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Dental Caries Experience in Relation to Physical Salivary Characteristics Among Gastro Esophageal Reflux Disease Patients

Marwa Siddik Abdulrazak1*, Alhan Ahmed Qasim1, Ali Ismael Falih2

1Department of Pedodontics and preventive dentistry, University of Baghdad, Baghdad, Iraq

2Department of gastroenterology and hepatology, University of Baghdad, Baghdad, Iraq

*Corresponding Author:
Marwa Siddik Abdulrazak
Department of Pedodontics and preventive dentistry,
University of Baghdad. Baghdad,
Iraq;
Email:
[email protected]

Received: 30-Apr-2022, Manuscript No. JDS-22-62259; Editor assigned: 03-May-2022, Pre QC No. JDS-22-62259 (PQ); Reviewed: 18-May-2022, QC No. JDS-22-62259; Revised: 01-Jul-2022, Manuscript No. JDS-22-62259 (R); Published: 11-Jul-2022, DOI: 10.4172/2320-7949.10.6.007

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Abstract

Background: Gastroesophageal Reflux Disease (GERD), a highly prevalent gastrointestinal disease, in which return of gastric content other than air to the mouth can, occurs. Much oral manifestation related to this disease including dental caries, dental erosion and changes in salivary flow rate and pH.

Materials and Methods: This is a cross-sectional study; all the patients participating in this study were attending the Gastroenterology and Hepatology Teaching Hospital in Baghdad who had endoscopically diagnosed with gastroesophageal reflux disease according to the Los Angeles (LA) classification, aged 20-40 years old and of both genders. Dental caries experience was implemented according to WH0 (2013). Unstimulated saliva samples were collected for estimation of salivary flow rate and pH.

Results: From the whole sample (98%) of the patients were with caries. Dental caries experience (DT, DS, DMFT) mostly were higher among patients that do not take medication than those take medication with no statistically significant difference except (MS and DMFS) these results were statistically significant.

Salivary flow rate show mild reduction with increasing disease severity for both groups concerning medication. Also dental caries experience (DMFS, DMFT) had a significantly negative correlation with salivary flow rate and salivary pH among patients with gastroesophageal reflux disease.

Conclusion: The study shows that GERD had an effect on salivary flow rate and pH and in turn this could negatively affect dental caries experience which can be controlled by taking the appropriate medication and controlling disease severity.

Keywords

Gastroesophageal reflux disease; GERD; Dental caries; Salivary flow rate; pH

Introduction

Gastroesophageal reflux is the return of gastric contents other than air through or into the esophagus. Gastroesophageal Reflux Disease (GERD) attribute to reflux that produces many symptoms or results in damage or dysfunction to the esophageal mucosa or adjoining organs of the upper aerodigestive system and sometimes the lower respiratory tract [1]. According to the Los Angeles (LA) classification, GERD is divided into 4 grades based on the extent of mucosal breakage designated A through D. Grade A represent one (or more) mucosal breakage not longer than 5 mm that does not continue between the peak of two mucosal folds, grade B shows one (or more) mucosal breakage more than 5 mm long that does not continue between the peak of two mucosal folds, grade C shows one (or more) mucosal breakage that is continuous between the peaks of two or more mucosal folds but in which the involvement is less than 75% of the circumference and grade D shows one (or more) mucosal breakage in which the involvement of at least 75% of esophageal circumference can occur [2].

GERD is a very widespread condition whose consequences of are not only localized in the esophagus but also it has been frequently reported of multiple extra-esophageal involvement [3]. The classical symptoms of GERD are Heartburn, regurgitation and Dysphagia [4,5]. While GERD may cause a wide spectrum of conditions as an extra-esophageal symptoms, including, Noncardiac chest pain, Asthma, Posterior laryngitis, chronic cough, recurrent pneumonitis, dental erosion and disordered sleep [6]. Oral manifestations of GERD could involve dental erosion, dental caries, halitosis, burning sensation, xerostomia and erythema of the uvula and palatal mucosa [7].

Dental caries is the localized destruction of susceptible dental hard tissue via acidic byproducts which is produced by the bacterial fermentation of dietary carbohydrates [8]. Thereby, it is a bacterial-driven, usually chronic, site-specific, multifactorial, dynamic disease process caused by an imbalance in the physiologic equilibrium between the tooth mineral and the plaque fluid; that is, when the pH drops and causes net mineral loss over time [9].

Various contradictory results about gastroesophageal reflux disease and dental caries was found in multiple studies [10-13]. Saliva is the biological watery secretions of salivary glands in oral cavities of humans and animals [14]. Human saliva had several functions including: moistening and lubrication, taste and smell, digestion, oral and esophageal mucosa protection, wound healing factors and tooth protection [15]. A significant association between GERD, reduced salivary flow rate and the subjective sensation of “dry mouth” (xerostomia) has been found in several studies [16,17]. Salivary flow rate and pH was found to be lowered among GERD patients as compared to the controls [18].

