hour esophageal pH testing.

DESIGN: Cross-sectional observational study.

SETTING: Tertiary referral center.

PATIENTS: The dental group consisted of 12 patients with idiopathic dental erosion who were identified by dentists and screened for gastroesophageal reflux disease using 24-hour pH testing. The gastroenterology group consisted of 30 patients who had 24-hour pH testing in the esophageal laboratory and who were referred for dental evaluation (10 did not have reflux, 10 had distal reflux, and 10 had proximal reflux).

MEASUREMENTS: 24-hour esophageal pH monitoring using a pH probe in the distal and proximal esophagus. Complete dental examination with particular attention to the presence and severity of dental erosion; plaque; gingival damage; and decayed, missing, and filled teeth. Analysis of saliva for pH, flow rates, buffering capacity, and calcium and phosphorus levels. Standardized questionnaire to ascertain possible causes of dental erosion and presence of reflux symptoms.

RESULTS: Ten of the 12 patients in the dental group (83% [95% CI, 52% to 98%]) had gastroesophageal reflux on esophageal pH monitoring. Nine had distal and 7 had proximal reflux. Seven had reflux in the upright position only, 1 had reflux in the supine position only, and 2 had both upright and supine reflux. No saliva abnormalities were found. Ten patients had typical symptoms of gastroesophageal reflux, but dietary or mechanical problems that may have been causing dental erosion were not identified. In the gastroenterology group, upright reflux was seen in 5 of the 10 patients with distal reflux and in all 10 patients with proximal reflux. In addition, 40% of patients in the gastroenterology group (12 of 30) had dental erosion (4 of the 10 with distal reflux [40%], 7 of the 10 with proximal reflux [70%], and only 1 of the 10 without reflux [10%]; P = 0.02 for those with reflux compared with those without reflux). The cumulative dental erosion score correlated with proximal upright reflux when all 24 study patients with erosion were analyzed (r = 0.55 [P < 0.01]); this correlation was even stronger in the subgroup of 12 patients with abnormal amounts of proximal upright reflux (r = 0.84 [P = 0.001]).

CONCLUSION: Dental erosion is a common finding in patients with gastroesophageal reflux disease and should be considered an atypical manifestation of this disease.

ABSTRACT VI: Oral and dental manifestations in gastroesophageal reflux disease.

Meurman JH, et al.

Oral Surg Oral Med Oral Pathol. 1994 Nov;78(5):583-9.

Source: Faculty of Dentistry, University of Kupio, Finland.

Abstract
One hundred seventeen patients with reflux disease were examined with respect to the severity of their disease and oral, dental, and salivary findings. Twenty-eight patients had dental erosion, whereas the remaining 89 patients did not. No mucosal changes could be observed to be linked with the reflux disease. In the mean, the patients with erosion were older (54 versus 49 years), and the mean duration of their reflux disease was longer in comparison to those without erosion (17 versus 11 years, respectively). The severity of the reflux disease was more marked among patients with erosion than in those without as assessed by esophagogastroduodenoscopy, the Maratka classification, histologic examination of gastric and esophageal biopsy specimens, and 24-hour esophageal pH monitoring. No statistically significant differences were observed between the groups in any salivary parameters studied, although the number of patients with low salivary-buffering capacity was higher among those with erosion than among those without. Patients taking beta-blocking agents or tranquilizers had more erosion than those who did not take these medications. The severity of the reflux disease was not associated with any subjective symptoms in the mouth or pharynx. The frequency of consumption of acidic drinks and foodstuffs as determined by a questionnaire did not differ between the patients with and without dental erosion. Thus severe reflux disease of long duration was found to be potentially detrimental to the teeth, whereas milder forms of the disease need not cause dental side effects.

ABSTRACT VII: Oral and dental manifestations in gastroesophageal reflux disease.

Meurman JH, et al.

Oral Surg Oral Med Oral Pathol. 1994 Nov;78(5):583-9.

Source: Faculty of Dentistry, University of Kupio, Finland.

Abstract
One hundred seventeen patients with reflux disease were examined with respect to the severity of their disease and oral, dental, and salivary findings. Twenty-eight patients had dental erosion, whereas the remaining 89 patients did not. No mucosal changes could be observed to be linked with the reflux disease. In the mean, the patients with erosion were older (54 versus 49 years), and the mean duration of their reflux disease was longer in comparison to those without erosion (17 versus 11 years, respectively). The severity of the reflux disease was more marked among patients with erosion than in those without as assessed by esophagogastroduodenoscopy, the Maratka classification, histologic examination of gastric and esophageal biopsy specimens, and 24-hour esophageal pH monitoring. No statistically significant differences were observed between the groups in any salivary parameters studied, although the number of patients with low salivary-buffering capacity was higher among those with erosion than among those without. Patients taking beta-blocking agents or tranquilizers had more erosion than those who did not take these medications. The severity of the reflux disease was not associated with any subjective symptoms in the mouth or pharynx. The frequency of consumption of acidic drinks and foodstuffs as determined by a questionnaire did not differ between the patients with and without dental erosion. Thus severe reflux disease of long duration was found to be potentially detrimental to the teeth, whereas milder forms of the disease need not cause dental side effects.

ABSTRACT VIII: Gastric reflux is a significant causative factor of tooth erosion.

Holbrook WP, et al.

J Dent Res. 2009 May;88(5):422-6.

Source: University of Iceland, Vatnsmyrarvegi 16, IS 101 Reykjavík, Iceland. phol@hi.is

Comment in
J Evid Based Dent Pract. 2010 Sep;10(3):176-8.
Abstract
Dental erosion is caused by dietary or gastric acid. This study aimed to examine 9?the location and severity of tooth erosion with respect to causative factors, and to determine whether the clinical pattern of erosion reflected the dominant etiological factor. The study involved 249 Icelandic individuals and included: a detailed medical history; clinical oral examination; salivary sampling, and analysis for flow rate, pH, and buffering capacity. Reflux was assessed in 91 individuals by gastroscopy, esophageal manometry, and 24-hour esophageal-pH monitoring. Reflux symptoms were reported by 36.5% individuals. Manometry results were abnormal in 8% of study participants, abnormal esophageal pH in 17.7%, and a pathological 24-hour pH recording in 21.3%. 3.6% were positive for Helicobacter pylori. Normal salivary flow was found in 92%, but low salivary buffering (10.4%) was associated with erosion into dentin (P < 0.05). Significant associations were found between erosion and diagnosed reflux disease (OR 2.772; P < 0.005) and daily consumption of acidic drinks (OR 2.232; P < 0.005).

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