Gastroesophageal reflux disease and oral manifestations

Gastroesophageal Reflux (GER) is a common condition in childhood characterized by rise of gastric contents into esophagus. According to International Consensus of Montreal, gastroesophageal reflux disease (GERD) is defined as the condition that develops when retrograde passage of gastric contents causes troublesome symptoms and/or complications that result in an impairment of quality of life of these [1]. In pediatric population, there are conditions at risk of developing GERD, like neurological impairment, history of esophageal atresia repaired and obesity [2]. The typical symptoms can include heartburn with or without regurgitation. For extra-esophageal syndromes, only dental erosions and Sandifer syndrome are considered conditions related to GERD. Acid reflux at level of oral cavity, in fact, can cause dissolution of tooth enamel, especially at level of palatal surfaces of back teeth, with a reported prevalence of up to 42% [3]. In a pediatric cross sectional study, in 112 children was found a significant incidence for dental erosion in patients with GERD respect to control group, both in primary and permanent teeth [4]. In general, however, oral manifestations of GERD are reported mainly. In pediatric population, dental erosion are not considered primary extra-esophageal manifestation of GERD because, when present, can be associated at multiple factors [5]. The typical manifestations can be considered dental caries, dry mouth, feeling at oral acid/burning sensation, halitosis, erythema of palatal mucosa and uvula. For diagnosis is mandatory exclude other causes, like dietary factors, drugs, poor oral hygiene, eating behavior disorders, genetic and racial factors. The esophageal pH monitoring and/or endoscopy are usually necessary just to confirm diagnosis of GERD. In this group of patients it’s possible to start a pharmacological therapy in association with modifications of diet (quantity and frequency of intake of foods and reduction of beverages that contain fat, sugars and acids) to decrease time of exposure at gastric acid and secretions. Therapeutic options are based on medical treatment or surgery in severe cases [6], although there are few studies to evaluate efficacy of treatment of GERD to prevent oral cavity lesions.

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