I don't have heartburn. . .

. . . or do I???

There is a common perception that we will easily 'know' if we have gastric reflux (heartburn).

We might reckon that we would have really obvious symptoms, like burning pain after meals, lots of burping, or a sour taste at the back of our mouth. A lot of people also assume that reflux is always the consequence of eating a 'bad' diet, and that if you eat a pretty healthy diet, you won't have reflux.

But surprisingly, these assumptions are not the case. Reflux is not just the consequence of eating poorly. It is also the case that a fairly significant number of people experience a version of reflux with few to no obvious symptoms. This condition is commonly referred to as 'silent reflux'. Its formal medical name is laryngopharyngeal reflux.

The precise number of people with silent reflux is unknown . . . because it is silent. Naturally, if you don't have any symptoms, you are not going to go to your GP to discuss it, because you don't have symptoms to complain about!

This hints at (if not directly points to) the fact that most silent reflux occurs when we are asleep.

A 2018 medical study showed that the prevalence of silent reflux in people with high blood pressure was 15.1%. If similar studies have been carried out for people without high blood pressure, I was unable to find them. My sense is that the prevalence of silent reflux in the general population is much higher than 15.1%. I have no scientific studies to base this on other than my observations in the clinic, every day.

'But hold on!', you might wonder. What on earth has a medical condition like silent reflux got to do with the dentist? And how can a dentist think that so many people have reflux?

It is an interesting fact that some of the impacts of silent reflux can be easily detected in a routine dental examination.

It is also the case that silent reflux can cause tooth symptoms that do not seem to be directly related to the stomach and digestive issues.

During a routine check up up, the skin of the mouth is examined. In people with chronic reflux, these signs can be detected:

• A white 'filminess' on the skin lining the cheeks, under the tongue and the palate,

• Strands of white, soft, loose material peeling from the skin lining the cheeks,

• A red coloured chemical 'burn' affecting the soft palate and back of the throat.

These signs are caused by acid from the stomach sitting directly on the lining of the mouth for several minutes.

A dental examination can reveal:

• Thin enamel on the molars with a distinctive eroded surface appearance (unlike the enamel thinning from tooth grinding),

• A hollowed-out effect on the tips of molar tooth cusps,

• The development of smooth rounded concavities on the inside surfaces of upper and lower teeth if stomach acid is pooling in the mouth during sleep.

These signs are caused by acid form the stomach sitting directly on the tooth surfaces, etching into the enamel and dentine for several minutes.

Sometime the patterns of acid damage are so distinctive that the dentist can tell which side a person predominantly sleeps on!

The chief dental symptom that reveals that silent reflux may be occurring is persistent tooth sensitivity.

If you have sensitive teeth that require the constant use of sensitivity toothpaste to manage, then it is important that you talk to your dentist.

Tooth sensitivity can also be caused by many other factors including tooth decay, tooth grinding or damage from excessively forceful brushing. It is important to have a correct diagnosis so that the problem is correctly managed.

If it appears that you may have silent reflux, then the next step is to speak to your GP for correct diagnosis and management of your digestive issues. Your dentist cannot help you with this part - beyond offering some supportive tips until you can see your doctor.

As with all dental symptoms, it is important to get them checked,

sooner rather than later.

They can be important indictors of general health issues that benefit from our attention and care.