Table 2. Studies investigating the relationship between reflux and dental disorders.
| References | Design | EL | Patients characteristics | Reflux diagnosis | Outcome association | Results | Main findings |
|---|---|---|---|---|---|---|---|
| Meurman [23] |
Prospective | B | Gr1: 28 erosion + | 1. GERD symptoms | Ass. mucosal changes & Reflux | - | Patients with dental erosion have a higher score at the Maratka classification (reflux severity) compared with Individuals without erosion. There are no mucosal and saliva changes associated with reflux. |
| Controlled | Gr2: 89 erosion - | 2. In some patients: | hygiene | Gr1>Gr2 | |||
| Gender: 78M/39F | Single-probe pH study | Saliva buffering capacity, viscosity and flow rate. |
Gr1 = Gr2 | ||||
| Age: 54–49 yo | Johnson & DeMeester | Gr1 = Gr2 | |||||
| Schroeder [24] |
Prospective | B | Gr1: 12 erosion + | 1. GERD symptoms | Prevalance GERD—LPR | Gr1: N = 9 & 7 | Patients with GERD or LPR at the dual-probe pH metry had a higher proportion of dental erosion. The propor- tion of dental erosion was particularly higher in LPR. There were no saliva disorders associated with reflux. |
| Controlled | Gr2-3: 10 LPR-10 GERD | 2. Dual-probe pH metry | Saliva: pH, flow rates, buffering capacity, Ca2+ & Phosphorus level |
Gr1: N = 0 | |||
| Gr4: 10 CT | |||||||
| Gender & Age: N.A. | Dental erosion (Gr2, 3, 4) | N = 7; 4; 1 | |||||
| Gudmundsson [25] |
Prospective | C | N = 14 erosion | 1. Dual-probe pH metry | Esophagitis GI endoscope (N = 12) | N = 9 | 75% of patients with dental erosion and who benefited from GI endoscopy had esophagitis. |
| Uncontrolled | Gender: 12M/2F | ||||||
| Age: 8–39 yo | |||||||
| Bartlett [26] |
Prospective | B | Gr1: 36 palatal erosion | 1. GERD symptoms | Distal reflux episodes | N = 23 | 64% of patients with dental erosions had GERD at the pH monitoring (pH<4, 4% of time). Patients with acid pH in distal esophagus had lower oral pH. The acid oral pH was associated with a higher tooth wear index. |
| Controlled | Gr2: 10 CT | 2. Dual-probe pH metry | Relation between: | ||||
| Gender: N.A. | Johnson & DeMeester | Esophageal distal & oral pH | + | ||||
| Age: 15–74 yo | TWI & acid oral pH | + | |||||
| Loffeld [27] |
Retrospective | C | N = 198 GERD | 1. GERD symptoms | Upper incisor damage (%) | 32.5% | GERD patients have a higher % of incisor damage. The duration of complaints was positively associated with the presence of upper incisor damage. |
| Gender: 118M/80F | 2. Reflux esophagitis | Lower incisor damage (%) | 7.8% | ||||
| Age: 17–93 yo | Lower & upper incisor damage (%) | 26.9% | |||||
| Jarvinen [28] |
Prospective | C | Gr1: 20 esophagitis + | 1. GERD symptoms | Dental erosion prevalence (Gr1-2) | N = 4; 0 | 20% of patients with esophagitis have dental erosion. |
| Uncontrolled | Gr2: 48 esophagitis - | 2. Reflux esophagitis | |||||
| Gender & Age: N.A. | |||||||
| Gregory-Head [29] |
Prospective | B | Gr1: 10 GERD—Gr2: 10 CT | 1. GERD symptoms | TWI score | GERD>CT | Tooth wear index score was significantly higher in patients with GERD compared with patients with GERD-symptoms and no reflux at the pH monitoring. |
| Controlled | Gender: N.A. | 2. Dual-probe pH metry | Mandibular surface involvement | GERD>CT | |||
