Both silent reflux—also known as Laryngopharyngeal reflux or LPR—and gastroesophageal reflux or GERD, can take a toll on the hardest substance in our bodies, our enamel. Chronic or frequent bouts of backflow from gastric contents with a low pH create an erosive environment and can steadily remove minerals such as hydroxyapatite from the teeth.
Since hydroxyapatite is like a strong scaffolding in the tooth structure, when damaged, it begins to weaken and breaks down exposed tooth surfaces.
While gastroesophageal reflux disease (GERD) has been studied extensively, silent reflux remains relatively understudied and diagnosing it can be challenging. Unlike GERD, which typically presents with obvious symptoms such as acid indigestion and heartburn, silent reflux symptoms can be more subtle. Symptoms such as throat clearing, persistent coughing, a sensation of a lump in the throat, and post-nasal drip may indicate silent reflux, but they could also be related to other conditions.
GERD can often be confirmed by eliminating symptoms through the use of proton-pump inhibitors to reduce gastric acid or via an upper gastrointestinal endoscopy. In contrast, diagnosing silent reflux may require tests like ambulatory pH monitoring to measure pH levels in the esophagus over a 24-hour period. However, it is important to note that there is currently no gold standard for making a definitive diagnosis of silent reflux.
Sometimes, it is the dental professional who may notice persistent coughing and throat clearing during dental procedures coupled with evidence of acid erosion on the teeth and may be the first to recommend a patient be evaluated for silent reflux. This is what I recently witnessed in my practice.
Upon noticing numerous sites of enamel erosion at cervical areas coupled with persistent throat clearing during an appointment, I inquired if my patient had ever been evaluated for silent reflux. He had not but said he was willing to discuss it with his physician during his upcoming annual physical. His chronic throat clearing had become a stressor to him around other people which is not uncommon for those living with silent reflux1, as a recent study elucidated. This discussion led to several assessments including an ambulatory pH test and upper endoscopy where other conditions were ruled out; yet a positive diagnosis of silent reflux while suspected; was not positively confirmed. The patient was started on a proton-pump inhibitor for the next few months, however, the persistent throat clearing did not improve.
As his dental hygienist, my role is to assess how to best protect and preserve already vulnerable erosive sites potentially still being bathed in reflux gastric acids. I did a quick inventory in the patient’s mouth where I identified 14 sites that would benefit from the protective properties in Shield Force Plus by Tokuyama Dental. If you haven’t used this product yet, you may not be aware just how easily you can integrate its application into an appointment. With Shield Force Plus, it takes 10 seconds to apply the liquid to the vulnerable site,10 seconds to air dry the surface, and 10 seconds to light cure. For 14 sites in this case, that’s an additional 7 minutes for treatment, coupled with a few minutes of education.
(Figure 1. Vulnerable erosion sites on the lingual, Courtesy of Karen Davis)
Like any care giver, I enjoy sharing good news with patients. Upon taking close up intra-oral images to educate the patient about the numerous erosive sites present in his mouth, I was able to explain to him about applying a protective shield over those sites to prevent further break-down and loss of minerals in the tooth structure, a solution lasting between 2-3 years before needing a re-application. That is good news! More good news? Shield Force Plus can also be applied as a dentinal desensitizer because it is highly effective for patients with tooth sensitivity. ADA procedure code D9911 can be utilized when applying Shield Force Plus on a per tooth basis for sensitivity and protection.
From my experience, whether suffering from reflux disease or not, I have found it easy to educate and apply Shield Force Plus for patients in their already-scheduled appointments. When other oral health priorities emerge, it is also beneficial to educate and inform the patient that this great product can be added to their next hygiene visit. I’m grateful for a product that is desensitizing and protective for my patients including those living with GERD and or silent reflux. How are you protecting your patients with the same conditions?
1Liu K, Krause A, Yadlapati R. Quality of Life and Laryngopharyngeal Reflux. Dig Dis Sci. 2023 Sep;68(9):3527-3533. doi: 10.1007/s10620-023-08027-8. Epub 2023 Jul 6. PMID: 37410247; PMCID: PMC10726674.