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Loss of enamel from the teeth can be caused by a number of things. Tooth grinding (nocturnal bruxism), medium or hard bristled toothbrushes that are used vigorously, and over indulgence in highly acidic foods such as citrus fruits can all lead to enamel loss. One reason for enamel loss that is often missed by the dentist is that caused by gastric reflux (GERD). Many people have this problem which allows stomach fluids to travel up the esophagus (the tube that goes from the mouth to the stomach). Usually this will cause symptoms of heart burn so that the person is aware of the problem. Drugs such as Nexium can easily control the difficulty. Studies have been done that indicate that approximately half of the individuals who have gastric reflux do not know that it is occurring! The classic appearance is that of smooth circular depressions of the enamel on the peaks of the teeth, often with exposure of the underlying dentin. Additionally, there will often be areas on the sides of the teeth that have otherwise unexplained enamel loss. Many times this loss is more profound on the side of the head the person sleeps, due to reflux occurring at night and the fluids pooling on that side. Almost always the lower teeth are affected more than the upper teeth, again due to the fluids being present there due to gravity. Control of this problem is not only important due to the loss of enamel, but more importantly due to the potentially life threatening consequences of acid erosion of the esophagus that can lead to esophageal bleeding.
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