| Age: 18–69 yo | Johnson & DeMeester | Maxillary surface involvement | GERD>CT | ||||
| Munoz [30] |
Prospective | B | Gr1: 181 GERD | 1. GERD symptoms | Dental erosion prevalence | GERD>CT | The % and severity of dental erosion was higher in GERD patients compared with controls. There were no differences between groups about the periodontal status. |
| Controlled | Gr2: 72 CT | 2. GI endoscopy | Periodontal statuts: | ||||
| Gender: 71M/110F | 3. Single-probe pH metry | Plaque index, hemorrhagic index, Gingival recessions |
GERD = CT | ||||
| Age: 48 yo | GERD = CT | ||||||
| Moazez, 2005 [12] |
Prospective | B | Gr1: 31 LPR—Gr2: 7 CT | 1. LPR symptoms | % of distal pH<4 | LPR>CT | The proportion of palatal tooth wear was higher in patients with a high number of pharyngeal reflux episodes compared with controls. |
| Controlled | Gender: 19M/12F | 2. Dual-probe pH metry | % of pharyngeal pH<5.5 | LPR>CT | |||
| Age: 43 yo | Ass. tooth wear & objective LPR | + | |||||
| Oginni [31] |
Prospective | B | Gr1: 125 GERD | 1. GERD symptoms | Impaired TWIs & Gr differences | Dental erosion is significantly more prevalent in GERD patients compared with CT. | |
| Controlled | Gr2: 100 CT | 2. Reflux esophagitis | GERD patients | 16%; GERD>CT | |||
| Gender: 57M/68F | CTs | 5% | |||||
| Age: 38 yo | |||||||
| Holbrook [32] |
Prospective | C | N = 91 erosion & GERD | 1. GERD symptoms | Low salivary buffering | 10.4% | 10% of suspected GERD patients had low salivary buffering capacity, which was associated with dental erosion. |
| Uncontrolled | symptoms | Ass. LSB & erosion | + | ||||
| Gender & Age: N.A. | Low esophageal pH | 17.7% | |||||
| Filipi [33] |
Prospective | C | N = 24 GERD | 1. GERD symptoms | Buffering capacity reduction | N = 13 | Patients with a long history of GERD had a higher risk of caries and erosions compared with short GERD history patients. 54% had buffering capacity disorder. |
| Uncontrolled | Gender: 7M/17F | 2. Single-probe pH metry | Caries & erosion prevalences | long GERD history> short GERD history |
|||
| Age: 46 yo | Johnson & DeMeester | ||||||
| Correa [13] |
Prospective | B | Gr1 = 30 GERD—Gr2 = 30 CT | 1. LPR symptoms | Dental erosion number & severity | GERD>CT | GERD patients have a higher number (and severity) of dental erosion than CT. The saliva buffering capacity is abnormal in GERD patients. |
| Controlled | Gender: 10M/20F | 2. Single-probe pH metry | Saliva buffering capacity | CT>GERD | |||
| Age: 33 yo | 3. GI endoscopy | ||||||
| Yoshikawa [34] |
Prospective | B | Gr1 = 40 GERD | 1. GERD symptoms | Decayed missing filled index | GERD>CT | Oral symptoms in GERD are likely to be associated with impaired salivary flow volume. GERD patients have a higher number of decay, erosion, and gingival disorders compared with CT. |
| Controlled | Gr2 = 30 CT | Montreal criteria | Papillary, marginal, attached index | GERD>CT | |||
| Gender: 21M/19F | Oral Hygiene Index | GERD>CT | |||||
| Age: 69 yo | Dental erosion prevalence (GERD) | 24.3% | |||||
| Salivary flow volume | CT>GERD | ||||||
| Song [35] |
Retrospective | B | Gr1 = 280 periodontis | 1. GERD symptoms | Ass. GERD & Periodontis | + | GERD is a risk factor for developing caries and chronic periodontis. |
