The effects of chronic exposure of the oral cavity to gastric acid can
be many and varied. Soft tissue symptoms (nonspecific burning and sen
sitivity) have been mentioned in the literature, but pathognomonic sof
t tissue lesions have not been documented. Dental erosion can be consi
dered to be the predominant oral manifestation of gastroesophageal ref
lux disease. Erosion begins with subtle changes in the surface enamel
and can progress to severe loss of tooth substance. Because the causes
of such tooth lesions may be multifactorial, combining the effects of
erosion, attrition, and abrasion and because of the subtle changes pr
esent in the beginning stages of such lesions, diagnosis may be diffic
ult. Although the basic mechanism of erosion in gastroesophageal reflu
x patients is the dissolution of enamel and dentin due to acid exposur
e, a multitude of other factors can modify the effects of gastric acid
. Salivary parameters, in particular, may play an important role in af
fecting oral pH after reflux episodes. Once dental erosion is diagnose
d, thorough evaluation is necessary to document the extent of damage a
nd to detect a cause, which may have both intrinsic and extrinsic comp
onents. Treatment goals include eliminating the causes of acid exposur
e, preventing the effects of acid exposure when it is not controllable
, treating symptoms of soft tissue irritation and dental erosion, and
restoring the dentition to an esthetically and functionally acceptable
level. (C) 1997 by Excerpta Medica, Inc.