Non-Cochrane · aetiology · PM32797062
Laryngopharyngeal reflux, gastroesophageal reflux and dental disorders: A systematic review.
Lechien Jerome R, Chiesa-Estomba Carlos M, Calvo Henriquez Christian, et al. · PloS one · 2020 · PubMed · doi:10.1371/journal.pone.0237581
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
10
current version
GRADE rated
0
No studies
1
Included studies
24
linked below
No studies 1 · 10%Ungraded 9 · 90%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (studies with >10 patients) with, or investigated for, reflux (GERD/LPR) or dental disorders | 24 studies included (22 clinical, 2 experimental animal); adults with GERD/LPR or dental disorders |
| Intervention | Gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), diagnosed by symptoms, findings, or objective testing (pH monitoring, MII-pH, reflux esophagitis) | GERD in the majority (N=20 studies); LPR distinguished in only 2 studies; nonacid reflux considered in no study |
| Comparison | Healthy individuals / control groups without reflux (in controlled studies) | Healthy controls in 11 prospective controlled studies |
| Outcomes | Dental disorders (mucosa inflammation/gingivitis/periodontitis, dental erosion, dental caries) and pathophysiological mechanisms (saliva physiology, oral microbiota) | Dental erosion (18 studies), reflux prevalence in erosion patients (4), caries (3), gingival/periodontal/mucosa inflammation (5), salivary changes (6); oral microbiota (0 studies) |
| Study designs | Clinical prospective, retrospective, randomized or non-randomized studies, or basic science research; adult population; English or French; peer-reviewed; more than 10 patients | 11 prospective controlled, 8 prospective uncontrolled, 3 retrospective chart reviews (clinical); 2 experimental rat-model studies |
| Timing | Not specified | Not specified |
Search date: January 1990 to December 2019 (publication period searched). Databases: PubMed; Cochrane Library; Scopus
Questions and results
Gastroesophageal or laryngopharyngeal reflux (GERD/LPR) vs Healthy individuals without reflux (controls)
Population: Adults with gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental erosion (prevalence and severity) Reflux (GERD/LPR) is associated with a higher prevalence and severity of dental erosion than in healthy individuals, but the evidence is heterogeneous, not pooled, and ungraded. Source: Abstract; Results 'Dental erosion in reflux patients'; Table 2 · same question in other reviews | Controlled studies showed GERD patients have a significantly higher rate or severity of dental erosion than healthy individuals; prevalence of dental erosion in reflux patients ranged from 16% to 44% versus <20% in… | 18 studies | Ungraded |
Dental caries Population: Adults The review reported higher caries scores in reflux patients than healthy individuals but did not formally demonstrate causation. Source: Results, Reflux, caries and oral mucosa disorders; Table 2 · same question in other reviews | no estimate extracted | 3 studies | Ungraded |
Dental caries (Decayed Missing Filled index) Reflux appears associated with a higher prevalence of dental caries than in healthy individuals based on three studies, though to a lesser extent than erosion; evidence is ungraded and not pooled. Source: Results 'Reflux, caries and oral mucosa disorders'; Table 2 · same question in other reviews | Three studies reported higher decayed-missing-filled index scores or a positive association between GERD and caries compared with controls (Yoshikawa, Song, Watanabe); no pooled estimate. | 3 studies | Ungraded |
Oral mucosa inflammation Population: Adults The review reported mixed findings for oral mucosa inflammation in reflux patients and did not formally demonstrate causation. Source: Results, Reflux, caries and oral mucosa disorders; Table 2 · same question in other reviews | no estimate extracted | 5 studies | Ungraded |
Dental erosion Population: Adults The review found a higher prevalence of dental erosion in reflux patients than healthy individuals but did not formally demonstrate causation. Source: Results, Reflux and dental erosion; Table 2 · same question in other reviews | no estimate extracted | 18 studies | Ungraded |