| Gr2 = 280 CT | Montreal criteria | Ass. GERD & caries | + | ||||
| Gender: 140M/140F | |||||||
| Age: 49 yo | |||||||
| Alavi [36] |
Prospective | B | Gr1 = 31 GERD—Gr2 = 71 CT | 1. GERD symptoms | GERD dental erosion prevalence | 22.6% | 22.6% of GERD patients had dental erosion, which was significantly higher compared with CT. |
| Controlled | Gender: N.A. | 2. Reflux esophagitis | CT dental erosion prevalence | 7% | |||
| Age: 30–50 yo | Comparison GERD vs CT | GERD>CT | |||||
| Deppe [37] |
Prospective | C | N = 71 GERD/NERD | 1. GERD symptoms | Oral mucosa erythema/ulcer | N = 19 (27%)–0 (0%) | 27% of GERD patients have oral mucosa acidic irritation. |
| Uncontrolled | Gender: 30M/41F | 2. Reflux esophagitis | Acidic palatal mucosa lesions | N = 10 (14%) | |||
| Age: 50 yo | Acidic tongue mucosa lesions | N = 4 (6%) | |||||
| Wilder-Smith, [38] |
Prospective | C | N = 374 erosion + | 1. GERD symptoms | MII-pH GERD prevalence | 69% | 69% of patients with dental erosion had GERD at the MII-pH. There was no significant association between reflux characteristics and dental erosion severity. |
| Uncontrolled | Gender: 222M/127F | 2. Acid reflux (MII-pH) | |||||
| Age: 35 yo | |||||||
| Vinesh [39] |
Prospective | C | N = 142 GERD | 1. GERD symptoms | Dental erosion (%) | 44.0% | Dental erosion, periodontitis and gingivitis are the most prevalent dental disorders found in GERD patients. |
| Uncontrolled | Gender: N.A. | Periodontis (%) | 25.5% | ||||
| Age: N.A. | Gingivitis—gingival ulcer (%) | 9.9%–2% | |||||
| Gingival or palatal erythema (%) | 5.7%–2.8% | ||||||
| Mouth floor erythema (%) | 1.4% | ||||||
| Milani [40] |
Prospective | B | Gr1 = 143 GERD | 1. GERD symptoms | GERD dental erosion prevalence | 25.9% | GERD patients had a higher prevalence of dental erosion compared with CT. |
| Controlled | Gr2 = 274 CT | CT dental erosion prevalence | 17.2% | ||||
| Gender: 43M/100F | Comparison GERD vs CT | GERD>CT | |||||
| Age: 43 yo | |||||||
| Watanabe [11] |
Retrospective | C | Gr1 = 105 GERD | 1. GERD symptoms | Salivary flow volume | CT>GERD | Oral soft tissue disorders, dental erosions and caries are associated with GERD. |
| Gr2 = 50 NER | 2. GI endoscopy: | PMA Index scores | GERD>CT | ||||
| Gender: 57M/48F | Gr1: reflux esophagitis | OHI-S | GERD>CT | ||||
| Age: 66 yo | Gr2: non-erosive reflux | Decay indices | GERD>CT | ||||
| Warsi [41] |
Prospective | C | N = 187 GERD | 1. GERD symptoms | Oral submucous fibrosis (%) | 66.3% | 35.3% of GERD patients have dental erosion. Nausea, vomitting, esophagitis, xerostomia, ulcer, gingivitis, & angular cheilitis were associated with GERD. |
| Uncontrolled | Gender: 109M/78F | 2. GI endoscopy | Oral ulceration (%) | 59.4% | |||
| Age: N.A. | 3. Reflux esophagitis | Dental erosion prevalence (%) | 35.3% | ||||
Abbreviations: Ass. = association; CT = control(s); EL = evidence level; GERD (s) = gastroesophageal reflux disease (symptoms); GI = gastrointestinal; Gr = group; LPR = laryngopharyngeal reflux; LSB = low salivary buffering; M/F = male/female; MII-pH = multichannel intraluminal impedance pH-monitoring; N.A. = not available; NER = non-erosive reflux; OHI-S = Simplified Oral Hygiene Indice; PMA = Papillary Marginal Attached; TWIs = tooth wear index score; yo = years old.