When you think about the causes of damaged teeth, you probably think about things like sugary foods or bad dental hygiene. However, as a dentist, one of the most common causes of damaged teeth I see is acid reflux.
Acid reflux is a condition that is exactly as it sounds. It’s when acid from the digestive system enters the esophagus causing discomfort. When it becomes more severe, it falls under a broader condition called GERD (gastro-esophageal reflux disease).
Some symptoms include:
- heartburn (chest pain after eating)
- acid reflux (where stomach acid comes back up into your mouth and causes an unpleasant, sour taste)
- sore throat
- bad breath
- bloating and belching
- tooth erosion or acid wear
- pain when swallowing
If any of these symptoms sound familiar, you’re not alone. Up to 60 percent of the population at some time during the year, experience symptoms of reflux disease, such as heartburn and acid regurgitation.
One of the most common approaches to deal with pesky acid reflux Is to use antacids. These may include medications known as proton pump inhibitors.
But while acid reflux sounds straightforward, the real cause is a bit more complicated than just too much acid. When we understand the root cause of acid reflux, then the use of antacids may not be helping and could make the condition worse.
Symptoms and side-effects of acid reflux
As a dentist, the long-term consequences of GERD symptoms can often be witnessed in the mouth. I’ve seen many patients that take antacids such as proton pump inhibitors, yet their acid reflux doesn’t heal.
Long term acid reflux has many side-effects:
- The low pH in the oral cavity due to the overflow of acid from the digestive system leads to tooth erosion and wear
- Tooth wear due to acid reflux may be identified as a loss of height of the teeth. Other presentations include wear of tooth surfaces on the inside of the teeth or palate.
- Patients often experience bad breath that seems to originate from the digestive system.
What is the root cause?
All of these conditions have one common underlying process. Acid balance in the mouth is controlled by the microbes in the mouth. The mouth is in direct communication with our gut microbiome. When we lose the balance of the digestive microbiome, we become more prone to infection with pathogens such as H.pylori.
Digestive imbalances are then relayed back to the mouth where enamel erosion can result.
The role of digestive and gut imbalance
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Ironically, while acid reflux is often thought to be caused by high stomach acid, oftentimes it can be due to low stomach acid, which also results in similar symptoms and sensations such as heartburn. The mechanism is that H.pylori has the ability to disable our release of stomach acid.
The problem with suppressed stomach acids is that low pH is used as a defense against certain bacteria. Bacterial overgrowth (SIBO for example) may be due to a lack of stomach acid in the first place.
When there is an overgrowth of the wrong species in the digestive system, improper digestion can occur. This can cause gas buildup and intra-abdominal pressure. We know that intra abdominal pressure is related to acid reflux or GERD.
So acid reflux is likely a bacterial imbalance, that may be due to LACK of stomach acid. This is why antacids don’t address the root cause of acid reflux. may make acid reflux worse.
H.pylori, gut health, and tooth erosion
Your tooth enamel is managed by the oral microbiome and internal mineral balances. It’s the hardest surface in the body and is in constant ion exchange in your mouth.
The pH of the mouth is governed both by bacteria and saliva. When there is a H.pylori infection in the digestive system, long term imbalance may also colonize the oral microbiome.
Recent studies have shown that the mouth is a common place to find H. Pylori.
In addition to causing problems for your stomach and GI tract, H. Pylori causes dental disease. H.pylori is present in the oral microbiome during gum disease. Bleeding gums or gum disease may be a sign of H.pylori infection in the mouth.
Treatments may focus on removing H.pylori from your stomach, but it will keep returning from your mouth. This means that you will be trapped in a never-ending cycle. Getting rid of your H. Pylori must include removing it from your mouth.
5 steps to heal your mouth and gut from reflux
Tooth erosion is a sign of long-term acid reflux caused by digestive imbalances. When the disease process has led to tooth erosion, it indicates long standing infection.
Here’s an approach you should take to heal your gut and oral microbiome.
1. Go for a full dental check-up and periodontal assessment to eliminate H.pylori colonization in the mouth
2. Get a complete digestive check-up, including a food intolerance test
3. Take an anti-microbial: bitter herbs are an excellent natural remedy to remove the infection in your digestive system:
- Gentian root
- Globe artichoke
4. Include dietary probiotics into your meals: The best form of probiotic will be a fermented vegetable or water kefir. They have fewer carbohydrates in comparison to fermented dairy for example and may help balance the gut microbiome.
5. Heal the gut lining by eating lots of collagen. This includes plenty of bone broths which contain the amino acids proline and glutamine that help to heal the intestinal cells.
Dr. Steven Lin is currently the Principal Dentist at Luminous Dentistry, a dental practice on the Central Coast of New South Wales, Australia, that strives to give individuals of all ages the best possible smile.
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