Some people with acid reflux disease develop complications in the mouth, throat or lungs, which may include wearing away of tooth enamel as well as asthma, chronic cough, hoarseness and laryngitis. Vomiting brings stomach acid into the mouth as well. If your dentist asked whether you have been sick a lot and the answer is no, reflux is still worth raising with your dentist and your own doctor, because you can have reflux disease without having heartburn.
Enamel, and what a dental exam can find
The part of a tooth you can see is the crown, and the outer surface of the crown is enamel. Just beneath the enamel is dentin, a substance harder than bone, and the root holds the blood vessels and nerves that supply blood and feeling to the whole tooth. Enamel is the layer that acid from reflux or vomiting wears away.
A dentist can find tooth decay you have not felt, because early tooth decay does not usually cause any symptoms, and tooth decay can be found during a regular dental check-up. Signs of tooth decay include white, brown or black staining on the tooth, and decay that is more advanced may form a hole, or cavity. A dentist can also check the teeth for soft or sticky areas, or take an x-ray, which can show decay. As tooth decay advances, it can cause a toothache or make a tooth sensitive to sweets, hot or cold.
Acid wear can show up at a dental exam too. In bulimia, an eating disorder in which regular episodes of eating a very large amount of food are followed by purging, such as vomiting or laxatives, to prevent weight gain, the enamel of the teeth may be worn away or pitted because of too much exposure to the acid in vomit. The same exam may show cavities or gum infections.
How does stomach acid reach a tooth?
Your esophagus is the tube that carries food from your mouth to your stomach. Reflux happens when the muscle at the end of your esophagus does not close properly, so stomach contents can move back up and irritate the esophagus. Having reflux occasionally is common. If you have symptoms at least twice a week, or they damage the lining of your esophagus, you may have gastroesophageal reflux disease, known as GERD. Its most common symptom is heartburn, a burning feeling in your chest or throat, and other symptoms may include tasting acid or food in the back of your mouth, a dry cough or hoarse voice, asthma-like symptoms and trouble swallowing.
Problems swallowing, or pain while swallowing, can be a reflux symptom and could also be related to complications of reflux disease or other serious health problems, so see your own doctor about either one (see Heartburn at night, and the warning signs that need a doctor).
When stomach contents come up through your esophagus and into your throat or mouth, which is called regurgitation, they may leave you tasting food or stomach acid, and your teeth meet that acid too.
The acid in tooth decay comes from somewhere else: when decay-causing bacteria come into contact with sugars and starches from foods and drinks, they form an acid that can attack the enamel and cause it to lose minerals. When a tooth is repeatedly exposed to acid, such as when you often have food or drink high in sugars and starches, the enamel continues to lose minerals.
Can worn enamel or early decay still be fixed?
Tooth decay has a stage at which it can still be turned back. A white spot may appear where minerals have been lost, and it is a sign of early decay. At that point decay can be stopped or reversed: enamel can repair itself using minerals from saliva and fluoride, from toothpaste or applied by a dentist or dental hygienist. If more minerals are lost than can be restored, the enamel weakens and eventually breaks down, forming a cavity. Dentists commonly treat a cavity by filling it: they remove the decayed tooth tissue and restore the tooth with a filling material.
Ask your dentist whether what they saw is acid wear alone, early decay that fluoride can still reverse, or a cavity, and what can be done about enamel that acid has already worn away.
If reflux brings the acid up, most people can manage reflux disease with lifestyle changes and medicine, and in rare cases surgery is needed. The lifestyle changes can include:
- eating smaller meals
- waiting at least 2 to 3 hours after eating before you lie down
- avoiding foods that bring on your symptoms, such as spicy foods, chocolate, caffeine or fatty foods
- raising the head of your bed
- quitting smoking
To help prevent tooth decay, you can:
- brush your teeth twice a day with a fluoride toothpaste
- drink tap water that has fluoride, or use a fluoride mouth rinse
- clean between your teeth regularly with floss or another between-the-teeth cleaner
- limit sugary drinks and foods high in sugars and starches, and limit snacking
- avoid tobacco products, including smokeless tobacco
- see a dentist for regular check-ups and professional cleanings
Dry mouth, saliva and your teeth
Saliva contains minerals such as calcium and phosphate that help keep teeth strong and fight tooth decay, and early decay can be repaired with minerals from saliva. Saliva also washes food particles away from the teeth and gums. Dry mouth increases the risk of tooth decay, and of fungal infections in the mouth, because saliva helps keep harmful germs in check.
