GERD and Reflux
Gastro-oesophageal reflux and obstructive sleep apnea occur together far more often than chance would predict, and there is a plausible mechanism running in both directions. For a dental practice this matters for a specific reason: nocturnal reflux leaves visible evidence on the teeth, and that evidence is sometimes the first indication either condition is present.
How obstruction promotes reflux
During an obstructive event you continue making respiratory effort against a closed airway, which generates strongly negative pressure in the chest. That pressure gradient favours movement of stomach contents up past the lower oesophageal sphincter. Add the fact that lying flat removes gravity's assistance and that swallowing and saliva production — the mechanisms that clear acid — both fall during sleep, and the acid that arrives stays in contact with tissue considerably longer than it would during the day.
How reflux worsens the airway
The other direction is also plausible. Acid reaching the larynx and pharynx causes inflammation and oedema of the very tissues that keep the upper airway patent, narrowing an airway that was already marginal. Reflux events also provoke arousals. The result is a self-reinforcing loop in which each condition makes the other worse, which is why treating one and ignoring the other frequently produces disappointing results.
What it does to the teeth
Dental erosion from reflux has a recognisable distribution, typically affecting the palatal surfaces of the upper teeth and the biting surfaces of the molars, and it looks quite different from grinding wear — cupped hollows, a smooth glazed surface, and existing fillings standing proud of the tooth around them. Because nocturnal reflux can occur without heartburn, this erosion pattern is sometimes the first sign anyone identifies, and it is a genuine reason to raise reflux with your physician.
How the two are managed together
Reflux is managed medically, by your physician or a gastroenterologist. Simple measures matter more at night than people expect — elevating the head of the bed, avoiding food in the hours before sleep, and left-side sleeping all have reasonable support. On our side, treating obstructive sleep apnea can reduce nocturnal reflux by removing the pressure swings driving it, and protecting eroded teeth is straightforward once the acid exposure is controlled. Restoring eroded teeth before that is done means restoring them twice.
Common questions
- I do not get heartburn. Can I still have reflux damaging my teeth?
- Yes. Silent reflux is well recognised, particularly at night, and the erosion pattern can be well advanced before any symptom is noticed. Where the dental pattern is present without symptoms, it is still worth raising with your physician.
- Will treating sleep apnea improve my reflux?
- Often it helps, because removing the negative pressure swings removes one of the drivers. It should not be presented as a treatment for reflux — that is managed medically, and this is a contributing mechanism rather than the whole cause.
- Should I brush my teeth after an episode of reflux?
- Not immediately. Enamel is temporarily softened by acid, and brushing straight away removes the softened layer. Rinse with water, and wait around an hour before brushing.
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