A 4-year-old with asthma has smooth, cupped-out erosion on the chewing surfaces of the teeth. Which is the most likely explanation?

A 4-year-old with asthma has smooth, cupped-out erosion on the chewing surfaces of the teeth. Which is the most likely explanation?

• A. Bruxism
• B. Bulimia
• C. Decreased saliva
• D. Gastroesophageal reflux

Answer: (D)

This pattern points to dental erosion from acid exposure. The smooth, cupped-out lesions on the chewing surfaces are typical of enamel dissolved by acid rather than worn away by grinding. In a child with asthma, stomach acid entering the mouth from gastroesophageal reflux is a common intrinsic source of such acid erosion. Saliva usually buffers and neutralizes acids, but chronic reflux can overwhelm this protection and sculpt the enamel on the occlusal surfaces of teeth. Bruxism causes attrition with grinding wear facets rather than smooth, cupped areas. Bulimia can cause erosion as well, but the typical pattern often involves the palatal surfaces of maxillary teeth from repeated vomiting; the described occlusal/chewing-surface erosion fits reflux better. Decreased saliva is a contributing risk factor for erosion in general, but the direct cause of this specific pattern here is acid exposure from reflux.

This pattern points to dental erosion from acid exposure. The smooth, cupped-out lesions on the chewing surfaces are typical of enamel dissolved by acid rather than worn away by grinding. In a child with asthma, stomach acid entering the mouth from gastroesophageal reflux is a common intrinsic source of such acid erosion. Saliva usually buffers and neutralizes acids, but chronic reflux can overwhelm this protection and sculpt the enamel on the occlusal surfaces of teeth.

Bruxism causes attrition with grinding wear facets rather than smooth, cupped areas. Bulimia can cause erosion as well, but the typical pattern often involves the palatal surfaces of maxillary teeth from repeated vomiting; the described occlusal/chewing-surface erosion fits reflux better. Decreased saliva is a contributing risk factor for erosion in general, but the direct cause of this specific pattern here is acid exposure from reflux.