Does Reflux Cause Tooth Damage?

My son had reflux as a baby. Could this have caused damage to his teeth? His pediatric dentist said he has decay and deep crevices in his teeth. Could this be caused by reflux? He is five, and the dentist told us his baby teeth can't be sealed. Is this true?

Question:

Reflux can indeed cause damage to tooth structure. In fact, it can cause loss of tooth structure. Loss of tooth substance by a chemical process, such as dietary, gastric, or environmental acids, is called erosion. The effects of erosion depend upon the concentration of acid, the amount of exposure, and the duration of exposure. The gastric acid in your son's stomach is a very strong acid.

Perimyloysis is the condition of dental erosion as a result of regurgitation. Generally, the lingual surface (tongue side) of the tooth is most affected. This erosion generally has a smooth appearance, and the posterior teeth have a more rounded appearance. When sections of these teeth are viewed under a microscope, however, the defects appear quite irregular.

Given the description of your son's teeth, I do not think that the erosive process caused by reflux is his condition. When teeth develop, they can develop from several lobes, mostly in the posterior region. As these lobes fuse together to form the complete tooth, grooves and pits are formed. In addition, defects can occur during enamel formation causing localized pitting defects. These enamel defects can be genetic, and will not necessarily carry over to the permanent teeth.

There might be several reasons why your dentist does not recommend sealants for the primary teeth. Sealants should not be placed if decay exists. On a few occasions, if an extremely small amount of decay is present, I have been able to remove the decay and place a sealant. Sealants will only bond with the tooth if sufficient enamel is present to help create that bond; therefore, if too much enamel is missing due to decay, erosion, or defects, a sealant will not be effective. In addition, sealants will not bond well to smooth surfaces. They will work best on the chewing surfaces of posterior teeth. Sometimes, they are effective in pits or grooves which might appear on the lingual surfaces of anterior teeth and upper molars and on facial (cheek side) surfaces of lower molars.

If there are any areas of tooth structure which might benefit from sealant placement, and if sealant placement is possible, sealants certainly can and should be placed on primary teeth. Ask your dentist to explain why he does not recommend their placement.

I hope your son does well with his dental treatment. Keep up good homecare; this will help.

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