Hydrochloric Acid, Six Hours a Night

Somebody in a thread about dental problems put it more precisely than most articles manage:

Mine wasn’t a case of dental Hygiene. It was a case of Acid reflux bathing my teeth in hydrochloric acid nightly. r/AskReddit

That is literally what is happening, and the arithmetic is worse than people assume.

The numbers

Enamel starts to dissolve below about pH 5.5.

A fizzy drink is around 2.5 to 3.5. Lemon juice is about 2. Those are the things people are warned about.

Stomach acid is 1.5 to 3.5, and pH is logarithmic — so it is not slightly stronger than a cola, it is dramatically stronger. It is also arriving from the inside, repeatedly, without any of the counterbalancing that food provides.

And it arrives at the worst possible time

The whole problem is the timing.

Lying flat makes reflux easier. Without gravity holding stomach contents down, the barrier at the top of the stomach has a much harder job.

Saliva production drops to almost nothing during sleep. Saliva is the mouth’s entire buffering system — it neutralizes acid and returns minerals to the enamel surface.

So the strongest acid the body produces arrives at the exact hour the only defense has switched off, and then sits there for six hours.

Which is why the reports are so often specifically about night:

I take good care of my teeth but the damage was done by nighttime acid reflux so I’m always fighting to stay ahead of wear. If you have acid reflux, take it seriously. r/LifeProTips

Take it seriously. That’s from somebody who did everything right and lost enamel anyway.

The pattern is recognizable

A dentist looking at photographs can often name the cause before being told:

This is severe decay, likely from acid. My assumption would be severe acid reflux from your medical conditions combined with dry mouth. r/askdentists

What they are seeing is a distribution that diet does not produce.

Translucency at the edges of the upper front teeth. As enamel thins, light passes through the edge instead of reflecting off it, and the tips start to look glassy and gray. Somebody watching this happen usually thinks it is a staining problem.

Worth separating from normal, because the edges of front teeth are naturally somewhat translucent:

It’s normal for them to be more translucent. If you don’t like it you can have the teeth veneered or crowned. Both would be unnecessary options r/askdentists

The difference is change. Translucency that has always been there is anatomy. Translucency that has appeared and is spreading is erosion.

Cupped hollows in molars. Small dish-shaped depressions in the chewing surfaces, where acid has dissolved the enamel from a broad area rather than a point.

And fillings standing proud. This is the giveaway that nothing else explains. Composite and amalgam do not dissolve in acid; enamel does. So a filling placed flush with the tooth ends up slightly raised as the tooth around it retreats. A dentist seeing that knows how much has gone and roughly how fast.

Which is why treatment order matters

The most important advice in these threads is not about teeth at all:

looks like acid erosion from reflux, vomiting and also bruxism as well..veneers and other things wont last. You should go to a dentist and address the root cause before restoration or cosmetic work. r/askdentists

Ortho first, then you need all of those top teeth crowned. More importantly, you need to get your acid reflux or whatever underlying condition you have under control r/askdentists

Restoration before control is money set on fire. Crowns and veneers are bonded to tooth structure at a margin, and acid attacks that margin. Rebuild a mouth without stopping the cause and the same process undermines the new work.

Somebody in the middle of working this out:

Why are they horrendous? What about the front teeth? I’m just seeking more opinions. I’m suffering from acid reflux and I think it is ruining my teeth r/askdentists

They were right, and the useful next step was a gastroenterologist rather than a cosmetic quote.

And there is a hidden cause behind the cause

This is the connection almost nobody makes:

NAD but if your baking up with acid reflux go get tested for sleep apnea r/askdentists

Obstructive sleep apnea and night-time reflux travel together. The mechanism is mechanical: an obstructed airway means the chest generates strong negative pressure trying to draw air in, and that suction pulls stomach contents upward past the barrier.

Which produces a chain that runs entirely out of sight. Apnea causes reflux, reflux dissolves enamel, and the person is treated for tooth wear for years without anybody asking how they sleep.

Grinding sits in the same cluster:

Could be a combination of airway issues, Acid reflux, grinding. Braces won’t be able to fix this. r/askdentists

Airway, acid, clenching. Three things that arrive together, all overnight, all invisible to the person having them.

What to actually do

Do not brush straight after reflux. The surface is softened. Brushing it then removes it. This is the single most common way people make erosion worse while trying to help.

Rinse with water instead, or water with a pinch of baking soda — alkaline, and it neutralizes rather than dilutes. Wait about thirty minutes, then brush.

Raise the head of the bed, not just the pillows. Pillows bend the body and can make it worse; raising the whole mattress head works.

Nothing to eat for three hours before lying down:

As someone who also has acid reflux eating snacks right before bed can be risky. Food causes increased acid release in the stomach, and once your body goes horizontal it has a much easier time regurgitating r/LifeProTips

Sleep on your left side. Anatomy — the junction sits higher relative to the stomach contents that way.

Treat the reflux medically. This is the actual answer, and it belongs to a doctor rather than a dentist.

Get assessed for sleep apnea if there is snoring, daytime tiredness, or waking with a sour taste.

And tell your dentist. Erosion that is being monitored gets fluoride varnish and early protection. Erosion that nobody knows about gets crowns.

The short version

Stomach acid is far stronger than anything you drink, it arrives when saliva has stopped, and it stays for hours.

The signs are translucent front edges, cupped molars, and fillings standing above the tooth around them.

And restoring the teeth before controlling the acid is the expensive way to do it twice.