An Investigation of The Relationship Between Erosive Tooth Wear and Gastroesophageal Reflux

Abstract

This thesis investigated possible risk factors for Erosive Tooth Wear (ETW) as a result of symptoms suggestive of Gastro-Oesophageal Reflux Disease (GORD). The studies included: A Laboratory/in-vitro study, a case control cross sectional study and an in-vivo study. Chapter one- The literature review in chapter one provides an overview of the available evidence for predictive factors for the development of erosive tooth wear. Current diagnostic measurements and assessments of erosive tooth wear in vitro and in vivo are also discussed, in addition to discussing diagnostic tools for monitoring oesophageal motility and the movement of the refluxate in the gastrointestinal tract as well as oesophageal and extraoesophageal symptoms. Chapter two- An in vitro study was done to understand the different effects of intrinsic and extrinsic acids on human polished enamel, mimicking real clinical situations by embedding the samples in human saliva, choosing the given time points and the stirring of acids to simulate a swishing behaviour. Chapter three- A clinical study was conducted on patients attending the Oesophageal Department at Guy’s hospital who were presenting with GORD symptoms. A symptoms diary was collected for a period of 7 days without medications prior to their appointment for the manometry and pH and impedance monitoring tests. These parameters were studied and analysed to assess the association between each parameter and the presence of ETW in order to assess predictive factors for ETW in this group of patients. 19 Chapter four- An in-vivo study was conducted to evaluate any differences in AEP between eroded and uneroded tooth surfaces in patients with GOR symptoms, with and without GORD diagnosis. This followed a similar study published by our group where differences were found in pellicle proteins on eroded vs uneroded surfaces in patients suffering from dietary ETW. Chapter five- Provides a general discussion of the overall findings of this thesis and chapter six suggests clinical implications and possible future work.