Materials and Methods

This is a cross-sectional study that was carried out after an authoritative approval from the Research Ethics Committee in College of Dentistry- University of Baghdad. The study sample consist of (100) Gastroesophageal Reflux Disease (GERD) patients, aged 20-40 years old and of both genders, (60) patients were taking medication for GERD (all types of PPIs and antacids). The patients were diagnosed by the specialist (Gastro Enterologist) as having any grade of GERD according to the Los Angeles (LA) classification. Only grade A and grade B were found during the time of the study that met with this study inclusion and exclusion criteria. All the patients who are attending to Gastroenterology and Hepatology Teaching Hospital in Baghdad who had endoscopically diagnosed with gastroesophageal reflux disease with no history of any other type of systemic disease were included. While patients having other types of systemic disease such as diabetes, cardiovascular disease, respiratory infection, metabolic syndrome, patients wearing appliances, patients taking medication for any other disease and smokers all were excluded.

WH0 (2013) criteria for estimation of dental caries experience was implemented by Decayed Missed Filled surfaces (DMFS) and Teeth (DMFT) index, using a plain mouth mirror and Community Periodontal Index (CPI) probe [19].

According to the University of Southern California School of Dentistry, unstimulated saliva samples were collected by passive drooling of saliva for five minutes in graduated test tubes [20]. Before starting the collection of saliva samples, information from the patients should be taken that insures they did not eat or drink anything in the last hour before the examination (water is excluded). Then rinsing the mouth with distilled (deionized) water and then the patient was told to relax for five minutes before starting the collection. Movement during the procedure should be minimized especially mouth movement. The patient is told to swallow to empty the mouth from saliva and then start the timing with slight opening of the mouth to allow the saliva to drool into the graduated tube and with forward inclination of the head. Finally after five minutes, the patients asked to collect all the remaining saliva in the mouth and spit it into the tube and this action should be done quickly. Then the flow rate was calculated by dividing the volume of whole saliva collected in milliliter (ml) on the time of collection in minute (min) [21].

Measurement of salivary pH was done by the use of digital pH meter which was immersed in the saliva sample tube, waiting for 30 second to get a stable reading then recording it.

Results

From the whole sample (98%) of the patient were with caries.

Table 1 illustrated a descriptive statistics of caries experience (DMFT) and its component (Decayed Teeth (DT), Missed Teeth (MT), Filled Teeth (FT)) among patients did take medication and patients who did not take medication by GERD severity. It reveals that in grade A, grade B and in the total sample the (DT, MT and DMFT) in patients that did not take medication was higher than patients who took medication while (FT) was higher in patients who took medication than in patients that did not take medication. All with no statistically significant difference except in (MT and DMFT) of the total sample.

GERD severity medication    
Yes NO    
Mean ± SE Mean ± SE T P value^
A DT 5.59 0.567 6.15 0.782 0.582 0.564
MT 1.53 0.344 3.90 1.209 1.886 0.073
FT 2.50 0.441 1.70 0.493 1.210 0.233
DMFT 9.62 0.704 11.75 1.427 1.340 0.191
B DT 5.46 0.547 7.10 0.817 1.666 0.105
MT 1.73 0.537 3.00 1.056 1.071 0.293
FT 1.88 0.577 1.60 0.494 0.375 0.710
DMFT 9.08 0.877 11.70 1.466 1.536 0.134
Total DT 5.53 0.396 6.63 0.564 1.585 0.117
MT 1.62 0.301 3.45 0.796 2.155 0. 036*
FT 2.23 0.353 1.65 0.344 1.183 0.240
DMFT 9.38 0.547 11.73 1.010 2.039 0.046*

Table 1: Descriptive and statistical test of caries experience by teeth among medication by GERD severity.

Table 2 shows that by groups and in the total, although subjects who do not take medication mostly have more caries experience by surface than those who take medication but with no statistically significant difference except in group A in (MS) and in the total in (MS and DMFS), these results are significant.