Oral mucosa inflammation (gingivitis, periodontitis, mucosal lesions) The association between reflux and oral mucosa inflammation (gingivitis/periodontitis) is inconsistent across five studies and remains ungraded. Source: Results 'Reflux, caries and oral mucosa disorders'; Table 2 · same question in other reviews | Five studies examined gingival/periodontal and mucosal disorders with inconsistent results: some reported more frequent mucosal inflammatory findings in GERD patients (Yoshikawa, Watanabe, Vinesh 25.5% periodontitis,… | 5 studies | Ungraded |
Comparison
Population: Adults with dental erosion
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Prevalence of GERD/reflux (esophagitis or positive pH testing) Among patients with dental erosion, 64% to 75% had GERD or reflux findings across four studies; evidence is ungraded and not pooled. Source: Results 'Reflux in patients with dental erosion'; Table 2 · same question in other reviews | Four studies reported the prevalence of GERD/reflux findings among patients with dental erosion, ranging from 64% to 75% (Bartlett 64% pathological distal reflux; Gudmundsson 75% esophagitis; Wilder-Smith 69% GERD at… | 3 studies | Ungraded |
Gastroesophageal or laryngopharyngeal reflux (GERD/LPR) vs Healthy individuals (controls)
Population: Adults with GERD/LPR reflux
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Salivary function impairment (buffering capacity, flow rate, oral pH) Reflux is associated with impaired salivary function (notably reduced buffering capacity) as a proposed pathophysiological mechanism, based on several ungraded studies. Source: Results 'Potential mechanisms of association: Clinical studies'; Table 2 · same question in other reviews | Mixed/controversial salivary findings: reduced salivary buffering capacity supported in three studies (Correa, Holbrook, Filipi) with low oral pH and reduced flow as additional factors in GERD patients, but Meurman and Schroeder found no significant salivary abnormalities; no pooled estimate. | 6 studies | Ungraded |
Gastroesophageal or laryngopharyngeal reflux (GERD/LPR) vs Healthy individuals (controls)
Population: Adults with GERD/LPR reflux
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral/pharyngeal microbiota modifications No eligible studies investigated reflux-related modifications of the oral or pharyngeal microbiota; this is an evidence gap identified by the review. Source: Abstract; Discussion (oral microbiota not investigated) · same question in other reviews | no estimate extracted | 0 studies | No studies |
Surgically induced or chronic acid gastroesophageal reflux (experimental) vs Non-reflux control animals
Population: Rat models with surgically induced or chronic acid gastroesophageal reflux
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental erosion, alveolar bone destruction and oral/pharyngeal lesions In experimental rat models, induced gastroesophageal reflux caused dental erosion, alveolar bone destruction and oral lesions compared with controls, supporting biological plausibility; evidence is ungraded animal research. Source: Results 'Experimental research'; Table 2 · same question in other reviews | Two rat-model studies found significantly higher rates of dental erosion, alveolar bone destruction and osteomyelitis (Higo) and shorter molar crown heights with dentin exposure, inflammatory infiltration and fibrosis… | 2 studies | Ungraded |
Included primary studies 24
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Alavi 2014 matched by author and year (probable) | this review only | Dental erosion | not extracted yet | not extracted yet |
| Bartlett 1996 A study of the association between gastro-oesophageal reflux and palatal dental erosion DOI:10.1038/sj.bdj.4809187 | this review only | Prevalence of GERD/reflux (esophagitis or positive pH testing) | not extracted yet | not extracted yet |
| Correa 2012 Salivary parameters and teeth erosions in patients with gastroesophageal reflux disease DOI:10.1590/s0004-28032012000300009 | this review only | Dental erosion | not extracted yet | not extracted yet |
| Deppe 2015 Erosive esophageal reflux vs. non erosive esophageal reflux: oral findings in 71 patients. PMID:26208714 | this review only | Oral mucosa inflammation (gingivitis, periodontitis, mucosal lesions) | not extracted yet | not extracted yet |
| Filipi 2011 Oral health status, salivary factors and microbial analysis in patients with active gastro-oesophageal reflux disease. PMID:21851356 | this review only | Salivary function impairment (buffering capacity, flow rate, oral pH) | not extracted yet | not extracted yet |
