Dental Erosion — ORE Part 1 MCQ
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Correct answer: B — Gastric acid (gastro-oesophageal reflux or vomiting)
The isolated involvement of palatal surfaces of upper anterior teeth with sparing of labial surfaces and lower teeth is pathognomonic for intrinsic gastric acid exposure from GORD or vomiting. Refluxed gastric acid attacks palatal surfaces first because: (1) the force of regurgitation propels gastric fluid forward; (2) palatal surfaces are remote from protective major salivary glands; and (3) the tongue maintains contact with gastric fluid against palatal teeth. With extended acid reflux, erosion progresses to occlusal surfaces of posterior teeth and eventually labial/buccal surfaces, but the initial selective palatal pattern is diagnostic. Dietary acids (citrus, carbonated drinks) cause generalised erosion preferentially affecting buccal surfaces during contact. Toothbrushing causes abrasion affecting accessible buccal and occlusal surfaces, not isolated palatal erosion. Occupational acid exposure produces diffuse, generalised erosion.
Reference: Cengiz S, Cengiz MI, Saraç YŞ. Dental erosion caused by gastroesophageal reflux disease: a case report. Case Reports 2009; PMC2740145 and Lagerlöf F, Oliveby A. The relationship between gastro-oesophageal reflux disease and dental erosion. Journal of Dentistry 1994; 22(6):613-620. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740145/