Diagnostic device Peptest has been used to help researchers investigate a potential link between salivary pepsin levels and tooth erosion.

Dental erosion – the loss of tooth enamel – has often been associated with reflux disease due to direct contact between tooth surfaces and acidic substances and digestive enzymes present in gastric refluxate.

Various case studies have previously concluded that patients diagnosed with gastro-oesophageal reflux disease (GORD/GERD) are at a higher risk of developing dental erosion.

In a new study – featured in the Journal of Clinical Advances in Dentistry – researchers sought to evaluate whether patients with dental erosions had high levels of the stomach enzyme pepsin in their saliva and to see if patients without dental erosions had no or low levels of pepsin.

Saliva samples of 50 patients at a dental surgery in Cottingham, East Riding of Yorkshire were provided and analysed using Peptest. Samples were provided upon waking, before eating and cleaning teeth and some samples were collected after eating lunch and dinner.

However, the study found that there was no correlation between positive pepsin levels and the presence of tooth erosion.

Saliva samples provided on waking generally had higher pepsin concentrations than those saliva samples provided post-prandial. Patients with dental erosions had significantly lower salivary pepsin concentrations in both on waking and post-prandial samples compared to those patients presenting with no dental erosions.

Researchers suggest that because pepsin is a larger molecule than acid it is too large to penetrate the tooth enamel and cause a breakdown in dentine, whereas acid being smaller easily penetrates resulting in demineralisation and tooth erosion/decay.

Jeanine Fisher, co-author of the study, said: “We hypothesised that there would be a strong link between salivary pepsin levels and tooth erosion and the aim of this study was to demonstrate this. However, there was no correlation between the presence of dental erosions and the presence of pepsin.

“There is still the intriguing question of why the patients who had no dental erosions presented with higher levels of pepsin whereas the patients with dental erosions had negative or low pepsin levels present as our data did not support the involvement of pH. The study would have benefited from the recruitment of more dental practices and evaluating patients in a narrower age range.”

You can download the research paper here.

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