Skip to main content

Dental erosion caused by gastroesophageal reflux disease: a case report



Chronic regurgitation of gastric acids in patients with gastroesophageal reflux disease may cause dental erosion, which can lead in combination with attrition or bruxism to extensive loss of coronal tooth tissue.

Case presentation

This clinical report describes treatment of severe tooth wear of a gastroesophageal reflux disease patient who is 54-year-old Turkish male patient. After his medical treatment, severe tooth wear, bruxism and decreased vertical dimensions were determined. The vertical dimension was re-established and maxillary and mandibular anterior and posterior teeth were prepared for metal-ceramic restorations. Metal-ceramic fixed partial dentures were fabricated as full mouth restorations for both maxillary and mandibular arches because of splinting all teeth. And then maxillary stabilization splint was fabricated for his bruxism history.


Significant loss of coronal tooth structure must taken into consideration. Gastroesophageal reflux disease by itself or in combination with attrition, abrasion or bruxism may be responsible for the loss. An extensive diagnostic evaluation is essential for the medical and dental effects of the problem.


Gastroesophageal reflux disease (GERD), is defined as involuntary muscle relaxing of the upper esophageal sphincter, which allows refluxed acid to move upward through the esophagus into the oral cavity [1]. Dental erosion has been reported with varying prevalences in the population and may be as high as 42% [2]. In adults, GERD is a highly prevalent disease with rates ranging from 21% to 56% in different countries [3]. It is difficult to compare prevalence studies because of the different indices used in the various studies and also because of the different teeth assessed in the sample [4].

It was reported that GERD was diagnosed by endoscopy, where visual identification of mucosal inflammation and oseophagitis was used to identify the existence of GERD [5]. The degree of erosion will depend upon how long the disease has been present and the frequency and quantity of regurgitation. Other causes of erosion such as dietary acids should also be considered [6]. Several factors are known to contribute to enamel erosion. It occurs at a pH of approximately 5.5, which is on the acidic side of the neutral point, and may vary depending on the concentrations of calcium and phosphate ions with the saliva [7]. If wear from other factors such as attrition is occurring at the same time as the erosion the tooth wear will be increased [8]. Combinations of erosion, attrition and abrasion are synergistic [9] and may be responsible for the lost tooth structure. The clinical appearance of the various sub-types of tooth wear can vary. Attrition in its purest form is typified by flattened occlusal surfaces which almost appear as if someone has filled the teeth with sandpaper. The presence of hypertrophic masseter muscles is another warning sign of the impact of bruxism. Erosion from dietary or gastric acids forms smooth lesions which typically appear as cupped occlusal/incisal and concave buccal/facial surfaces. When erosion is the dominant factor, the buccal and lingual surfaces of the upper incisors appear smooth and shiny with a generalised loss of anatomy. The tooth surface continually changes as the acid partially dissolves the outer layer of enamel or dentine which then becomes more susceptible to abrasion or attrition [10].

It is recognized that refluxed acid attacks the palatal surfaces of the upper incisor teeth first, later, if the condition continues, erosion of the occlusal surfaces of the posterior teeth in both arches and the labial or buccal surfaces results from an extended period of acid reflux [11, 12]. It is suggested that the force of the regurgitation passing from the pharynx into the mouth propels the gastric fluid forward and causes damage first to the palatal surfaces of the maxillary teeth. In addition, the palatal surfaces are also relatively remote from the major salivary glands and the tongue may also be involved by maintaining contact of the gastric fluid against the palatal surfaces of the teeth. The lower teeth are not affected in the early stages as the tongue provides some protection [13]. In more severe cases however, the protection from the tongue is overwhelmed and the pattern of erosion may be more widespread, usually with the occlusal and buccal surfaces of the lower teeth being eroded next [11].

A simplified wear index has been proposed to define wear on four levels; no wear, enamel exposure, mild and severe dentine exposure. The classification is not only dependent upon the severity of the wear but also the age of the patient [14].

The authors concluded that patients diagnosed with GERD were at a high risk of developing dental erosion. The buffering capacity of the stimulated saliva from the control subjects was significantly greater than patients with symptoms of GERD [15]. Also, subjects diagnosed with GERD had significantly higher tooth wear index scores compared with control subjects [2, 15]. A number of case reports have identified gastroesophageal reflux as the likely cause of tooth wear [3, 16]-[18]. In contradictory, it was shown that there was no correlation between GERD and clinical parameters [19]-[20] but, morphometric analysis of the palatal epithelium in GERD patients showed a statistically significant difference from the healthy control group in the study [19]. The results of morphometric analysis showed a significant difference between groups with respect to luminal and basal surface ratio, thickness of epithelium, and amount of fibroblasts/mm3. The smaller the value of the relationship between the basal surface and the external surface, the more severe the aggression received by the epithelium. The values obtaied represent an irritation of the palatal epithelium, which in turn is reflected by a deepening of the epithelial crests in the connective tissue and of the connective papillae in the epithelium. Individuals with the more severe cases of reflux have a more compromised epithelium [19].

