Gastroesophageal Reflux Disease (GERD) is a chronic condition defined by the frequent backflow of stomach contents into the esophagus, leading to bothersome symptoms and potential complications. While often associated with heartburn and chest discomfort, this retrograde flow of acidic material can travel further up, reaching the throat and mouth. This exposure of delicate oral and pharyngeal tissues to harsh stomach substances can contribute to, or directly cause, a variety of problems, including lesions and sores. This extra-esophageal manifestation means the effects of GERD can extend far beyond the digestive tract, altering the environment of the upper airway.
How Acid Reflux Changes the Oral Environment
The stomach’s contents are highly acidic, typically registering a pH around 2. The lining of the mouth and throat is not built to withstand this corrosive environment, as it is normally maintained at a near-neutral pH of approximately 7.2. When stomach contents repeatedly reflux into the pharynx and oral cavity—a condition sometimes referred to as Laryngopharyngeal Reflux (LPR) or “silent reflux”—the delicate mucosal barrier is compromised.
This damage is caused by hydrochloric acid and the digestive enzyme pepsin. Pepsin is a protein-digesting enzyme that activates in a low-pH setting and can remain temporarily present on oral and laryngeal tissues. Even after the acid is cleared by saliva, a subsequent minor acid exposure can reactivate the pepsin, allowing it to degrade the protective proteins within the mucosal cells.
The chronic chemical irritation leads to inflammation and widening of the tight junctions between epithelial cells, increasing tissue permeability. This breakdown allows the acid and pepsin to penetrate deeper, resulting in cellular damage. The long-term exposure causes a chronic inflammatory response, making the tissues more susceptible to injury and the formation of erosions or ulcers.
Identifying Specific Oral Symptoms Linked to GERD
The direct chemical injury from reflux can manifest as several distinct physical symptoms, including what might be perceived as mouth sores. Genetic studies have found a causal relationship between GERD and an increased risk of mouth ulcers. These acid-related lesions are mucosal erosions resulting from the direct contact of gastric contents with the soft tissues of the palate, gums, or tongue.
One of the most recognized oral signs of chronic reflux is dental erosion, which involves the non-bacterial loss of tooth enamel. The acid washes over the teeth, particularly the inner surfaces, dissolving the enamel and leaving the teeth vulnerable to sensitivity and discoloration. The acidic environment can also lead to xerostomia, or dry mouth, which occurs because the body’s natural defense mechanisms are overwhelmed.
Other common extra-esophageal symptoms include chronic irritation of the throat, hoarseness, and a frequent need to clear the throat. Dysgeusia, or an unpleasant, bitter, or sour taste, is also a frequent complaint due to the presence of regurgitated stomach acid.
When Mouth Sores Are Not Related to GERD
While GERD can cause lesions, not every mouth sore is a result of acid reflux, and it is important to distinguish between the various causes. The most common cause of recurrent mouth sores is aphthous ulcers, often called canker sores. These are small, painful ulcers that appear on the inside of the cheeks, lips, or on the tongue. They are often triggered by minor trauma, stress, or nutritional deficiencies, such as a lack of iron, folate, or Vitamin B-12.
Lesions can also be caused by viral infections, most notably herpes simplex virus, which results in cold sores. Other non-reflux causes include local physical trauma, such as accidentally biting the cheek or irritation from a sharp tooth or dental appliance. Certain systemic conditions, like inflammatory bowel disease, can also manifest as mouth ulcers that require a different diagnostic approach.
Protecting the Mouth and Throat from Reflux Damage
Protecting the oral cavity from reflux damage requires managing GERD and employing specific oral hygiene strategies.
Lifestyle Adjustments
Lifestyle modifications, such as avoiding late-night meals and elevating the head of the bed while sleeping, help use gravity to reduce the frequency of reflux events reaching the mouth. Reducing the consumption of known trigger foods, including highly acidic, fatty, or spicy items, can also decrease the overall acidity and volume of the refluxate.
Immediate Post-Reflux Care
After a reflux episode, immediately rinse the mouth with plain water to wash away the acid. Chewing sugar-free gum after a meal is beneficial because it stimulates saliva production, which acts as a natural buffer to neutralize the acid and restore a normal pH balance. It is important to wait at least 30 minutes before brushing the teeth following a reflux event.
Dental Protection
Reflux acid temporarily softens the tooth enamel, and immediate brushing can cause the abrasive action of the toothbrush to wear away the softened enamel, accelerating the erosion. Using fluoride toothpaste and an alcohol-free mouthwash can help strengthen the remaining enamel and prevent further demineralization. Regular visits to a dentist are recommended to monitor for early signs of dental erosion and receive protective treatments like fluoride applications.