Keyi Wu, Víctor I Madariaga, Tantry Maulina, Lingyun Cao, Geert J Bulte, Yasmijn J van Herwaarden, X Frank Walboomers, Bas A C Loomans, Tatiana Pereira-Cenci
Current evidence suggests possible association between GERD and specific oral manifestations such as erosive tooth wear, burning mouth and halitosis. Salivary characteristics and oral microbiome are potentially associated with the spectrum of GERD-related esophageal diseases. No salivary biomarker has achieved optimal combined sensitivity and specificity.
OBJECTIVE: This scoping review was conducted to map evidence on associations between oral manifestations and gastroesophageal reflux disease (GERD) and its related esophageal diseases, including non-erosive reflux disease, erosive esophagitis, Barrett's esophagus and esophageal adenocarcinoma.
DATA: The protocol was published on OSF (https://osf.io/8w9rv/). Eligible studies included clinical studies reporting associations between oral manifestations and GERD-related esophageal diseases. The methodological quality of the included studies was assessed using Mixed Methods Appraisal Tool (MMAT). Data were charted on study characteristics, diagnostic criteria, oral manifestations measures and key findings.
SOURCES: A comprehensive search was performed in PubMed, Embase, Scopus, the Cochrane Library, Web of Science, and OPENGREY in February 2024 and updated in July 2025.
STUDY SELECTION: In total, 162 studies were included (97% cross-sectional and 3% longitudinal). Fifty studies reported erosive tooth wear. Salivary characteristics alterations were identified across the GERD spectrum in 42 studies. Investigations into oral microbiome (n = 15) revealed associations with esophageal disease severity. Salivary pepsin was the most studied biomarker (n = 17), showing moderate but variable accuracy. Fifty-seven studies reported other oral manifestations, with burning mouth, halitosis, xerostomia, and tooth sensitivity commonly linked to GERD.
CONCLUSIONS: Current evidence suggests possible association between GERD and specific oral manifestations such as erosive tooth wear, burning mouth and halitosis. Salivary characteristics and oral microbiome are potentially associated with the spectrum of GERD-related esophageal diseases. No salivary biomarker has achieved optimal combined sensitivity and specificity.
CLINICAL SIGNIFICANCE: This review highlights substantial opportunities for the fields of gastroenterology and dentistry to collaborate on joint clinical strategies aimed at prevention and early diagnosis.