If you have been vomiting, the dryness may come from that: vomiting can leave you dehydrated, and a dry mouth is one symptom of dehydration in adults.
Dry mouth has several possible causes, including:
- side effects of some medicines, since hundreds of medicines can cause the salivary glands to make less saliva, and medicines for high blood pressure, depression and bladder-control issues often cause dry mouth
- Sjögren's disease, HIV/AIDS and diabetes
- radiation therapy, chemotherapy and immunotherapy for cancer
- nerve damage from an injury to the head or neck
If you think you have dry mouth, see your dentist or doctor to find out why your mouth is dry. They will review your medical history and ask about any medications you take, and may suggest blood tests or a test that measures how much saliva you produce. Meanwhile, these can relieve the dryness:
- drinking plenty of water, and sipping water or a sugarless drink during meals
- avoiding or limiting drinks with caffeine, such as coffee, tea and some sodas
- chewing sugarless gum or sucking on sugarless hard candy to get saliva flowing
- not using tobacco or alcohol
- using a humidifier at night
Spicy or salty foods may cause pain or a burning sensation in a dry mouth. Some sugarless chewing gums and candies contain xylitol and may help prevent cavities.
Your answer to the dentist, and who else to tell
If you have been sick a lot, tell your dentist, and say roughly how often. If some of that vomiting is something you bring on yourself, or you are worried about the way you eat, talk to a primary care provider, such as your own doctor, who can refer you on to a psychologist, psychiatrist, clinical social worker or other qualified mental health professional. Over time, bulimia nervosa can lead to serious health consequences, including worn tooth enamel and increasingly sensitive and decaying teeth, a chronically inflamed and sore throat, and swollen salivary glands in the neck and jaw area, and with treatment people can recover from eating disorders.
If you have not been sick, tell your dentist that, and ask whether reflux could explain what they see. If you think you may have reflux disease, see your own doctor, and mention the dentist's finding along with any sour taste, cough or hoarseness you have noticed.
Signs that mean calling 911, your dentist or your own doctor
Heartburn burns in the chest, but chest pain that comes with shortness of breath, or pain in your jaw or arm, can signal a heart problem. Get medical help right away for any one of them: go to an emergency department or call 911.
Blood in the vomit, dark material in it the color of coffee, or vomiting you think comes from poisoning means calling 911 or going to an emergency room. Any one of the signs below means contacting your doctor's office right away, or going to an emergency room if you cannot reach the office (see Can't keep fluids down for 12 hours? Contact a provider right away):
- vomiting for longer than 24 hours
- no fluids kept down for 12 hours or more
- a headache or a stiff neck
- not urinating for 8 hours or more
- severe pain in your stomach or belly
- vomiting 3 or more times in 1 day
An infected tooth can form an abscess, a pocket of pus that may cause pain, facial swelling and fever, and untreated abscesses may get worse and can lead to life-threatening complications. Contact your dentist if you have a throbbing toothache that does not go away, or if you notice a bubble or pimple on your gums. That is pain in a tooth; pain in your jaw or arm, with or without chest pain, is the heart sign that goes to 911 or an emergency room.
As a NicoCares patient, let your care team know promptly about the dentist's finding, and how often you have had reflux or vomiting, by messaging them on Spruce, where your care team answers patients. Because NicoCares does not say how soon a Spruce message is answered, the signs above go to 911, an emergency room, your dentist or your doctor's office instead.
