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With all of the stresses of parenting a child with gastric reflux (GR) it is not as if we needed something else to add to the list, but as I have discovered when my children were much older the issue of tooth decay and enamel thinning needs to be raised and monitored from the eruption of the very first tooth. Although this is usually only a possible problem for more severe long term cases of GR it is wise to be extra vigilant. Mild cases which have subsided by 12 months of age probably won’t be a problem.
The early tooth decay or enamel thinning is caused by stomach acids being refluxed into the mouth and settling around the teeth and frequently left for periods of time without being diluted or cleaned away. I have known shocked parents who have taken their toddler or child for their first dental nurse visit finding themselves being reprimanded and re-educated on tooth brushing and appropriate foods to prevent tooth decay. For GR children it seems that stomach acid on the teeth rather than neglectful dental hygiene may be the cause of tooth decay. Regular brushing is generally enough for non GR children but more attention is needed for GR children.

What can cause it?
• Smaller more frequent feeds are sometimes needed to reduce GR episodes but can contribute to tooth decay.
• Some medications contain sugar
• Fizzy drink is known to causes GR episodes and can contribute to loss of tooth enamel.
• LACTULOSE which is given for constipation alongside Infant Gaviscon is very high in sugar and no sugar free option is available.
• Acidic drinks like full strength orange juice can encourage GR episodes.

What can we do?
• Rinse mouth with water or brush teeth more regularly after meals or after obvious reflux episodes.
• Avoid full strength juice. Water and milk are the best fluids. If giving juice to babies (after three months of age) and toddlers it should be diluted 5ml of juice to 50ml water, or diluted at minimum 50/50 with water for older children
• Rinse the mouth thoroughly with water after medication as well as at mealtimes.
• If sugary foods are given, give them at mealtimes or with other foods is best.
• As soon as your child is able or old enough switch to tablet medications rather than liquid or ask your GP for a sugar-free option.
• If your child is older than one year and has GR, ask your dentist if fluoride supplements to strengthen the enamel would be suitable for him or her.
• If your child still has GR when the adult teeth have emerged discuss with your dentist about having a sealant or plastic coating painted on as added protection. After discussing the issue with my dentist I found out that the cost was approximately $50 to $80 per tooth, not too bad as you would only be doing one or two teeth at a time.
• Regular annual visits to your dental nurse or family dentist from two years of age. If your dental nurse is unable to see your child that frequently, you could consider contacting a registered government school’s dental scheme provider. You local GP should have a list. If not you could phone around the local schools to locate one.

© Jennifer Howard, National Coordinator, Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust March 2005.
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Page last modified 18-Aug-2007 by Roz (Website Manager, Crying Over Spilt Milk).