Spectrum of dental manifestations of GERD and approaches to their verification

Gastroesophageal reflux disease (GERD) ranges among the most common diseases in therapeutic practice. In addition to the classic complaints, patients often experience extraesophageal symptoms, which can complicate the diagnosis of GERD and require a multidisciplinary approach to the patient management with the assistance of related specialists. These include dental manifestations of GERD, which can be conveniently classified into lesions affecting the soft tissues (vermillion border of the lips, tunica mucosa of mouth, tongue, periodontal tissues) and the dental hard tissues (enamel and dentin) in the oral cavity. Epidemiological data on the prevalence of these or other dental manifestations of GERD are limited and heterogeneous. The article considers a number of pathogenetic factors that explain the cause-and-effect relationship between oral/dental lesions and GERD, including the direct damaging effects of aggressive refluxate molecules, changes in the physicochemical properties of saliva expressed as a decrease in its buffering capacity, reduction in secretion of mucin, growth factors, and antimicrobial peptides, and bruxism. From a practical perspective, it is quite difficult to find a link between GERD and possible dental manifestations due to the heterogeneity and nonspecificity of the latter. If GERD is suspected in patients with oral and/or dental lesions, it is reasonable to use the GERDQ questionnaire, esophagogastroduodenoscopy, and, in some cases, 24or 48-hour pH-impedance measurements and high-resolution manometry. The salivary pepsin and bile acid tests may be used as a potential screening tool to identify a cohort of individuals requiring further examination.