Oral symptoms associated with GERD are burning mouth syndrome, dental sensitivity, loss of vertical dimension, and esthetic problems [18]. Tooth wear is a multifactorial process. The impact of wear is usually progressive but can be slow. The wear results in shortened clinical crowns and in conjunction with alveolar compensation complicates treatment [10].

This case report presents the clinical findings, diagnosis, medical and dental rehabilitation of a patient with GERD with severe tooth erosion.

Case presentation

A 54-year-old Turkish man came to our clinic Department of Prosthetic Dentistry, 19 Mayis University, Faculty of Dentistry with the lack of esthetics and function of his teeth. In his medical examination he had gastroesophageal reflux disease history for about 4-5 years and had paid no attention because of any symptoms affecting his life. Also, brushing teeth behaviour was once a day and bruxism history was present. In his clinical examination there was generalize dental erosion including dentin on the occlusal, buccal and palatinal surfaces of maxillary teeth; occlusal and buccal surfaces of mandibular teeth and cervical lesions were seen (Figures 1, 2 and 3) (Smith and Knight Wear Index, Score 3-4) [14]. The questionnaire detailed the patient's possible exposure to etiologic factors associated with dental erosion, including ingestion of citrus fruits, vinegar and carbonated drinks. The patient did not admit to ingest high consumption of acidic foods and drinks.

Figure 1
figure 1

Pre-op intraoral front view in occlusion.

Figure 2
figure 2

Pre-op intraoral occlusal view of upper arch.

Figure 3
figure 3

Pre-op intraoral occlusal view of lower arch.

Impressions of both arches were made with irreversible hydrocolloid (Cavex Impressional, Cavex Holland BV: Haarlem, The Netherlands) and poured with a type V dental stone (Glastone 3000, Dentsply International Inc, PA 17405-0872, USA). After determining the occlusal vertical dimension with mounted diagnostic casts and face dimensions, there was decreased vertical dimension. Diagnostic casts were mounted on a semi-adjustable articulator (Stratos 300; Ivoclar Vivadent AG FL-9494 Schaan Liechtenstein, Austria) using a face-bow transfer (UTS3D; Ivoclar Vivadent AG FL-9494 Schaan Liechtenstein, Austria) and a centric relation record (Memosil 2, Heraues Kulzer GmbH Grüner Weg 11-63450 Hanou, Germany). First of all the patient was referred to a gastroenterologist. The epithelial irritation of esophagus was reported in the endoscopic examination and results confirmed GERD. The appropriate pharmacologic agent has been prescribed and the GERD was controlled. After the medical treatment, a maxillary acrylic resin (Vertex Orthoplast, Vertex Dental, Zeist, The Netherlands) splint was fabricated with flat occlusal scheme for the increase of vertical height and for protection of the teeth against further gastric acid and bruxism. Acrylic resin was applied in 1 mm and 2 mm increments to the occlusal surface of the splint over a 30 day period to establish a 3 mm increase in occlusal vertical dimension (OVD). No complaints like muscle pain or discomfort and difficulty in function occurred after the increase in OVD. After re-establishing the vertical dimension, maxillary and mandibular anterior and posterior teeth that were restored with resin-based composite restorations (Filtek Z250; 3M ESPE AG Dental Products, D-82229 Seefeld, Germany) were prepared for metal-ceramic restorations, and laboratory-processed provisional restorations (Luxatemp, DMG 22547 Hamburg, Germany) were fabricated at the new OVD and cemented with zinc-oxide eugenol (Temp-Bond; Kerr Corp). A full contoured wax-up on the mounted casts made it possible to evaluate tooth dimensions to achieve optimal esthetics. Definitive impressions of the prepared maxillary and mandibular teeth were obtained using polysiloxane impression material (Elite HD+, Zhermack 45021, Rouigo, Italy). Working casts were generated from Type IV die stone and mounted into the articulator using interocclusal records. Shade determination (Vita 3D; VITA Zahnfabrik, Bad Sackingen, Germany) was made. Metal-ceramic fixed partial dentures (Wiron 99; Bego,Bremen, Germany/Vitadur Alpha; VITA Zahnfabrik, Bad Sackingen, Germany) were fabricated as full mouth restorations for both maxillary and mandibular arches because of splinting all teeth, evaluated intra-orally, and adjusted (Figures 4, 5, 6, 7 and 8). Because of the diurnal and nocturnal bruxism history of the patient, teeth restored with crowns could be subject to move. The adjacent crowns were splinted to give more support to individual teeth. On the other hand, the patient was clearly informed of the importance of oral hygiene by giving more attention using proximal brushes and dental floss. For lateral movements group disclusion achieved so that masticatory loads would be uniformly distributed on the reconstructed teeth. The full-mouth restorations were cemented with glass-ionomer cement (Meron, Voco, Cuxhaven, 274457, Germany). Also, for bruxism history a laboratory-processed maxillary stabilization splint prescribed for nighttime use was fabricated, adjusted and placed (Vertex Orthoplast, Vertex Dental, Zeist, The Netherland) (Figure 9). The patient was followed up for 2 years without any complaints. The patient' s esthetic and functional expectations were also satisfied.

