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Reflux and Tooth Decay

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Question

My daughter’s teeth are badly decayed due to chronic reflux and the acid in the regurgitation. Her dentist is recommending that the teeth be pulled.

Answer of our experts

It is very common for children with CdLS to have a great number of dental problems. Reflux and the acid that enters the mouth can cause a serious breakdown of the enamel covering the teeth

Once the protective layer of enamel has been altered, large dental cavities can destroy the teeth in a short period of time. Often it is extremely difficult to provide adequate oral hygiene for the children due to their protective and resistant actions, keeping us from gaining access to the mouth. Getting a toothbrush to the areas furthest back in the mouth can be a challenge. This is where the acid can have its most devastating affects. Therefore, in a situation where oral hygiene is difficult, the teeth chronically come in contact with strong stomach acids and we can expect dental cavities, leading to infections and abscesses

It is not surprising that the dentist you are working with might have prescribed removal of some teeth. Many times the teeth are just not restorable. If there is not enough of the tooth left to place a filling or a crown, removal is the only answer. Treatment will probably have to take place in a hospital setting. Conscious sedation or general anesthesia may be necessary for your daughter in order that adequate cooperation can be attained to perform a safe dental operation

Our top priority is always to save teeth and bring the oral condition back to a healthy and functional state. Extractions are our last resort, but certainly they often are the only treatment possible. Discuss your concerns with your dentist, ideally a pediatric dentist. If a second opinion would help in assuring that you are well informed, then I strongly recommend it. You might find that the treatment prescribed by your current dentist is the only way to go

RM/TK 7-13-10

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Recommendation(s)

Feeding and Dental Difficulties

R12
In every CdLS individual with prolonged and marked feeding difficulties, the multidisciplinary assessment (from healthcare workers across many disciplines) should consider (temporary) placement of a gastrostomy (surgical opening through the abdomen into the stomach) as a supplement to oral feeding.
R13
In individuals with CdLS who have recurrent respiratory infections, reflux and/or aspiration (breathing foreign objects into airways) should be ruled out.
R14
The palate should be closely examined at diagnosis. In case of symptoms of a (submucous) cleft palate, referral for specialist assessment is indicated.
R15
Dental assessment and cleaning should take place regularly; a more thorough dental examination or treatment under anaesthesia may be necessary.

Recommendation(s)

Reflux

R32
Consider always gastro-oesophageal reflux disease (GORD) in any individual with CdLS owing to its frequency and wide variability in presentation, which includes challenging behaviour.
R33
Modification of nutrition and proton pump inhibitors (PPI) are the first-line treatments of GORD. Anti-reflux medications need to be used to their maximum dosage. Surgical interventions for GORD should be limited to those individuals with CdLS in whom nutritional and medical treatments have been unsuccessful or airway safety is at risk.
R34
If GORD symptoms persist, endoscopy should be strongly considered whilst an individual with CdLS is still in paediatric care.
R35
Surveillance for Barrett’s Oesophagus needs to be discussed with and decided together with the family, balancing the potential gain in health and burden for the individual with CdLS.

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Please take note that the Ask the Expert service is comprised of volunteer professionals in various areas of focus. Answers are not considered a medical, behavioral, or educational consultation. Ask the Expert is not a substitute for the care and attention your child’s personal physician, psychologist, educational consultant, or social worker can deliver.

 

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