Acid Reflux (Gastroesophageal Reflux Disease)

Teeth are so hard you would think they would be indestructible and that they would not be adversely affected by anything. Due to the strength of enamel and bone, they should remain the same from the day the teeth come into the mouth to the day they are no longer needed. Unfortunately, this is far from true. While we would like the think of teeth as being strong and unchanging, most people know that teeth can be damaged by tooth decay-causing bacteria. We know, too, that teeth can be damaged by mechanical means—attrition caused by tooth grinding and clenching and abrasion caused by improper toothbrushing. However, few people know that there is a third factor that can destroy teeth—chemical erosion.

Chemical erosion is caused by excess acid coming in contact with a tooth for extended periods of time. The acid attack can be self-inflicted (bulimia) or more commonly from a problem with acid reflux. In acid (gastric) reflux, the acidic and partly digested contents of the stomach are returned back into the throat and oral cavity. Normally, the lower esophageal sphincter muscles (LES), connecting the esophagus with the stomach, closes once food passes into the stomach. This closure prevents the stomach contents from flowing back up into the esophagus. Acid reflux occurs when this sphincter does not work properly and allows acidic fluid to return to the esophagus and higher—the mouth.

This condition can actually be noted by a dentist long before it is acknowledged by a patient or physician. The dentist will see a characteristic smooth and circular erosion of the cusp tips of the lower first molars. The cusp tips (bumps on a tooth) lose their peak, flatten, and become concave. Soon the enamel cover is broached and the underlying dentin is exposed. Because dentin is “softer” than enamel, the erosion can progress more quickly. This acid erosion has a very different appearance from tooth loss due to a mechanical etiology. Attrition and abrasion have a very sharp, edged, and well-delineated look. Chemical erosion has a softer and more rounded presentation and is localized first to lower first molars (lower first molars are the first permanent molars to erupt into the mouth) so that the permanent teeth have the longest potential exposure. When the acid refluxes (returns) to the mouth, it pools mostly around the first lower molars. This is the site of the most erosive features.

A significant portion of the population experiences acid reflux at least once a month. About 25% of those who are affected are aware of their problem. Infants and young children can be affected, and there may be a genetic component to the disease. Early diagnosis from erosion of the permanent lower first molars can be made as early as 7 or 8 years of age. A hiatal hernia may weaken the LES and cause reflux. Diet and lifestyle contribute to acid reflux. Chocolate, peppermint, citrus, tomatoes, fried or fatty foods, coffee (especially acidic coffee), alcoholic beverages, garlic, and onions are foods to avoid. Weight gain (also weight gain associated with pregnancy) and smoking (by relaxing the LES) may be contributing factors. Further information may be obtained from the Internet by going to a search engine and typing in “acid reflux”, “gastric reflux”, or “gastroesophageal reflux disease (GERD)”.

As is true with most medical and dental problems, the earlier the diagnosis is made, the easier it is to treat. If we have brought this condition to your attention, we ask that you speak to your physician. Variable factors include the nature and severity of the problem, as well as frequency and type of fluid that refluxes from the stomach. Change in diet, eating habits, and/or medication (over-the-counter or prescription) can be effective. Dentally, once the enamel is broached and the dentin becomes visible, it is recommended that the affected areas be protected by covering them with an enamel replacement—a tooth-colored bonding material. This material not only protects the dentin and enamel but it also may be more resistant to the acid than is naturally occurring dentin. Many times, drilling preparation is not needed.

If you have any questions about acid reflux, please feel free to ask us!  

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Wisdom Teeth (Third Molars)

Human beings have more teeth than they actually need: four more teeth, to be exact. The third molars (wisdom teeth) are the last teeth on each side and in each arch of the mouth. If we don’t need them, why do we have them? Hundreds of thousands of years ago, our ancestors didn’t look a great deal like we do today. They had smaller bodies but larger and more powerful jaws. Their diet dictated this jaw structure and number of teeth. Our ancestors ate tougher and more abrasive types of food. It wasn’t cooked well, and it wasn’t ground up well. There were a lot of hard grains and foods that required lots of chewing. Big jaws were capable of holding more teeth for this chewing.

Today, we don’t need the heavy grinding capacity that early humans had. Food is easier to eat, less abrasive, and much softer. Evolution is reacting (slowly) to this fact by decreasing the size of our jaw bones and chewing muscles. The human jaw that once comfortably held 12 molars (32 teeth total) is now often only large enough to hold eight molars (28 teeth total). Unfortunately, our jaws are getting smaller faster than our wisdom teeth are disappearing. The wisdom teeth often do not have enough room to grow properly. Eventually, thousands of years from now, humans will not have wisdom teeth. They have lost their function and are gradually disappearing, just like the appendix.

Since the jaw is too small (for most people) to accommodate the third molars, they come into the mouth partially, poorly positioned, or not at all. They can be fully erupted, partially erupted, a soft tissue impaction, partial bony impaction, or full bony impaction. If teeth come in well and you are able to keep them clean, we leave them alone. If they are crowded or poorly positioned and cannot be kept clean, they are like an accident waiting to happen. Decay and gum infection are likely to result. These teeth are usually removed—ideally before they begin to cause big problems with the second molars that are directly ahead of them. Teeth that are partially erupted should always be removed: there is too much opportunity for gum infection to begin. If the teeth cannot be cleaned, chronic painful inflammation may occur (pericoronitis). The earlier they are removed, the better your healing will be.

Less complex extractions (fully erupted teeth or partial soft tissue impactions) can be done by a general dentist. We will refer difficult extractions to an oral surgeon for treatment. Depending on the type of extraction and the medical history of the patient, the extractions may be done in an office or in the hospital. This will be determined after viewing radiographs of the teeth. Having all four wisdom teeth out at the same time is a common practice. Postoperative discomfort can be minimal to extreme—in the case of difficult full bony impactions. Antiinflammatory and pain relief medications are prescribed appropriately.

We do not need wisdom teeth to eat well. If they need to come out, it is better they come out (1) before they cause problems with the adjacent teeth that you really need and (2) when you are younger and heal well. If you need to have one wisdom tooth taken out, also have the opposing wisdom teeth removed. When a tooth does not meet an opposing tooth, it “super erupts” or continues to grow out of the normal position. When left for some time, the remaining tooth can develop decay and gum disease and cause the same thing to happen to the tooth in front of it.