In some instances, saliva substitutes may be prescribed or recommended. Patients often consume many exogenous dietary acids, which will exacerbate any

tooth erosion associated with acid regurgitation. Patients with xerostomia may eat acidic fruits, chew or suck acidic sour-tasting candies and gums, use citric acid candy sprays, and rinse their mouths with acidic cola-type beverages to stimulate saliva production and to remove the remnants and taste of regurgitated stomach contents. Patients should be advised to avoid such acidic foods PD0325901 concentration and beverages and instead rinse their mouths either with water, milk, sodium bicarbonate solutions or sodium fluoride mouth rinses. Tooth brushing and chewing hard foods and sugar-free gums should be avoided for approximately 2 h after a regurgitation episode to allow for the re-establishment of salivary pellicle and subsequent tooth surface remineralization. Recurrent acid regurgitation and partial remineralization of exposed root surfaces of maxillary posterior teeth, particularly in older persons, may result in dark, softened, sensitive dentin that is susceptible to abrasion. Tooth brushing should be done carefully, using a soft multitufted tooth brush and a low-abrasive high sodium fluoride-containing dentifrice. Patients with GERD should be referred for dental consultations for the collaborative management

of any associated oral manifestations. GSK-3 inhibitor Erosive tooth wear may be accelerated by parafunctional habits and abrasive diets, and wear rates should be monitored periodically to evaluate tooth wear progression. Prevention of further tooth wear is a priority involving local preventive, restorative and maintenance phases.74 Preventive measures may involve the stimulation or substitution of salivary secretions (after assessing their quantity and quality), neutralizing the effects of endogenous and exogenous acids, reducing tooth sensitivity, providing dietary advice (regarding dental

erosion, dental caries and oral mucosal sensitivity), enhancing tooth surface integrity (using acidulated phosphate fluoride, metallic ions), and placing adhesive physical barriers on susceptible tooth surfaces.58 Oral discomfort and malodor caused by xerostomia should be alleviated both by home and professional dental care. The importance of adequate fluid intake should be reinforced in GERD sufferers, especially in the elderly living in hot and dry conditions. ALOX15 As saliva flow decreases during sleep, a humidifier may be required to relieve symptoms of sleep-related xerostomia.58 According to many research publications, the association of tooth erosion and GERD is stronger than generally perceived by physicians. Tooth erosion usually progresses slowly, and its signs are often subtle and not readily observed during a cursory oral examination under less-than-ideal conditions. Failure to diagnose early signs of erosive tooth wear can result in significant damage to the dentition and the masticatory system before treatment is sought.