Do any of these sound like you?
You wake up clearing your throat.
The edges of your front teeth look more see-through than they did in photos from five years ago.
Your hygienist asked if you have heartburn, and you said “not really,” because at your age, isn’t a little heartburn just… normal?
If you’re nodding at any of those, keep reading. Because what I’m about to tell you is something I see in my chair long before your doctor ever picks up on it.
I had a patient…I’ll call her Linda. She was in her early 50s, active, healthy, and ate well. She came in for a routine cleaning and everything looked fine from the front. But when I tilted my mirror and looked at the backs of her upper front teeth—the palatal surfaces, the side you can’t see in a selfie—they looked like someone had taken a pencil eraser to them. They had a cupped, shiny and thin appearance. Turns out, the enamel was being dissolved from the inside out.
I asked her if she had reflux. She said no, that it was just a little heartburn, nothing serious.
Then I asked if she was on any medications. Prilosec. A PPI, proton pump inhibitor, the class of drugs that shuts off stomach acid production. She’d been on it for nine years. Her doctor told her the reflux was “under control.”
Her teeth said otherwise…
That’s the thing about acid erosion from reflux: it’s silent. You don’t taste the acid. You don’t feel the damage. But stomach acid that creeps up while you sleep, even a small amount, hits those palatal surfaces first.
Over time it moves to the chewing surfaces of your molars. If a hygienist has ever asked you out of nowhere whether you have reflux, now you know why they were asking.
This is something dental school never taught me to look for. We were trained to diagnose cavities and gum disease. Nobody connected the erosion patterns on the backs of upper teeth to what was happening in the esophagus. I had to learn that on my own, over decades, by paying attention to what my patients’ mouths were trying to tell me.
I had another patient with erosion so severe (years of it, layered on top of itself) that the pattern told me this wasn’t just about enamel anymore. The damage was too aggressive, too deep, too consistent. I referred her for an esophageal evaluation. Her doctor hadn’t flagged anything. She had no GI diagnosis. But I’d been looking at the inside of her mouth for long enough to know this level of acid exposure doesn’t stay in the mouth.
She ended up needing surgery for esophageal damage from chronic acid regurgitation.
I saw it before her MD did. And not because I’m smarter, but because dentists see our patients twice a year, and look at surfaces nobody else examines.
That’s the whole point of what I do: your mouth is an early warning system for the rest of your body. And dentists are the ones with the best seat in the house, but only if they know what to look for. That’s why I always say your dentist is a critical part of your healthcare team.
Here’s something else I have seen in practice that almost nobody connects. Patients with sleep apnea who also have acid erosion.
The mechanism is worth understanding: When your airway collapses during sleep — which is what happens in obstructive sleep apnea — the effort to breathe against that closed airway creates significant negative pressure inside your chest. That pressure change can physically pull the valve at the top of your stomach (the LES, the lower esophageal sphincter) open, letting acid leak upward. You never taste it. You never wake up from the reflux itself. But your teeth will show it every time.
If you snore, wake up with a dry mouth, or your partner says you stop breathing at night, this could be feeding the erosion cycle without you ever knowing. A sleep study is worth pursuing — and if you need help finding a provider, an AADSM-trained dentist or a myofunctional therapist through the Functional Dentist Directory are good places to start.
Your stomach may not be producing enough acid to close the LES properly in the first place. As we age, as stress accumulates, and especially after years on a PPI, acid production can decline. Some practitioners believe this creates a vicious cycle: less acid means weaker valve tone, which means more reflux of whatever acid remains, which means your doctor prescribes more suppression. Meanwhile, undigested food ferments, pressure builds, the valve opens, and the cycle continues.
I want to be careful here because this is an area of active research and debate, and I’m a dentist, not a gastroenterologist.
But I can tell you what I see: patients on long-term PPIs whose erosion doesn’t improve. Patients who taper off under their doctor’s supervision and whose teeth actually stabilize. And a growing body of research connecting low stomach acid to the exact reflux patterns I can diagnose in the mouth.
If this is sounding uncomfortably familiar or if you’ve been on a PPI for years and you’re still seeing damage, then here’s what I’d do, in this order…
1. Help your stomach actually digest the food in front of it.
If you’ve been on a PPI for a while, digestion is often compromised. Undigested food ferments, pressure builds, the valve opens, and the cycle keeps going. The single change I’ve seen move the needle fastest is a full-spectrum digestive enzyme taken with meals.
This is what I take and what I recommend: 17 enzymes, full-spectrum, taken with meals.
And please: if you’re on a PPI, don’t stop cold. The acid rebound is real and it’s miserable. Talk to your doctor about tapering, if that’s something that makes sense for your unique situation.
2. Get the overnight acid off your teeth and soothe the tissue it’s been sitting on.
Before you brush in the morning, before your coffee…I recommend swishing with an oil pulling blend for one to three minutes. This does two things: it lifts the overnight acid and bacteria off your enamel, and it helps relieve the irritated oral mucosa after those acids have been in contact with your soft tissue all night. The MCT oil base is gentler on your microbiome than coconut oil (I wrote about why here).
Then brush with an oral microbiome friendly nano-hydroxyapatite toothpaste but don’t rinse after, so the nano-HAP has time to sit on your enamel and start depositing minerals back where the acid took them. (Code ATD15 for 15% off.)
And scrape your tongue. Acid reflux doesn’t just sit on your teeth — it coats your tongue, and everything living on that surface gets swallowed into your gut all day. A stainless steel tongue scraper every morning takes 10 seconds and meaningfully changes what your mouth sends downstream.
3. Rebuild from the inside.
If acid has been eroding your enamel, your body needs the raw materials to repair it. This D3/K2 Complex is on my shortlist for anyone with erosion. D3 helps your body absorb calcium, K2 directs it into bone and teeth instead of soft tissue. You’re rebuilding from the inside, not just the surface.
I’d also add their CoQ10. There’s a well-documented connection between CoQ10 deficiency and periodontal disease, and if acid reflux has been irritating your gum tissue, CoQ10 supports the cellular function your gums need to heal.
4. Fix how you drink your morning coffee.
I’m not telling you to give it up. I love my morning cappuccino. But caffeine relaxes the LES, the same valve we’re trying to keep tight. So a few things matter: never drink it on an empty stomach, because the acid needs somewhere to go. Eat a little fat and protein first. Stay upright for at least an hour after — no lying on the couch. And don’t stack a second cup in the afternoon.
My swap is this wonderful tea, which gives the same gentle lift, the L-theanine lowers cortisol (which matters, because stress is one of the biggest reasons your stomach stops producing enough acid in the first place), and it’s far easier on the valve.
5. Stop grazing between meals.
Every bite reopens the LES and restarts the acid cycle. Eat at meals. Close your mouth between them. Let your saliva do its job…saliva is the only acid neutralizer your body makes on its own, and it only works when your mouth is at rest. A great replacement is xylitol gum.
6. Find out what’s actually living in your mouth.
If you want to know whether the bacteria being disrupted by acid reflux are also a systemic risk, a spit test can tell you exactly what’s living in your oral microbiome. I serve as the scientific advisor for this company because measuring what’s there (rather than guessing) is where dentistry needs to go. Use code DRB for 10% off.
The next time a doctor writes you a script to turn your stomach acid down, ask a second question: has anyone actually looked at what the acid is doing to my teeth?
If someone you love has been on a PPI for years, or if their dentist keeps telling them they grind their teeth without ever asking why, forward this to them. They deserve to know what their mouth might be trying to say.
-Dr. B
P.S. Please do not quit a PPI cold. Talk to your doctor about whether tapering makes sense for your unique situation. And if you don’t have a dentist who’s connecting the dots between your mouth and the rest of your body, the Functional Dentist Directory is a good place to start.
Want to Go Deeper?
Dental Erosion and Gastroesophageal Reflux
Chakraborty A, Anjankar AP. Association of Gastroesophageal Reflux Disease With Dental Erosion. Cureus. 2022;14(10):e30381. PubMed
Dundar A, Sengun A. Dental approach to erosive tooth wear in gastroesophageal reflux disease. African Health Sciences. 2014;14(2):481–486. PubMed
Cengiz S, Cengiz MI, Saraç YŞ. Dental erosion caused by gastroesophageal reflux disease: a case report. Cases Journal. 2009;2:8018. PubMed
Sleep Apnea and Gastroesophageal Reflux
Jung HK, Choung RS, Talley NJ. Gastroesophageal reflux disease and sleep disorders: evidence for a causal link and therapeutic implications. Journal of Neurogastroenterology and Motility. 2010;16(1):22–29. PubMed
Shepherd K, Orr W. Mechanism of Gastroesophageal Reflux in Obstructive Sleep Apnea: Airway Obstruction or Obesity? Journal of Clinical Sleep Medicine. 2016;12(1):87–94. PubMed
Low Stomach Acid and Reflux
Hypochlorhydria (Low Stomach Acid): Symptoms, Tests, Treatment. Cleveland Clinic. Read it here
From the Ask the Dentist Archives
I owe you an update on oil pulling… Why I switched from coconut oil to MCT oil, and how to oil pull properly.
Your “natural” toothpaste is doing more harm than good… The essential oils problem, and why I helped develop Fygg.
What I Wish Dental School Had Taught Me About the Oral Microbiome The foundational article on why your mouth’s ecosystem matters.
Podcast Episode #48: What are the benefits of Oil Pulling? I go deeper on oil pulling in this episode.