The Damage Was on the Inside, Where Nobody Looks

Quick answer: Stomach acid erodes the inner surfaces of the upper back and front teeth — the side facing the tongue and palate — which is exactly where nobody looks in a mirror. It is often the first sign of reflux in people who have no heartburn at all.

The call

He came about sensitivity, and mentioned in passing that his teeth "felt different" with his tongue.

Gadi, 45, from Tzur Hadassah, had no dental complaint you could see. From the front, his teeth looked entirely normal.

What we found

The finding was on the palatal surfaces — the inner side of the upper teeth, facing the roof of the mouth.

Enamel had been dissolved away across the inner surfaces of all six upper front teeth, leaving them thinned, smooth and slightly yellow where dentine showed through. The upper back teeth showed cupping on the biting surfaces, with two amalgam fillings standing visibly proud of the tooth around them.

The lower teeth were largely spared, which is characteristic — the tongue and the pooling of saliva in the floor of the mouth give them some protection.

That distribution is the signature of intrinsic acid: acid arriving from the stomach rather than from the diet. Dietary erosion tends to hit the outer and biting surfaces first, because that is where drinks contact. Gastric acid washes over the palatal surfaces of the upper teeth.

Gastric acid is also considerably stronger than most dietary acids, so the damage tends to be more severe.

The history that mattered, drawn out with specific questions rather than "do you get heartburn", because he did not:

• An acid or bitter taste in the mouth on waking, most mornings. He had assumed this was normal.
• A chronic dry cough for about two years, investigated once and attributed to allergy.
• A hoarse voice in the mornings that cleared through the day.
• Occasional throat clearing.
• No heartburn, no pain, no indigestion.

That combination — dental erosion on palatal surfaces plus morning acid taste, cough and hoarseness without heartburn — is a recognised presentation of laryngopharyngeal reflux, sometimes called silent reflux, where acid reaches the throat and mouth without producing the classic burning symptom.

His dental erosion was the first hard evidence anyone had of it.

What we did

Referred him to his family doctor, with a written summary describing the erosion pattern and the associated symptoms. That letter did real work — it turned a vague cough into a specific question.

He was investigated and treated for reflux over the following months. The management was theirs, not ours.

Dentally, in the meantime:

• Baseline casts and photographs. Progression cannot be assessed without them.
• High-fluoride toothpaste and varnish to harden the remaining enamel.
• Do not brush after an episode of reflux. Rinse with water, or a bicarbonate rinse to neutralise, and wait an hour.
• Sensitivity management for the exposed dentine.
• No restorations yet. Rebuilding worn surfaces while acid is still arriving means the restorations fail. Stabilise the cause first.

The outcome

His reflux was confirmed and treated, and the morning acid taste and cough resolved over about three months.

Casts at twelve months showed no measurable further loss. At that point we began restoring the worst-affected upper front teeth with composite to restore the palatal surfaces and the edges — done in the right order, on a mouth where the acid had stopped.

The cough, incidentally, had been bothering him more than his teeth for two years.

What to do if this happens to you

1. Ask your dentist to look at the inner surfaces. You cannot see them yourself.
2. Report an acid taste on waking, a chronic cough or morning hoarseness, even without heartburn.
3. Do not brush straight after reflux or vomiting. Rinse and wait an hour.
4. Get the medical cause treated first. Restorations placed into ongoing acid attack do not last.
5. Ask for baseline casts so progression can be measured.
6. Mention any history of vomiting, including eating disorders and pregnancy sickness. The pattern is similar and the conversation is confidential.

Sensitivity with no obvious cause? Ramat Beit Shemesh Urgent Dental Care examines the surfaces you cannot see. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh

This is a composite clinical story. It reflects a presentation we see regularly in Beit Shemesh and Ramat Beit Shemesh; the name and details are illustrative and are not those of a real patient.