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Bad Tastes in Your Mouth in the Morning? Patients Beware of GERD! By Dr David Leader

Some of us wake regularly or occasionally with a sour taste and perhaps a sore throat.
There are a few common causes of bad taste. The some causes can and should receive treatment. There is no
treatment for other causes.

Gastro-esophageal reflux disease or GERD, affects as much as half the population. Bad or sour taste is one
symptom that patients may discuss with their dentist before their physician. Other oral signs and symptoms
include tooth sensitivity, tooth erosion, and an increase in tooth decay  (see photos). Other symptoms
include frequent sinusitis, frequent heart burn, and chest and upper back pain.  Some patients have no
noticeable symptoms - known as "Silent GERD". Silent GERD may be a significant cause  of sleep disorders.
GERD is a treatable, but serious condition.

Normally, the pyloric valve prevents  stomach contents from backing up into the esophagus or food pipe.
Reflux occurs when stomach acid flows up  the esophagus. While the stomach lining protects soft tissue
from acid, the esophagus, throat and teeth do  not have protection against stomach acid.

A primary cause of GERD is weakening of the pyloric valve  by a peptic ulcer (a sore near the pyloric valve)
or hiatal hernia (part of the stomach presses through the  diaphragm into the chest).

Another cause of GERD is an increase in pressure in the stomach or abdomen. Obesity, frequent coughing as
in asthma, and pregnancy can cause enough of an increase in abdominal pressure  to force stomach contents
up into the esophagus.

Other medical conditions may cause the stomach to empty more slowly. Diabetes and diseases that affects the
normal function of nerves and muscles may slow the movement of food through the esophagus and stomach.

Finally, connective tissue disorders such as scleroderma and lupus erythematosis, may change texture and
pliability of the stomach, its lining and the  pyloric valve. When these organs become thicker and less pliant,
gastric reflux may result.

The effects of GERD range from bothersome to life threatening. Stomach acid causes ulcers, scarring and other
injury to the lining of the esophagus. Those changes can turn into esophageal cancer. Acid traveling farther up
the food pipe will enter the throat and mouth causing bad taste (parageusia), sore throat, damage to the vocal
chords, and tooth damage. Dentists sometimes diagnose GERD  in their patients and refer to a physician for
confirmation and treatment.

Treatments for GERD reduce the production and effect of gastric acid. Start by cutting out carbonated beverages,
citrus juice, alcohol, coffee and black and green teas.  These beverages are highly acidic, and caffeine causes
the cells of the stomach lining to release more acid.Foods that set off attacks of GERD include strong spices
and tomato products. Physicians usually prescribe antacids (Tums, Gaviscon) and acid reducing medications
(Prilosec, Acifex). Patients will learn which foods and beverages are more likely to affect them.

Additionally, nicotine and or smoke from tobacco use increases GERD. Nicotine increases acid production
and impairs muscle function. Saliva reduces the concentration of acid in the stomach and esophagus.
Smoking dries the mouth, reducing saliva. Smoking cessation is effective in the treatment of GERD.

Never brush right after an attack of reflux. Acid weakens the tooth surface, then even a soft brush may
remove tooth substance. Instead, rinse with a teaspoon of baking soda in a cup of water. Brush a few hours
later.

Another cause of parageusia (bad taste) is candidiasis or yeast infection. Candidiasis is often associated
with dry mouth (xerostomia). Hundreds of medications cause xerostomia. Xerostomia is associated with various
medical conditions including depression, rheumatoid diseases, and diabetes. Without saliva to wash away
yeast and support the growth of beneficial bacteria, yeast may grow, producing flat or raised, irritated
red patches, and white patches that rub off. Antibiotics kill of beneficial bacteria supporting the growth
of yeast.

Improve xerostomia by drinking plenty of water, sucking on sugar free candies and chewing sugar free gum.
Stay away from alcohol and caffeine. Use bland mouth rinses such as Biotene and Oasis. dentists and
physicians may prescribe artificial saliva (Salivart, Oasis). Medications (Salagen, Evoxac) may slowly
increase production of saliva.

Dentists and physicians treat candidiasis with anti-fungal medications including nystatin and clotrimazole.
Yeast may be hard to eradicate, so follow through with all treatment. Some physicians and dietitians
recommend consuming yogurt with active bacterial cultures to aid in the repopulation of the oral cavity
with beneficial bacteria.

When asked, dentists will try to rule out infection as a cause of sour taste. Dental and sinus infections
will cause bad taste if the infection leaks into the oral cavity.

Some medications doctors prescribe may cause change in taste (dysgeusia). Medications may damage taste buds,
or patients may  taste their medication in their saliva. When medication causes paraguesia or dysgeusia,
discuss the problem with your physician. Do not expect to cease a treatment unless there is an effective alternative.

Finally, treatments do not exist for two frequent sources of dysgeusia - pregnancy  and certain foods.
No one knows why pregnancy may cause both dysgeusia and parageusia.Pregnancy causes a change in the level
and balance of hormone levels and water retention; both may relate to taste changes. Many foods, famously
onion and garlic, carry sulfur compounds that enter the blood stream and release back into the breath and
saliva. Most of us choose to live with these foods even with this drawback. 

Do you suffer with bad taste in the morning? Speak with your dentist and your physician. The cause may be simple or complex, serious or not. Learning the cause may help you sleep better.
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