What is it?
Reflux is stomach contents flowing back into the oesophagus and, at times, as far as the mouth. Stomach acid is strong enough to dissolve enamel. The mark it leaves in the mouth is different from decay: decay is destruction caused by bacteria, while erosion is a chemical dissolving caused by acid.
Wear shows most on the palate side of the upper front teeth and on the biting surfaces of the back teeth. Enamel thins, teeth become see-through, their edges turn notched, and the yellow tissue underneath starts to show. Over time the edges of fillings sit higher than the tooth, because the filling does not dissolve while the tooth around it does.
The complaint does not always take the form of heartburn. A sour taste rising into the mouth at night, a burning throat in the morning, long-lasting hoarseness, post-nasal drip and a feeling of something caught in the throat can all go along with reflux. In some people the only sign is teeth becoming more sensitive.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
The valve at the top of the stomach loosening
When the ring of muscle at the lower end of the oesophagus does not close properly, stomach contents escape upwards. Excess weight, a hiatus hernia and pregnancy are the main things that make this closure harder.
- 02
Eating patterns and habits
Heavy meals eaten late, acidic and fizzy drinks, coffee, alcohol and smoking all trigger reflux. Lying down straight after eating makes it easier for acid to escape upwards.
- 03
Night-time leaks
Lying flat, gravity is not on your side; acid that comes up at night stays in the mouth for longer. In people whose breathing is strained during sleep, changes in pressure inside the chest can add to the picture.
- 04
Weaker protection on the mouth's side
Saliva dilutes acid and reduces its effect. When dry mouth, breathing through the mouth at night or medicines that reduce saliva are in play, the same amount of acid does far more damage.
How does it progress?
- 1
Enamel loses its shine
The surface turns dull and mild sensitivity to cold and to sweet things begins. The length and shape of the tooth have not changed yet. At this stage the real work is stopping the source.
- 2
Enamel thins and what lies beneath shows through
The edges of the front teeth become see-through and small hollows form on the cusps of the back teeth. Sensitivity increases; the edges of fillings begin to stand higher than the tooth around them.
- 3
Tooth surface is clearly lost
Teeth become shorter, the yellow inner tissue is exposed over a wide area, and sensitivity affects daily life. The need for restoration comes up at this stage.
- 4
The height of the bite changes
Widespread loss of tooth substance affects how the teeth meet and the line of your smile. Treatment moves beyond a single tooth and turns into rebuilding the whole bite.
How is it treated?
The dentist manages the damage in the mouth, not its source. By looking at the pattern of wear the dentist can tell acid contact apart, applies fluoride and protective treatments to reduce sensitivity, and rebuilds the lost surfaces with composite or with crowns. As long as the acid contact continues, a restoration will have a shorter life.
Diagnosing reflux and treating it with medication belongs to a gastroenterology doctor. If your symptoms continue, if a sour taste rises into your mouth at night, or if the wear is progressing at your check-ups, you will be referred for assessment. Starting a stomach medicine, its dose and its length are not matters for a dentist to decide.
If the two sides do not move together, the result does not last. Where the source is not brought under control, wide restorations would be expected to break and need replacing early; and if the source is corrected while the mouth side is neglected, the sensitivity and the loss of tooth substance carry on.
- A feeling of food sticking when you swallow, or difficulty swallowing
- Losing weight without meaning to, and loss of appetite
- Blood in your vomit or in your stools
- Hoarseness lasting more than three weeks
How is it prevented?
- Do not lie down within two hours of eating; finish your evening meal at least three hours before you go to bed.
- Do not brush straight after a sour taste has risen into your mouth; you would wear away the softened enamel. Rinse with water first, wait around half an hour, and brush then.
- Have acidic and fizzy drinks with a meal rather than spreading them across the day; drinking through a straw reduces contact with the tooth surface.
- If your mouth is dry at night, tell your dentist; when saliva falls, the same acid does more damage.
Frequently asked questions
- Is the wear on my teeth from reflux or from grinding?
- It can be both together. Clenching and grinding wear teeth down mechanically and leave flat, shiny worn surfaces. In acid erosion the surfaces look dull, cupped and see-through. The pattern found at the examination is what tells them apart.
- Does worn enamel grow back?
- Enamel that has been lost does not come back; enamel is not a living tissue and does not renew itself. What can be done at an early stage is to stop the loss and reduce the sensitivity. Where the loss is advanced, the missing surface is made up with a restoration.
- I take a stomach medicine, will my teeth still wear?
- The wear can carry on. Although the medicine reduces the strength of the acid, it does not always stop the leak itself; night-time leaks and dry mouth can continue. This is why the wear needs to be monitored with regular check-ups.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.