Gastroenterologist discusses treating GERD dental patients after the holidays

Lauren Gerson, MD, a gastroenterologist at California Pacific Medical Center in San Francisco, speaks with RDH eVillage on the influence GERD may have on dental patients, and options GERD patients can pursue to improve their condition in the coming year.

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Dr. Lauren Gerson

At the launch of each New Year, most people have healthier habits on their minds. Indulging over the holidays and the promise of a fresh start may inspire an array of resolutions dedicated to improving the way we treat our bodies. Those who struggle with gastroesophageal reflux disease (GERD) and suffer from painful acidic regurgitation and potential dental damage caused from overeating and consuming certain foods may be resolving to explore new ways to treat their conditions in 2016. We spoke to Lauren Gerson, MD, a gastroenterologist at California Pacific Medical Center in San Francisco, to elaborate on the influence GERD may have on dental health through the holidays and beyond, and options GERD patients can look to improve their condition in the coming year.

RDH eVillage: Dental patients seen during the holiday season are often in the middle of eating or drinking too much. Should a dental professional be aware of the distinctions between mild heartburn and GERD?

Dr. Gerson: Heartburn can be considered an intermittent symptom of burning behind the chest bone or fluid in the mouth that occurs rarely (less than once a month) after overeating and does not require treatment. Patients with GERD will report these symptoms more frequently, at least twice or more per week. If they have regular ongoing bothersome symptoms, patients should be referred for evaluation and treatment, including improved diet and exercise, medication, and in more severe cases, interventions like Transoral Incisionless Fundoplication (TIF) procedure or surgery.

RDH eVillage: What symptoms should dental professionals search for during the dental exam to determine if a more serious digestive disease is indicated in the oral cavity?

Dr. Gerson: The most reliable suggestion of GERD should be the patient’s history of ongoing symptoms of regurgitation and substernal burning, in addition to epigastric pain, chest pain, and/or dysphagia. However, dental erosion may also be an indicator of GERD. While the evidence linking GERD to dental erosions deserves further study, there have been an increasing number of publications supporting the potential correlation between GERD symptoms and dental erosion due to the acidity of the fluids regurgitated and its effect on the enamel. To prevent serious damage, it is important for dental professionals to be aware of GERD as a possible contributing factor to dental erosion so they may alert their patients and allow them to seek treatment earlier.

RDH eVillage: Is there any advice that you would encourage dental professionals to pass along to patients with known GERD episodes?

Dr. Gerson: I would advise dental professionals to be aware of the triggers of GERD symptoms, as well as the ways in which patients can manage them. Patients should avoid eating large meals prior to bedtime as this can provoke GERD. They should also try to avoid eating two to three hours before bedtime. Eating small frequent snacks is less likely to cause GERD compared to large meals high in fat that are more likely to delay gastric emptying and therefore cause reflux of acid into the esophagus. Excessive alcohol usage can also provoke GERD in some individuals, so it’s important for patients to be conscious of how much they are consuming.

If GERD symptoms are consistently disrupting patients’ day-to-day lives, dental professionals may suggest they consider changing their diets, take daily medication such as proton pump inhibitors before meals, or consider mechanical methods of treatments, such as surgery or the TIF procedure with the EsophyX device, which is performed through the mouth and eliminates the potential side effects that come with other surgical interventions such as laparoscopic antireflux surgery. There are more options than ever for patients of GERD that work with a wide breadth of lifestyles so they can enjoy 2016 without the discomfort of reflux.

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