The teeth are sensitive to acid. In a healthy person, acid in the mouth usually stems from either acid-producing bacteria or acidic foods.
However, there is another frequently overlooked source of acid that can severely damage the teeth over time, though: acid reflux.
What is acid reflux?
Reflux typically refers to gastric juice that irritates the esophagus and causes heartburn. Reflux can, however, also be a gaseous, fine mist, and rise into the throat and airways. This kind of reflux is known as airway reflux or also as silent reflux because it causes unspecific symptoms that are usually not associated with the condition.
How acid reflux damages the teeth
When the acidic gases reach the oral cavity, they lower the pH of the mouth. The dental enamel is sensitive to acid and can be damaged by it. The technical term for this phenomenon is enamel erosion.
The gases carry an enzyme from the stomach with them, called pepsin. Because pepsin breaks down proteins, it is vital for the digestive process. Unfortunately, though, pepsin can irritate mucous membranes which can cause a multitude of symptoms like hoarseness, sore throat, cough, and asthma. It can also be the cause of bad breath.,
Reflux damages the teeth, especially at night. Saliva can neutralize acid, thereby disarming the reflux. At night during sleep, though, saliva production is reduced. So, at night the natural reflux defence mechanisms are lowered.
How to recognize tooth damage caused by acid reflux
Tooth damage caused by acid reflux is dangerous because it is a creeping process that can take place over many years (even decades) before it gets noticed. In the meantime, a lot of irreversible damage can occur.
Unfortunately, most dentists are not familiar with silent reflux and don’t associate the typical signs of tooth damage with the condition. You should pay attention when your dentist talks about the condition of your teeth, as in combination with other symptoms, this can provide vital clues pointing towards silent reflux.
To determine whether you have silent reflux, you should assess whether you have additional symptoms that point towards silent reflux. Usually, those show up before tooth damage. The RSI test measures how pronounced different symptoms are. Some doctors who commonly see airway reflux patients ask their patients to complete the RSI at a doctor’s visit. You can also take the test online on Refluxgate.
Prevention of further tooth damage by silent reflux
To prevent further tooth damage, the cause, i.e., the silent reflux, has to be eliminated as far as possible. It also helps to avoid acid foods, because they also attack the teeth and worsen the symptoms of silent reflux.
 Roesch-Ramos L, Roesch-Dietlen F, Remes-Troche JM, et al. Dental erosion, an extraesophageal manifestation of gastroesophageal reflux disease. The experience of a center for digestive physiology in Southeastern Mexico. Rev Esp Enferm Dig. 2014;106(2):92-7.
 Johnston N, Dettmar PW, Bishwokarma B, Lively MO, Koufman JA. Activity/stability of human pepsin: Implications for reflux attributed laryngeal disease. Laryngoscope. 2007;117(6):1036-9.
 Ranjitkar S, Kaidonis JA, Smales RJ. Gastroesophageal reflux disease and tooth erosion. Int J Dent. 2012;2012:479850.