Figure 4
figure 4

Post-op intraoral front view in occlusion.

Figure 5
figure 5

Post-op intraoral right lateral view in occlusion.

Figure 6
figure 6

Post-op intraoral left lateral view in occlusion.

Figure 7
figure 7

Post-op intraoral occlusal view of upper arch.

Figure 8
figure 8

Post-op intraoral occlusal view of lower arch.

Figure 9
figure 9

Post-op frontal view with stabilisation splint.


Contemporary dentistry offers many treatment options, from conservative to invasive for tooth loss: direct resin composite restorations, laboratory-made adhesive restorations (resin composite, all-ceramic and metal alloys), laboratory-made full crown restorations (metal, metal-ceramics and all ceramics). An acidic environment affects the solubility of dental hard tissue. Gastric contents may have an acidity below pH 1; regurgitation therefore can have a severe demineralizing effect on tooth structure and restorative materials [21]. It was reported that the posterior composite and poly-acid modified composite were effected with respect to surface changes following exposure to simulated gastric juice [22]. Under oral conditions, in the absence of mechanical forces, chemical process or dissolution can produce an increase of surface roughness. These undesirable damages have been associated with the chemical degradation of the surface and subsurface, which may involve either the resin matrix, the filler, or the matrix-filler interface [23]. Due to these facts, metal-ceramic fixed partial dentures was planned for our patient. In his anamnesis, he had paid no attention because of any symptoms affecting his life. But his endoscopic examination showed epithelial irritation.of esophagus and confirmed as silent GERD . Silent GERD is defined as gastric reflux without symptoms such as belching, unexplained sour taste or heartburn [17]. Our patient is with long-standing GERD and may become symptom free but may continue to reflux. Also, due to his neglect for the medical treatment in his history, we assumed him as a self-medicate patient.


This clinical report describes the dental treatment of a GERD patient by fabricating metal-ceramic fixed partial dentures after his medical diagnosis and treatment.


Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.



Gastroesophageal Reflux Disease


Occlusal Vertical Dimension.


  1. Bartlett DW, Evans DF, Smith BG: Oral regurgitation after reflux provoking meals: a possible cause of dental erosion?. J Oral Rehabil. 1997, 24: 102-108. 10.1046/j.1365-2842.1997.d01-267.x.

    Article  CAS  PubMed  Google Scholar 

  2. Gregory-Head BL, Curtis DA, Kim L, Cello J: Evaluation of dental erosion in patients with gastroesophageal reflux disease. J Prosthet Dent. 2000, 83: 675-680. 10.1067/mpr.2000.107193.

    Article  CAS  PubMed  Google Scholar 

  3. Broliato GA, Volcato DB, Reston EG, Kramer PF, Marquezan M, Ruzzarin F: Esthetic and functional dental rehabilitation in a paient with gastroesophageal reflux. Quint Int. 2008, 39: 131-137.

    Google Scholar 

  4. Nunn JH: Prevalence of dental erosion and the implications for oral health. Eur J Oral Sci. 1996, 104: 156-161. 10.1111/j.1600-0722.1996.tb00064.x.

    Article  CAS  PubMed  Google Scholar 

  5. Jarvinen V, Meurman JH, Hyvarinen H, Rytomma I, Murtomaa H: Dental erosion and upper gastrointestinal disorders. Oral Surg Oral Med Oral Pathol. 1988, 65: 298-303. 10.1016/0030-4220(88)90113-2.

    Article  CAS  PubMed  Google Scholar 

  6. Bartlett DW, Evans DF, Anggiansah A, Smith BGN: A study of the association between gastro-esophageal reflux disease and palatal dental erosion. Br Dent J. 1996, 181: 125-132.

