Dental Care and Reflux

The Reflux Mom’s Guide to Healthy Teeth: When your child has GERD
Part 1

Children with Gastroesophageal Reflux Disease (GERD) are at risk for developing dental problems. During a reflux episode, stomach acid may enter the esophagus and mouth (also called backwashing) exposing the teeth to stomach acid.  Over time, the stomach acid can wear out the outer layer of the tooth (called enamel), especially in the back of the mouth and the inside surfaces near the tongue.

Dental Problems associated with GERD include:

Tooth Enamel Erosion: When the protective layer of enamel is worn away, the teeth may be sensitive to foods and temperatures. Sensitivity can make tooth brushing uncomfortable.

Cavities: The dentist may notice a pattern of cavities on the back teeth (molars) and inside surfaces of the teeth in the back of the mouth.

Bad Breath: The backwashing of acid and stomach contents into the mouth (also called regurgitation) may lead to bad breath.

My daughter had a new cavity at each dental check up during the years when her reflux was at its worse. I tried every type of tooth brush and tooth paste and helped her brush daily. Her reflux was worse at night and I think she was just bathing her teeth in acid all night. Reflux was already making her asthma hard to manage. The added dental problems just added to my worries and frustration.

Toddlers and children with long term, chronic reflux symptoms may become highly sensitive to the taste and texture of foods and may resist touch near or in the mouth. This hyper sensitivity to touch and tastes can make daily brushing and oral care an ordeal. Going to the dentist may be traumatic to a child with oral sensitivity. It may be uncomfortable and aversive to have the dentist touch around and in the mouth.

I tried every brand of “kid friendly” toothpaste but they were all flatly rejected by my daughter. The reality is a kid with reflux doesn’t like most flavors that non refluxers find to be appealing. She would taste the bubblegum/fruity/minty flavor while brushing and again, mixed with acid when it backwashed a few minutes later. Who could blame her for avoiding tooth brushing?

Once the reflux is under control through medical treatment such as medication and diet, the teeth will be protected from further damage.

In my next blog, I will discuss recommended treatments and how to find a pediatric dentist for your child.

The Reflux Mom’s Guide to Healthy Teeth: Recommended Treatments
Part II

When your toddler or child has Gastroesophageal Reflux Disease (GERD), it is important to locate a dentist to help you manage dental care and reduce cavities. I highly recommend finding a pediatric dentist, a dentist with additional training in pediatrics. If you need assistance locating a pediatric dentist, ask your Pediatrician for a referral or go to the American Academy of Pediatric Dentistry website at www.aapd.org and use the dentist locator.

Whether or not your child has GERD, the AAPD recommends scheduling an office visit when your child is one year of age or when the first tooth erupts. It is extremely important for a toddler or child with GERD to have regular dental appointments beginning in infancy. The dentist may be able to prevent dental problems with fluoride treatments and sealants (a special coating applied to the surfaces of the teeth to protect the enamel). Best of all, the dentist will give you advice on age-appropriate home care.

Our pediatric dental office is kid friendly from the moment you enter the door. There is a two story play gym and child sized furniture in the waiting area. The treatment areas are full service with kid sized sinks for brushing, a TV screens at each examination station with the latest DVD’s. While the kids wait for the dentist, they can play video games or select prizes and stickers from the prize drawer. The dental staff explain everything they are doing in simple language and help the children feel comfortable and in control. Each child leaves with a Goodie bag filled with prizes and dental care products. This is so different from the dental experience I had as a child!

A pediatric dentist will help you:

1. Develop age appropriate tooth brushing routines at home.

1. Select the best toothbrush for your child’s age and size (small with soft bristles is better than large with hard bristles).

1. Offer advice on healthy eating to prevent cavities (reduce sugar, juice, sticky foods and increase vitamins and calcium for healthy teeth).

1. Make going to the dentist a positive experience.

What parents can do:

1. Be extra vigilant about scheduling regular visits with the pediatric dentist. Most dentists recommend a visit every 6 months. A child with GERD may need to be seen more frequently.
2. Talk to the pediatrician and the pediatric gastroenterologist about healthy eating to keep teeth healthy.
3. Talk to the pediatric dentist about managing oral sensitivity from GERD.
4. Consult a speech therapist or feeding team about severe oral sensitivity if it affects dental care and eating.

It can seem overwhelming to manage the dental problems from GERD as well as the GERD. I think it is easy to overlook dental care when there are so many day to day challenges from GERD. By partnering with a pediatric dentist, you will find the best treatment approach to protect the teeth during a critical time. Make home dental care a “must do” activity, just like giving medication.

The Reflux Mom’s Best Tips for Healthy Teeth…When your child has GERD
Part III

When your child has Gastroesophageal Reflux Disease or GERD, brushing teeth and going to the dentist are just as important as taking reflux medication and going to the GI doctor. When you are spinning in circles from caring for your child with GERD, dental care may seem low on the worry list. There is evidence that children with GERD may be at greater risk for cavities so dental care is very important to the overall health of your child.

Here are my best tips for dental care when your child has Gastroesophageal Reflux Disease:

At Home:

1. Provide fun toothbrushes and kid friendly toothpaste.
2. Purchase a child sized toothbrush. Remember, soft and small is better than large and firm. Your dentist can help you select the proper toothbrush.
3. A preschooler may need a step stool to reach the sink and dental care tools such as a toothbrush, toothpaste and cup for rinsing the mouth.
4. Place a mirror at your child’s level so she can see herself brushing.
5. Set up a home brushing routine. A sticker chart may help both of you to remember to brush.
6. Brushing timer. Our pediatric dentist gave my daughter a minute timer to help her increase the time spent brushing.
7. Stay out of it: Let your child manage home dental care as much as possible. Again, your doctor will give you guidance on how much assistance is needed and developmentally appropriate. Have someone else brush your teeth to understand how it feels.

Before Going to the Dentist:

1. Read a book about going to the dentist.
2. Practice playing dentist for a child who is fearful or unsure about what to expect.
3. If your child has a complex medical history, prepare a summary of current medications and treatments.
4. Take your child to your dental appointment so she can see mommy and daddy receiving dental care.
5. Call ahead to discuss your concerns if your child has significant fears about the dentist so the office staff will be prepared and extra attentive.

At the Dental Appointment:

1. Update the dentist about current medications and medical conditions.
2. Ask the dentist about the best toothbrush and toothpaste to use.
3. Develop a home care plan. I like it when the dentist talks directly to my kids and reminds them of the plan.
4. Ask the doctor about follow up visits. Most dentists recommend a dental visit every 6 months.

Jack’s Dental Visit

A preschooler named Jack went to the dentist last week for his six month visit.  Jack has had way too many medical appointments and tests due to GERD and other health issues so he was not too thrilled by the idea of going to the dentist. His mom knew that Jack would be uncomfortable if she discussed his medical issues in front of the dentist so she called the dentist and updated her about the recent changes to his medications and the recent test results. She also warned the dentist that Jack might be a bit fearful about coming to the dentist after a recent hospitalization.

On the day of the visit, Jack’s mom said, “First we will go to the dentist, then we will go to the park across the street. “ Jack did not look happy in the dentist office but he cooperated with the brushing and treatment. The dental assistant was clearly ready for him and made a special effort to give him lots of choices and extra prizes for cooperating. The dentist talked to Jack about the slide and the swings at the park and sent him on his way.

A combination of a skilled pediatric dentist and a mom who understands the importance of helping her child accept and participate in dental care, Jack will have healthy teeth and a positive attitude about going to the dentist.

Copyright 2008, Jan Gambino, From Jan’s Blog, www.healthcentral.com