GERD severity medication    
Yes NO    
Mean ± SE Mean ± SE T P value^
A DS 7.91 1.135 8.95 1.603 0.540 0.592
MS 7.59 1.713 19.25 5.873 2.330 0.024*
FS 4.44 1.021 4.00 1.273 0.267 0.790
DMFS 19.94 2.248 32.20 7.375 1.933 0.059
B DS 7.88 .988 10.85 1.895 1.479 0.146
MS 8.58 2.653 15.00 5.282 1.163 0.251
FS 3.27 .939 4.55 2.169 0.588 0.560
DMFS 19.73 2.961 30.40 6.459 1.621 0.112
Total DS 7.900 0.766 9.900 1.235 1.453 0.149
MS 8.017 1.492 17.125 3.913 2.478 0.015*
FS 3.933 0.706 4.275 1.242 0.257 0.798
DMFS 19.850 1.792 31.300 4.841 2.537 0.013*

Table 2. Descriptive and statistical test of caries experience by surfaces among medication by GERD severity.

Table 3 illustrates salivary flow rate and pH among medication by GERD severity. In regard to salivary flow rate (SFR) results found that in grade A higher flow rate among patient who did not take medication and in grade B and in total higher flow rate was found in patients who did take medication than those who did not with statistically no significant difference.

 GERD severity                           Medication    T    P value
                   Yes                NO
 Mean  ± SE  Mean  ± SE
 A  SFR  0.509  0.049  0.545  0.057  0.469  0.641
 PH  6.688  0.062  6.54  0.105  10.298  0.2
 B  SFR  0.51  0.059  0.383  0.056  1.532  0.133
 PH  6.569  0.092  6.6  0.071  0.255  0.8
 Total  SFR  0.509  0.037  0.464  0.042  0.8  0.426
 PH  6.637  0.053  6.57  0.063  0.802  0.425

Table 3. Descriptive and statistical test of salivary Flow rate and PH among medication by GERD severity.

In regard to pH results found that in grade A and in total pH was higher among patient who did take medication than those who did not and in grade B higher pH was found in patients who did not take medication with no statistically significant difference.

Table 4 Regarding taking medications, the significant correlations are in both groups only DMFS and DMFT, in subjects who take medications, only MT and MS, while in subjects who don’t take medications, only DT and DS, about PH, significant correlations are in both groups only DMFS and DMFT, in subjects who take medications, only MT, MS and Fs, lastly subjects who don’t take medications, only DS; while other correlations are negative weak not significant.

VARS. SFR PH
Yes NO Yes NO
r p R p r p r P
DT -0.138 0.293 -0.412 0.008 -0.036 0.785 -0.285 0.075
MT -0.285 0.027 -0.260 0.105 -0.288 0.026 -0.289 0.071
FT -0.085 0.521 -0.029 0.857 -0.250 0.054 0.024 0.885
DMFT -0.311 0.016 -0.445 0.004 -0.345 0.007 -0.379 0.016
DS -0.128 0.329 -0.481 0.002 -0.097 0.460 -0.350 0.027
MS -0.288 0.026 -0.261 0.104 -0.287 0.026 -0.292 0.067
FS -0.068 0.603 -0.140 0.389 -0.265 0.041 -0.021 0.899
DMFS -0.321 0.012 -0.369 0.019 -0.385 0.002 -0.331 0.037

Table 4. correlation between medication, dental caries experience and salivary flow rate and pH.

Discussion

Patients diagnosed with GERD using upper Gastrointestinal (GI) endoscopy were included in this study because upper GI endoscopy is counted as the gold standard for confirming GERD [22].

The relation between changes in the oral cavity and systemic health has been widely established [23,24]. Because the oral cavity is a part of the gastrointestinal system, oral disorders can be a manifestation of gastrointestinal disease [25]. Several studies have found that patients with GERD are more prone to dental caries than the healthy population [26,27].

This study found that patients who did not take medication had significantly higher dental caries experience than those who took medication, this might be related to the use of antacid, which used by GERD patients [28]. Furthermore it was demonstrated that the use of PPI can restore normal oral pH and even salivary flow in GERD patients and this confirm with the results found in this study. Also salivary flow rate is significantly reduced in patients with GERD [29].

As far as a recent study found that salivary microbiome of GERD patients who use PPI was quite similar to that of negative controls without the disease that did not use PPI. This would imply that there is at least some benefit in the oral cavity with the use of those drugs in people with GERD.

Also in this study a negative correlation was found between salivary flow rate and pH with dental caries experience in both patients who took medication and whom did not [30]. This could be due to the additive effects of direct acid injury, low salivary buffering capacity, and increased opportunistic bacterial populations, all of which contribute to a substantial increase in tooth decay and loss. Indeed saliva is an essential defense mechanism from acid exposure exists in the oral cavity: the amount and quality of saliva provide protection via acid clearance and neutralization.

Conclusion

The study shows that GERD had an effect on salivary flow rate and pH and in turn this could negatively affect dental caries experience which can be controlled by taking the appropriate medication and controlling disease severity.

Conflicts of The Interest

No conflicts of the interest

Acknowledgments

Special thanks for everyone who helped in the completion of this research.

References

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