| Gregory-Head 2000 matched by author and year (probable) | this review only | Dental erosion | not extracted yet | not extracted yet |
| Gudmundsson 1995 Tooth erosion, gastroesophageal reflux, and salivary buffer capacity DOI:10.1016/s1079-2104(05)80280-x | this review only | Prevalence of GERD/reflux (esophagitis or positive pH testing) | not extracted yet | not extracted yet |
| Higo 2009 An animal model of intrinsic dental erosion caused by gastro‐oesophageal reflux disease DOI:10.1111/j.1601-0825.2009.01561.x | this review only | Dental erosion, alveolar bone destruction and oral/pharyngeal lesions | not extracted yet | not extracted yet |
| Holbrook 2009 Gastric Reflux is a Significant Causative Factor of Tooth Erosion DOI:10.1177/0022034509336530 | this review only | Salivary function impairment (buffering capacity, flow rate, oral pH) | not extracted yet | not extracted yet |
| Jarvinen 1988 Dental erosion and upper gastrointestinal disorders DOI:10.1016/0030-4220(88)90113-2 | this review only | Dental erosion | not extracted yet | not extracted yet |
| Loffeld 1996 Incisor Teeth Status in Patients with Reflux Oesophagitis DOI:10.1159/000201365 | this review only | Dental erosion | not extracted yet | not extracted yet |
| Meurman 1994 Oral and dental manifestations in gastroesophageal reflux disease DOI:10.1016/0030-4220(94)90168-6 | this review only | Prevalence of GERD/reflux (esophagitis or positive pH testing) | not extracted yet | not extracted yet |
| Milani 2016 Gastro-oesophageal reflux disease and dental erosions in adults: influence of acidified food intake and impact on quality of life DOI:10.1097/meg.0000000000000622 | this review only | Dental erosion | not extracted yet | not extracted yet |
| Moazzez 2004 Dental erosion, gastro-oesophageal reflux disease and saliva: how are they related? DOI:10.1016/j.jdent.2004.03.004 | this review only | Dental erosion | not extracted yet | not extracted yet |
| Munoz 2003 Dental and periodontal lesions in patients with gastro-oesophageal reflux disease DOI:10.1016/s1590-8658(03)00215-9 | this review only | Dental erosion | not extracted yet | not extracted yet |
| Oginni 2005 The prevalence of dental erosion in Nigerian patients with gastro-oesophageal reflux disease. PMID:15740613 | this review only | Dental erosion | not extracted yet | not extracted yet |
| Schroeder 1995 Dental Erosion and Acid Reflux Disease DOI:10.7326/0003-4819-122-11-199506010-00001 | this review only | Dental erosion | not extracted yet | not extracted yet |
| Shimazu 2018 Dental and oropharyngeal lesions in rats with chronic acid reflux esophagitis DOI:10.1016/j.anl.2017.08.011 | this review only | Dental erosion, alveolar bone destruction and oral/pharyngeal lesions | not extracted yet | not extracted yet |
| Song 2014 The relationship between gastroesophageal reflux disease and chronic periodontitis. PMID:24516699 | this review only | Dental caries (Decayed Missing Filled index) | not extracted yet | not extracted yet |
| Vinesh 2016 A Clinicopathologic Study of Oral Changes in Gastroesophageal Reflux Disease, Gastritis, and Ulcerative Colitis DOI:10.5005/jp-journals-10024-1959 | this review only | Oral mucosa inflammation (gingivitis, periodontitis, mucosal lesions) | not extracted yet | not extracted yet |
| Warsi 2019 Risk factors associated with oral manifestations and oral health impact of gastro-oesophageal reflux disease: a multicentre,… PMID:30928919 | this review only | Oral mucosa inflammation (gingivitis, periodontitis, mucosal lesions) | not extracted yet | not extracted yet |
| Watanabe 2017 Oral soft tissue disorders are associated with gastroesophageal reflux disease: retrospective study. PMID:28784097 | this review only | Dental caries (Decayed Missing Filled index) | not extracted yet | not extracted yet |
| Wilder-Smith 2015 Gastro-oesophageal reflux is common in oligosymptomatic patients with dental erosion: A pH-impedance and endoscopic study. PMID:25922678 | this review only | Prevalence of GERD/reflux (esophagitis or positive pH testing) | not extracted yet | not extracted yet |
| Yoshikawa 2012 Oral symptoms including dental erosion in gastroesophageal reflux disease are associated with decreased salivary flow volume and… DOI:10.1007/s00535-011-0515-6 | this review only | Dental caries (Decayed Missing Filled index) | not extracted yet | not extracted yet |