    Article  CAS  PubMed  Google Scholar 

  7. Gudmundsson K, Kristleifsson G, Theodors A, Holbrook WP: Tooth erosion, gastroesophageal reflux, and salivary buffer capacity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995, 79: 185-189. 10.1016/S1079-2104(05)80280-X.

    Article  CAS  PubMed  Google Scholar 

  8. Smith BGN, Knight JKA: Comparison of patterns of tooth wear with aetiological factors. Br Dent J. 1984, 157: 16-19. 10.1038/sj.bdj.4805401.

    Article  CAS  PubMed  Google Scholar 

  9. Davis WB, Winter PJ: Dietary erosion of adult dentine and enamel. Br Dent J. 1977, 143: 116-119. 10.1038/sj.bdj.4803957.

    Article  CAS  PubMed  Google Scholar 

  10. Bartlett DW: The role of erosion in tooth wear: aetiology, prevention and management. Int Dent J. 2005, 55: 277-284.

    Article  PubMed  Google Scholar 

  11. Bartlett DW, Evans DF, Smith BG: The relationship between gastro-esophageal reflux disease and dental erosion. J Oral Rehabil. 1996, 23: 289-297. 10.1111/j.1365-2842.1996.tb00855.x.

    Article  CAS  PubMed  Google Scholar 

  12. Spigset O: Oral symptoms in bulimia nervosa. Asurvey of 34 cases. Acta Odontol Scand. 1991, 49: 335-339. 10.3109/00016359109005929.

    Article  CAS  PubMed  Google Scholar 

  13. Allan DN: Dental erosion from vomiting. Br Dent J. 1969, 126: 311.

    CAS  PubMed  Google Scholar 

  14. Smith BG, Knight JK: An index for measuring the wear of teeth. Br Dent J. 1984, 156: 435-438. 10.1038/sj.bdj.4805394.

    Article  CAS  PubMed  Google Scholar 

  15. Moazzez R, Bartlett DW, Anggiansah A: Dental erosion, gastro-esophageal reflux disease and saliva: how are they related?. J Dent Res. 2004, 32: 489-494. 10.1016/j.jdent.2004.03.004.

    Article  Google Scholar 

  16. Moazzez R, Anggiansah A, Bartlett DW: The asociation of acidic reflux above the upper oesophageal sphincter with palatal tooth wear. Caries Res. 2005, 39: 475-478. 10.1159/000088182.

    Article  CAS  PubMed  Google Scholar 

  17. Roekel NBV: Gastroesophageal reflux diseae, tooth erosion and prosthodontic rehabilitation: a clinical report. J Prosthodont. 2003, 12: 255-259. 10.1016/S1059-941X(03)00104-9.

    Article  PubMed  Google Scholar 

  18. Ali DA, Brown RS, Rodriguez LO, Moody EL, Nasr MF: Dental erosion caused by silent gastroesophageal reflux disease. J Am Dent Assoc. 2002, 133: 734-737.

    Article  PubMed  Google Scholar 

  19. Silva MAG, Damante JH, Stipp ACM, Tolentino MM, Carlotto PR, Fleury RN: Gastroesophageal reflux disease: New oral finding. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001, 91: 301-310. 10.1067/moe.2001.111139.

    Article  CAS  PubMed  Google Scholar 

  20. Munoz JV, Herreros B, Sanchiz V, Amoros C, Hernandez V, Pascual I: Dental and periodontal lesions in patients with gastro-esophageal reflux disease. Dig Liver Dis. 2003, 35: 461-467. 10.1016/S1590-8658(03)00215-9.

    Article  CAS  PubMed  Google Scholar 

  21. Oh W, DeLong R, Anusavice KJ: Factors affecting and ceramic wear: a literature review. J Prosthet Dent. 2002, 87: 451-459. 10.1067/mpr.2002.123851.

    Article  PubMed  Google Scholar 

  22. Myklebost P, Mosseng OE, Gjerdet NR: Roughness of filling materials subjected to gastric juice. J Dent Res. 2003, 82: 378.

    Google Scholar 

  23. Turssi CP, Hara AT, Serra MC, Rodriguez JR AL: Effect of storage media upon the surface microorphology of resin-based restorative materials. J Oral Rehabil. 2002, 29: 864-871. 10.1046/j.1365-2842.2002.00926.x.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Seda Cengiz.

Additional information

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

SC and MİC performed for the case and prepared the manuscript. YŞS supervised the case and reviewed the manuscript. All authors read and approved the final manuscript.

Rights and permissions

Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and permissions

About this article

Cite this article

Cengiz, S., Cengiz, M.İ. & Saraç, M.İ. Dental erosion caused by gastroesophageal reflux disease: a case report. Cases Journal 2, 8018 (2009).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: