Thanksgiving and Christmas dinners can be considerable—and very tasty. At the heart of every holiday meal is the custom that we indulge our appetite to the point where it hurts. Overeating is generally the culprit that brings on indigestion and heartburn after these festive occasions. Most of us are willing to put up with a bit of stomach discomfort for the sake of a special meal but what about when you have regular chest pain after meals? What causes indigestion and heartburn besides overeating?

Indigestion is a feeling of fullness or discomfort during or after a meal. It can also cause a burning pain (heartburn) in the chest, known as acid reflux. Acid reflux, or GERD (gastroesophageal reflux disease) is caused by acids from the stomach that rise into the esophagus. Besides overeating, there are a number of associated diseases that can cause indigestion and GERD, for instance: ulcers, irritable bowel syndrome, and thyroid disease. Medications such as aspirin, estrogen, oral contraceptives, steroids and antibiotics may also be a cause. Lifestyle issues like eating too much, eating too fast, eating high-fat foods, stress, alcohol, smoking and fatigue are also contributing factors.

Frequent heartburn (more than twice a week) is cause for concern. Your physician may recommend a simple test to evaluate if you have GERD.

There are also silent signs of GERD. Often patients do not know that they have GERD because they don't experience the burning sensation or taste the acid. Those who have had GERD for several years may become accustomed to the feeling to the extent that they ignore it. Another common occurrence is for reflux to occur during sleep. These indicators are often hidden until some damage has occurred. Fluid from the stomach is highly acidic; when it enters the esophagus it causes inflammation, thinning of the esophageal wall and can lead to tears and/or esophageal cancer. Another indicator of GERD is the teeth. The same acid that can damage the esophagus is strong enough to dissolve (erode) teeth. I look first at the tooth enamel for signs of a frosty and rough appearance to determine if my patients suffer from GERD. Long term GERD will even cause cupped areas in the biting surfaces and/or near the gum line. If the condition continues to go unchecked, teeth will become thinner, shorter, chipped and eventually expose the inner darker layer of the tooth (dentin). Dentin is softer than enamel and will erode even faster. When patients reach this stage of tooth erosion they usually experience some pain and have limits to their ability to chew – and may lead to tooth loss.

What are the medical treatments for GERD? Often lifestyle changes are sufficient. Eat right, lose excess weight, moderate exercise, stop smoking, limit alcohol, get the right amount of sleep and elevate the head of the bed about 6 inches (not an extra pillow). If these changes don't make a difference, medication may be needed. Most often over-the-counter medicines like Prilosec or Zantac are enough. In more severe cases prescription strength medicine or even surgery may be necessary to control GERD.

What are the dental treatments for teeth affected by GERD? If there is limited tooth damage prevention of acid erosion may be the only treatment. Once dentin is exposed some form of renewal of enamel is important to protect the teeth, this could be as simple as a tooth-colored restorations or more involved treatment such as onlays or crowns.

At your next dental visit ask your dentist if he or she sees any signs of acid erosion of your teeth. If so, get their advice about the degree of erosion on your teeth and whether you should have the teeth renewed. Also ask if you need to talk with your physician about being tested for GERD. And by all means, enjoy that pumpkin pie!

Dr. Robert A. Gallegos is a Fellow of the American Academy of General Dentistry, he is on the faculty of the Scottsdale Center for Dentistry where he is an Assistant Faculty in cosmetic and advanced dentistry, he is a mentor at the Pankey Institute for Advanced Dental Education and a general member or Fellow of several dental groups including the American Dental Association. Dr. Gallegos practices dentistry in Middleburg, VA. You can learn more about his practice at www.MiddleburgSmiles.com.