Gastro-oesophageal reflux related dental erosion — ORE Part 1 MCQ

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ModerateRestorative DentistryGastro-oesophageal reflux related dental erosionORE Part 1

A 32-year-old patient presents with smooth, cupped wear affecting the palatal surfaces of the maxillary incisors and occlusal surfaces of posterior teeth. He reports morning sour taste and intermittent heartburn but drinks little fruit juice. Salivary flow appears normal. What is the most likely cause?

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Correct answer: E — Intrinsic acid exposure from gastro-oesophageal reflux

The clinical presentation is pathognomonic for gastro-oesophageal reflux disease (GORD) dental erosion. Palatal erosion of maxillary incisors is the cardinal manifestation, occurring because the force of regurgitated gastric acid propels fluid anteriorly and the palatal surface is remote from protective salivary glands. Occlusal posterior wear follows if reflux is prolonged. Smooth, cupped morphology is characteristic of erosion from intrinsic (gastric) acid. The symptoms (morning sour taste, heartburn) and exclusion of dietary acid (low juice intake) and primary salivary dysfunction (normal flow) support GORD over extrinsic erosion. Attrition produces flattened, faceted surfaces, not cupped lesions, and does not preferentially involve palatal surfaces. Abrasion is associated with toothbrushing trauma to cervical and facial surfaces. Fluorosis is a developmental defect, not progressive wear. External resorption would show radiographic root shortening and a different clinical pattern. Even asymptomatic patients with palatal erosion warrant GORD assessment.

Reference: Royal College of Surgeons Dental Faculty, Clinical Guidelines for Dental Erosion (2021). https://www.rcseng.ac.uk/-/media/files/rcs/fds/guidelines/erosion-guidelines_2021_v4_mj.pdf