Medical ConditionsEndocrine, GI & renal: Gastroesophageal reflux disease

Gastroesophageal reflux disease

Also called: GERD

Overview

Board takeaway: Evaluate possible reflux and protect the teeth. Palatal and occlusal acid erosion may be the only sign of silent reflux, which is common in neurologically impaired children.

How does Gastroesophageal reflux disease affect dental management?

Treat the acid source and protect the remaining tooth structure together. Erosion suggests acid exposure; it does not establish GERD on its own.

Find the source: ask about regurgitation, vomiting, rumination, acidic drinks, medicines, and feeding.
Refer and document: arrange pediatric/GI evaluation when reflux is suspected; record the pattern and progression with photographs and an erosion index.
Fluoride: age-appropriate toothpaste and professional application according to caries risk.
Prescription-strength paste: requires an age- and swallowing-appropriate plan; fluoride does not replace reflux control.
After acid exposure: rinse with water if the child can rinse safely; avoid immediate brushing.
Routine hygiene: use a soft brush. Sugar-free gum is an option only if chewing and swallowing are safe.
Restore selectively: address pain, exposed dentin, loss of function, or substantial structural loss; severely affected primary molars may need stainless steel crowns.
Review response: reassess both symptoms and documented wear after medical and dental treatment.

The erosion measures above are supported by the supplemental ADA resource; AAPD fluoride guidance supports the caries-prevention plan.

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Acid source	Typical distribution	Interpretation
Intrinsic: reflux/vomiting	Maxillary palatal and molar occlusal surfaces.	Compatible with gastric acid; does not establish GERD alone.
Extrinsic: acidic drinks	Often labial maxillary anterior surfaces.	Ask about diet and exposure pattern.
Either source	Cupping and restorations standing proud.	Document progression; the appearance alone does not date onset.

Exam pearl

What is Gastroesophageal reflux disease?

A digestive disorder in which reflux of stomach contents into the esophagus causes troublesome symptoms or complications, rather than occasional uncomplicated reflux.

What are the main systemic features of Gastroesophageal reflux disease?

Infants: Physiologic reflux in infants usually resolves by 12–18 months
Older children: heartburn, regurgitation, cough, hoarseness, asthma exacerbation
Associated conditions: More common with cerebral palsy, Down syndrome, obesity, prematurity and asthma
Treatment: Treated with lifestyle changes, H2 blockers, proton pump inhibitors, fundoplication

What oral findings occur in Gastroesophageal reflux disease?

Smooth, silky erosion and cupping on the palatal surfaces of maxillary incisors and the occlusal surfaces of molars
Primary teeth erode faster than permanent teeth
Dentin hypersensitivity, halitosis, palatal erythema

For Gastroesophageal reflux disease, how do intrinsic and extrinsic erosion differ?

Intrinsic acid (reflux, vomiting): maxillary palatal surfaces, molar occlusal surfaces
Extrinsic acid (acidic drinks): labial maxillary anterior surfaces
Proud restorations show loss of the surrounding tooth structure. Compare serial records to establish whether wear is progressing; this finding alone does not date the erosion.

A 7-year-old with cerebral palsy has cupped, smooth erosion on the molar occlusal surfaces and palatal surfaces of the maxillary incisors. What do you suspect?

Suspect intrinsic acid erosion from gastroesophageal reflux, which is common and often silent in neurologically impaired children.
Next steps: review reflux, vomiting, rumination, diet, and medicines; arrange pediatric/GI assessment, document baseline wear, and start a swallowing-safe preventive plan. Reassess progression after the acid source is addressed.

Sources

Supplemental erosion management: ADA: Dental erosion
Supplemental study guide: Pediatric Dental Study Guide: Gastroesophageal Reflux Disease (GERD)
Definition: NIDDK: GER and GERD in children
Fluoride Therapy

How does Gastroesophageal reflux disease affect dental management?

Treat the acid source and protect the remaining tooth structure together. Erosion suggests acid exposure; it does not establish GERD on its own.

Find the source: ask about regurgitation, vomiting, rumination, acidic drinks, medicines, and feeding.

Refer and document: arrange pediatric/GI evaluation when reflux is suspected; record the pattern and progression with photographs and an erosion index.

Fluoride: age-appropriate toothpaste and professional application according to caries risk.

Prescription-strength paste: requires an age- and swallowing-appropriate plan; fluoride does not replace reflux control.

After acid exposure: rinse with water if the child can rinse safely; avoid immediate brushing.

Routine hygiene: use a soft brush. Sugar-free gum is an option only if chewing and swallowing are safe.

Restore selectively: address pain, exposed dentin, loss of function, or substantial structural loss; severely affected primary molars may need stainless steel crowns.

Review response: reassess both symptoms and documented wear after medical and dental treatment.

The erosion measures above are supported by the supplemental ADA resource; AAPD fluoride guidance supports the caries-prevention plan.

Scroll across to view all columns

Acid source	Typical distribution	Interpretation
Intrinsic: reflux/vomiting	Maxillary palatal and molar occlusal surfaces.	Compatible with gastric acid; does not establish GERD alone.
Extrinsic: acidic drinks	Often labial maxillary anterior surfaces.	Ask about diet and exposure pattern.
Either source	Cupping and restorations standing proud.	Document progression; the appearance alone does not date onset.

What are the main systemic features of Gastroesophageal reflux disease?

Infants: Physiologic reflux in infants usually resolves by 12–18 months

Older children: heartburn, regurgitation, cough, hoarseness, asthma exacerbation

Associated conditions: More common with cerebral palsy, Down syndrome, obesity, prematurity and asthma

Treatment: Treated with lifestyle changes, H2 blockers, proton pump inhibitors, fundoplication

For Gastroesophageal reflux disease, how do intrinsic and extrinsic erosion differ?

Intrinsic acid (reflux, vomiting): maxillary palatal surfaces, molar occlusal surfaces

Extrinsic acid (acidic drinks): labial maxillary anterior surfaces

Proud restorations show loss of the surrounding tooth structure. Compare serial records to establish whether wear is progressing; this finding alone does not date the erosion.

A 7-year-old with cerebral palsy has cupped, smooth erosion on the molar occlusal surfaces and palatal surfaces of the maxillary incisors. What do you suspect?

Suspect intrinsic acid erosion from gastroesophageal reflux, which is common and often silent in neurologically impaired children.

Next steps: review reflux, vomiting, rumination, diet, and medicines; arrange pediatric/GI assessment, document baseline wear, and start a swallowing-safe preventive plan. Reassess progression after the acid source is addressed.