Chulalongkorn University Dental Journal

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Teeth are the important elements of a personûs face. Thus, enamel loss in the anterior teeth can affect a personûs overall appearance and confidence. Enamel loss can be caused due to physiological factors (abrasion, attrition and abfraction) or by chemical dissolution (erosion), as occurs in a gastroesophageal reflux disease (GERD) patient. GERD is the retrograde flow of gastric contents into the oral cavity. Most GERD patients present classical symptoms (a heartburn sensation or regurgitation). In the case of a silent refluxer, dental erosion might be the first condition that can be observed. Among the responsibilities of the dentist is to recognize tooth wear from GERD, allowing early detection of silent GERD before complications develop and it becomes more difficult to treat. This paper describes the sequence of treatment for a silent GERD patient, including clinical examination, medical diagnosis, and medical and dental treatment. This can be used as a guideline to provide optimal treatment for GERD patients, especially those with silent GERD. In the case study, posterior teeth were restored with direct resin composites, onlays and crowns, following a minimally invasive concept. The patient was referred for proper medical treatment to stop the progression of GERD. Temporary crowns of anterior teeth were used to assess function, phonetics and dental esthetics of the patient. Once the temporary crowns were deemed appropriate, they were transferred for fabrication of all-ceramic crowns. As a result of this treatment, excellent function was obtained, while the patient regained confidence because of her new, esthetically pleasing smile.



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