What does this mean?
When stomach contents travel up the gullet they leave a sour, burning or metallic taste in the mouth. The reason this stands out at night is the lying position: the help of gravity is gone, saliva flow drops during sleep, and swallowing becomes less frequent. The acid that reaches the mouth therefore stays on the surface far longer than it does during the day.
What sets this apart is that the symptom does not stay a stomach matter alone but leaves its mark on the tooth surface. The longer the contact with acid lasts, the softer and thinner the enamel becomes. Over the years the palate side of the upper front teeth turns translucent, the cusps of the back teeth flatten, and fillings look as though they stand proud of the tooth surface. Unlike decay it spreads over wide surfaces and is seen on both sides; it does not hollow out a single spot.
Night-time acid also has a sleep and breathing side. Lying on your back, snoring, breathing through your mouth at night and acid escaping at night are often found together in the same person. Waking with a bone-dry mouth, burning in the throat, long-lasting hoarseness and a feeling of something catching in the throat are the accompanying signs that suggest this link.
Although sour fluid coming up at night starts on the stomach side, some of its consequences appear in the mouth. The headings below relate both to the acid itself and to the mouth staying dry through the night.
Likely causes
What helps at home?
- Do not brush your teeth straight after sour fluid has come up; softened enamel wears away more under a brush. Rinse your mouth with water first and wait about half an hour before brushing
- Finish your last meal at least three hours before you go to bed, and raise the head of the bed by a few centimetres
- Cut down on acidic drinks, lemon water and night-time snacks; make drinking water through the day a habit
- Use fluoride toothpaste and a soft brush, and brush without pressing hard; if the symptom carries on you also need to be assessed on the stomach side
- If you have a feeling of food catching, or pain, when you swallow
- If you are losing weight without meaning to, or you have vomited blood or passed black stools
- If your hoarseness has lasted longer than three weeks
- If your teeth are getting shorter, their edges are turning translucent, or sensitivity to cold has risen quickly
- If you wake at night with your breathing blocked, or you feel you are choking when you lie down
Frequently asked questions
- Isn't it better to brush my teeth when sour fluid comes up?
- In this situation it can have the opposite effect. In the minutes after contact with acid, enamel softens for a while; brushing at exactly that moment increases the loss of material from the surface. Rinsing with water first and putting brushing off for about half an hour is safer for the tooth surface.
- Will my worn teeth go back to how they were?
- Enamel that has been lost does not form again. The priority is therefore to reduce the acid reaching the mouth and to protect the surface that is left. If the loss has progressed, covering the surface may come onto the agenda; but restorations placed while the cause carries on have a shorter life, so both sides need to be dealt with together.
- I take reflux medicine, can my teeth still be affected?
- They can be. Even if the medicine reduces the burning, stomach contents may still reach the mouth, and a person does not always notice it. Whether the wear is progressing is followed at dental check-ups at set intervals, with photographs and a comparison of impressions if needed.
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.