Acid Mouth & Oral Currents- An Alternative Model of Dental Destruction

(ARTICLE for Health Professionals)

While the dental profession has focused on bacteria as the primary etiologic factor for acid attack on the human dentition it has ignored the elephant in the room…the stomach. The ebb and tides of the oral fluids contaminated with reflux from the stomach has a greater impact in many individuals than the evil plaque which has hogged more than its share of the spotlight.

This is not to say that plaque is not an important factor, but for a moment let’s entertain the idea that for the last 80 years the dental profession became obsessed about bacteriology and missed an opportunity to see the bigger picture. The problem of acid reflux is wide spread and likely worse now than it ever has been. The stomach acid that finds its way up into the mouth overwhelms the current preventive measures of the best home care and professional methods that are aimed at the bacterial model of decay.

While we could sit back and repeatedly crown and fill and ultimately offer dental implants and assorted acid resistant frameworks, dental professions should do more than simply benefit from a largely preventable problem.

Let’s back up and look at the term ‘Acid Mouth’ that actually was used in the early part of the last century. The author discovered a reference to this term while reviewing antique dental advertisements on an online auction website. The feeling was euphoric as the advertisement used exactly the right name for the public to understand the condition described (for which a brand of toothpaste was purported to be the cure). Re-discovering this condition may offer help to thousands of patients across the globe.

While there are other sources of acids, which can be introduced by way of the mouth to the oral cavity, acid reflux commonly referred to as GERD was rarely mentioned in dental training. The author was first exposed to the importance of this condition as related to potential damage to the dentition through the post-graduate training offered by the Seattle Institute (Dr. Frank Spear).

While many dental professionals waggled fingers about poor brushing and flossing, and infrequent dental visitations the real cause was neglected. The stomach acid would seep up like a toxic tide each night and pool around the helpless teeth. The salivary glands were turned off for the night and the burning fluids were no longer neutralized by the buffering of the saliva. To aggravate the situation, regular swallowing and gravity that kept the acids at bay were to be put aside for a typical 7 hours per 24 hour period, 365 days per year.

The hydrolytic pressure often accentuated and directed in reverse of normal function by an obese midsection applied to the full stomach contents of the nocturnal victim. The sloshing, steaming primordial ooze composed of fast food (preserved with chemicals such as citric acid and disodium inosinate), phosphoric acid enhanced carbonated beverages and homemade stomach acid without malice traveled up the oesophagus and then entered the oral cavity.

The concept presented in this article is the pattern of flow or ‘oral current’ of the harmful solution within the mouth is unique to each individual. The fluid will pool/gravitate to the side closer to the earth which could change over the sleeping period with positional changes. The flow or currents would also be affected by the position of remaining teeth, the level of the interdentally papillae, the tongue size, shape and action, and any dental work.

The damage to the teeth would be related a number of factors including the pH of the assaulting fluid, the relative susceptibility of the exposed tooth structure to the acid (dentin would soften much faster than enamel), the duration of the exposure. The author postulates that the use of high fluoride toothpastes and plaque control would provide a minor amount of protection, perhaps equal to putting on a life jacket at the beach as a tsunami is about to strike.

The factors increasing the risk of acid reflux are well known and include obesity, smoking, pregnancy, consumption relative to sleep times (how much is in the stomach when the person goes to bed), use of certain drugs/medications and anatomical susceptibility. What isn’t well known is the massive importance this disorder has on a patient’s dental health.

At the time of writing this article, the author had recently seen a physician as a dental patient related to a toothache. The medical doctor was surprised to learn that the large cavity which went from zero to the nerve in about 12 months could be related to his occasional ‘heart burn’. In short, the medical community needs to help dentists take this problem more seriously and treat it sooner than the two to three episodes of heartburn per week guideline.

The signs of acid reflux can be noticed by a dentist often before a patient even feels any symptoms. The prudent advice may be to ask about common symptoms and habits like burning throat, persistent cough, smoking, and snacking before bedtime. Weight loss and smoking cessation can discussed and be referred to their primary care physician. If the medical doctor does not take aggressive action when the problem is significant the dental patient will potentially develop dental complications that can often necessitate full mouth reconstruction. While lucrative, the health professions must do more to intercept this problem that can affect the young and old and everyone in between.

Acid Mouth and oral currents can be considered when treatment planning, considered when designing the finish line of restorations, and the long term prognosis of specific recommendations. Dentists and hygienists need to realize that plaque is not always the most destructive acid source in the oral cavity. We need to be ashamed that we have dropped the ball on this medico dental challenge and the author recommends dentists should take steps to forward this article to their physician colleagues to open the doors to discussion.

A dentist who diagnoses a patient with ‘Acid Mouth’ can take the first steps towards treatment that can reduce the damage to the dentition, reduce the incidence of oesophageal cancer and possibly reduce lung disease related to aspiration of stomach contents. Dentists need to add “Do you suffer from occasional heart burn?” on their health questionnaires. Maybe it could be added somewhere between “Do you have venereal disease?” and “Have if you had a magic wand, what would you want your teeth to look like?”.

About the author:

Dr. Michael Zuk is a general practitioner from Red Deer, Alberta. He is the author of several publications including ‘Confessions of a Former Cosmetic Dentist’ and is a consultant to the non-profit website acid mouth.com. The author gives permission to duplicate the article in its entirety by anyone interested in sharing it with other health professionals.