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Caries Risk
Many medical conditions result in increased risk for caries, including the following:

 
1.
Gastroesophageal Reflux Disease (GERD):
 
Enamel: Intensely hard calcareous substance that forms a thin layer partly covering the teeth; the hardest substance of the animal body; consists of minute prisms arranged at right angles to the surface and bound together by a cement substance.
Enamel erosion by acid exposes the underlying
Dentin: A calcareous material similar to bone but harder and denser that composes the principal mass of a tooth; consists of a matrix containing minute parallel tubules which open into the pulp cavity and during life contain processes of the cells of the pulp.
dentin. This is usually most severe on palatal surfaces.
 
Reflux precautions, dietary modifications, and medications can be considered for treatment of GERD.
 
Patients should be counseled to rinse the mouth with water or a dilute baking soda solution to neutralize the oral pH. Immediate brushing may accelerate enamel loss. (See Bulimia for more information.)
 
2.
Bulimia. Similar to GERD, recurrent emesis increases the risk for caries due to enamel erosion by gastric acid.
 
3.
Attention Deficit Hyperactivity Disorder (ADHD). Children with ADHD have an increased rate of caries, which is not well understood. The increased rate of caries may be the result of medication side effects, oral hygiene, and/or dietary habits.
 
4.
Xerostomia: Abnormal dryness of the mouth due to insufficient saliva production.
Xerostomia from a primary disease or a medication. (See Medication Effects for more information.)

Refer to Chapter 4: Caries for a complete review of the pathogenesis of caries.
 
 
Repeated acid exposure causes enamel erosion and increases caries risk.
 
Rinsing the mouth after episodes of reflux or emesis can help neutralize the gastric acid.
 
Caries rates are higher in children with ADHD.



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