Dental Problems in Children with GERD

J Burns, M.Ed, B Anderson
October 2005

Written By Jan Burns, M.Ed. and Beth Anderson of PAGER - Pediatric GastroEsophageal Reflux Association
www.reflux.org
[This information was originally published in booklet form by PAGER at a cost of $5.00 per copy. If you find it helpful, please consider supporting their important work by making a donation to them at www.reflux.org.]

Question: Do children with acid reflux have more dental problems than other children?

Answer: Yes, there is some evidence that children with pediatric acid reflux are more likely to experience several types of dental problems including: cavities, bad breath and enamel erosion. Children with acid reflux who experience frequent vomiting (daily, weekly) are especially at risk for tooth decay.


Question: Why do children with acid reflux have more dental problems than other children?

Answer: Acid Reflux can cause the teeth to be exposed to acid due to the abnormal backwashing of stomach contents into the esophagus and mouth. Stomach acid is very caustic and can quickly strip away the outer layer of enamel, especially on the inner surfaces of the teeth next to the tongue.

Some children with acid reflux may experience the following problems:

• Poor nutrition in infancy may lead to soft teeth.
• Frequent meals and snacks may lessen reflux symptoms but cause an increase in tooth decay.
• The child with acid reflux may favor a diet rich in carbohydrates. Unfortunately, starchy foods tend to stick on the teeth and cause decay.
• Multiple medications may be needed to treat reflux and associated complications. However, sugar is frequently added to medications and is known to cause tooth decay.
• Some medications decrease saliva, which helps to “wash” the teeth of food and irritants.
• Some children with acid reflux dislike toothbrushing due to oral sensitivity, a hyperactive gag reflex or negative oral experiences. In addition, enamel erosion can cause sensitivity and make toothbrushing unpleasant.
• Many children report that toothpaste tastes bad and they are less likely to brush their teeth effectively as a result.
• A pacifier may help with the fussiness associated with acid reflux but it can lead to problems with tooth alignment later on.
• Fluoride, a key component of dental health may be lacking.
• Dental care may be overlooked in a child with overwhelming medical needs. There may be little time and money left to attend to dental health.
• Going to the dentist may be traumatic for a child with oral sensitivity, a strong gag reflex, swallowing difficulties, nausea and vomiting.
   

Question: What can be done to help my child with acid reflux?

Answer: There are many things parents can do. Your child should be seen by a dentist when his/her first tooth erupts or by 12 months of age. The dentist will advise you on proper brushing and preventative dental care. As soon as your child has teeth, begin brushing or wiping the teeth every day. Talk with your pediatrician about nutrition, fluoride, vitamins and minerals to develop healthy teeth. If your child needs frequent, small meals, minimize the amount of sugar served and wash/rinse or brush teeth after each meal. Remember to have your child rinse his/her mouth with a small amount of water or brush after taking medicine too. Some children with reflux need sealants on the surfaces of the teeth or a fluoride varnish to protect the teeth. Talk with your dentist about the best treatment for your child. Try several kinds of toothpaste to find a favor that is acceptable to your child with reflux. Remember, only a small dab of toothpaste is needed. Prescription brand toothpaste contains more fluoride and foams much less than regular toothpaste. Make tooth-brushing fun by providing appealing toothbrushes, cups and a low mirror so your child can see himself/herself brushing. Pretend play may allow a child to act out going to the dentist and lower stress.

Remember

• Schedule an appointment with a pediatric dentist as soon as the first tooth erupts. Brush or wipe teeth after meals and reflux episodes.
• Consult your child’s pediatrician or pediatric gastroenterologist about nutrition, diet and vitamins.
• Consult a pediatric dentist about proper tooth brushing and fluoride treatments.
  
  For information on pediatric dental care contact:
  
  American Academy of Pediatric Dentistry 211 East Chicago Ave., Ste. 700
  Chicago, IL, 60611
  312-337-2169
  www.aapd.org
  
  American Society of Dentistry for Children
  875 Michigan Ave, Suite 4040
  Chicago, IL, 60611-1901
  312-943-1244

Copyright PAGER Association 2005. Used with permission. Original document can be viewed at www.reflux.org