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Good morning.

What is Gastroesophageal reflux disease, or GERD? It occurs when stomach acid regurgitates back into the esophagus, causing a burning sensation in the chest, commonly referred to as heartburn.

Why do some patients with obstructive sleep apnea (OSA) not improve even when their treatment device fits well?

This issue looks at how mouth acidity, GERD, and medication side effects might be affecting your results, and what you can do about it.

In Today’s Edition:

-The Acid-Airway Axis: Why GERD and dry mouth might be undermining OSA therapy
-SSRIs, Saliva, and Sleep: What every dental team should know about medication-induced acidity
-Clinical Script: How to screen for GERD-OSA risk in under 30 seconds during hygiene
-New Patient Downloads: Printable tools from Dr. Bennett’s office for same-day implementation
-Coach Cathy’s Corner: Quick tips to calm reflux and sleep better

5-minute read👇

Clinical Corner

🥼Use the clinical corner as your secret weapon to impress your colleagues and patients!

Key Takeaways🔑

• GERD and OSA fuel one another through airway inflammation and acid microaspiration

• SSRIs and other meds reduce saliva, increasing oral acidity and risk of erosion, caries, and airway irritation

• Targeted lifestyle coaching (hydration, alkaline foods, positional therapy) can break this inflammatory loop

The Acid-Airway Axis: What Dentists Must Know

Your patient’s airway doesn’t end at the soft palate—it continues to the esophagus, where gastric acid can ignite inflammatory cascades that narrow the upper airway. New studies confirm what clinicians like Dr. Jonathan Aviv have long warned: chronic reflux doesn’t just damage the throat—it may contribute to the pathophysiology of OSA.

Dentists are uniquely positioned to detect early signs of acidic oral environments, including enamel erosion, dry mouth, a burning sensation on the tongue, and even halitosis. Left unchecked, these oral clues may reflect a systemic pattern of nighttime reflux, sleep disruption, and subclinical inflammation.

Medication Matters: Saliva Suppression and Acid Risk

SSRIs like fluoxetine, sertraline, and paroxetine are known to reduce salivary flow, which:

• Increases the oral cavity’s acidity

• Worsens GERD through altered autonomic function

• Reduces appliance tolerance due to mucosal irritation

Your role as a sleep dentist includes recognizing these side effects and guiding patients toward supportive strategies, such as saliva substitutes, xylitol rinses, and remineralizing gels.

The Science:

Studies have demonstrated that antidepressants—even SSRIs—can reduce salivary flow and impair the oral cavity’s acid‑buffering capacity (Hunter et al., 1995; Daly, 2016). Furthermore, recent evidence links xerogenic medication use with both hyposalivation and increased prevalence of GERD (Sangalli et al., 2023).

• Hunter, K. D., Wilson, W. S., & Dawes, C. (1995). The effects of antidepressant drugs on salivary flow and content of sodium and potassium ions in human parotid saliva. Archives of Oral Biology, 40(10), 983‑989.

  • This study found that certain antidepressants (including SSRIs such as fluoxetine and paroxetine) are associated with reduced stimulated parotid salivary flow and corresponding subjective dry mouth symptoms.

• Daly, C. (2016). Oral and dental effects of antidepressants. Australian Prescriber, 39(3), 84‑88.

  • This review article reports that while tricyclic antidepressants cause a significant reduction in salivary flow (58%), SSRIs still produce a measurable reduction (~32%) and outlines how reduced salivary flow compromises the protective buffering, lubrication, and remineralization functions of saliva.

• Sangalli, L., Eldomiaty, W., & Miller, C. S. (2023). Xerogenic medications may contribute to decreased unstimulated salivary flow in patients with oral burning and/or gastroesophageal reflux disease. Frontiers in Dental Medicine, 4, 1047235.

  • This recent study shows a clear association between use of xerogenic medications (including centrally acting medications with anticholinergic or sympathomimetic effects) and reduced unstimulated salivary flow in patients with GERD—supporting the link between medication‑induced dry mouth and reflux/airway risk.

Practice Growth: Scripts and Screening Strategies

Inspired by Dr. Bennett’s "Sleep-Airway-Ortho Master Plan," here’s a script to use during hygiene visits when dry mouth and acid risk are observed:

Then offer a GERD/OSA Risk Handout and/or Dry Mouth/Medications/Acid Reflux Handout and invite the patient for a Sleep-Airway Evaluation.

NEW: Free Patient Tools & Workflow Downloads

Suspected GERD + OSA Patient Educational Handout
Visual guide to help patients understand the mouth-gut-sleep connection
Click Here to download

Dry Mouth, Medications, and Acid Reflux Educational Handout
Designed for SSRIs, SNRIs, and antihistamines
Click Here to download

Coach Cathy’s Take

Quick Tips to Calm Reflux and Sleep Better

Even small changes can reduce acid and help your airway heal:

• Eat smaller meals – Less pressure = less reflux

• Raise the head of your bed – Gravity helps overnight

• Avoid eating 2–3 hrs before bed

• Choose alkaline water over soda or citrus

• Manage stress – Breathing & walking help digestion

• Avoid tight waistbands after meals

Something Sweet

🍭Stuff so sweet you might get a cavity..

CE Opportunities / Events

Miscellaneous….

Every patient you help breathe better, sleep deeper, and feel stronger is a life changed for the better. Keep asking the deeper questions. Keep connecting the dots. You're not just treating teeth, you’re transforming health.

Thanks for being part of the movement.

Until next week,
The— Dr. Michael & Cathy Bennett
More Than Teeth | A Mission for Generational Health