Dental erosion associated with asymptomatic gastroesophageal reflux

An eight-year-old girl presented with severe erosion of the primary dentition and early erosion of the erupted permanent teeth. Although the pattern of erosion was consistent with that seen with acid erosion, the diagnosis could not be elucidated from the patient's symptoms, or medical or dental history. A 24-hour pH probe study documented severe gastroesophageal acid reflux. Oral salivary pH tested during sleep nightly for one week revealed low oral pH. Treatment with metoclopramide and ranitidine was instituted to decrease acid availability for reflux. Custom-fitted, maxillary and mandibular trays were fashioned to deliver sodium fluoride gel twice daily, and fissure sealants were placed in the hopes of retarding erosion of existing permanent teeth, as well as preventing similar erosion of erupting permanent dentition.