# Management of Dental Demineralization in a Patient with Complex Medical Conditions: A Case Report and Clinical Outcomes

## TL;DR

This case report describes the successful treatment of severe dental demineralization in a patient with GERD and Brugada syndrome using personalized strategies and interdisciplinary care.

## Contribution

The paper presents a novel case highlighting the interplay between GERD, Brugada syndrome, and dental demineralization, along with an effective management approach.

## Key findings

- A 27-year-old patient with GERD and Brugada syndrome showed significant improvement in enamel integrity after 120 days of treatment.
- Plaque index and gingival inflammation were reduced through fluoride-based therapies and behavioral modifications.
- The case emphasizes the need for interdisciplinary care in managing dental demineralization in patients with complex medical conditions.

## Abstract

Background and Clinical Significance: Dental demineralization is a multifactorial process influenced by biofilm activity, diet, and systemic conditions. While gastroesophageal reflux disease (GERD) is known for its role in enamel erosion, its contribution to cariogenic processes remains underexplored. Additionally, Brugada syndrome, a genetic arrhythmia disorder, may indirectly affect oral health due to medical complexities and reduced motivation for dental care. This case highlights the management of extensive mineral loss in a patient with GERD and Brugada syndrome, emphasizing the importance of personalized remineralization strategies and interdisciplinary collaboration. Case Presentation: A 27-year-old male with Brugada syndrome, treated with a subcutaneous implantable cardioverter defibrillator (S-ICD), presented with widespread enamel demineralization, multiple active carious lesions, and gingival inflammation. Clinical evaluation revealed a high DMFT index (15), significant plaque accumulation, and an oral pH of 5.8, indicating an elevated risk of mineral loss. Poor hygiene habits, frequent sugar intake, and GERD-related acid exposure contributed to his condition. The therapeutic approach included patient education, fluoride-functionalized hydroxyapatite toothpaste and mousse, dietary modifications, and restorative procedures. After 120 days, improvements included enhanced enamel integrity, a reduction in plaque index (from 50% to 25%), and the resolution of gingival inflammation (BOP: 38% to 12%). Conclusions: This case underscores the importance of an integrated approach to managing dental demineralization in patients with systemic conditions. The combination of remineralization therapy, behavioral modifications, and structured follow-up yielded significant clinical benefits. Further research is needed to develop standardized protocols for individuals at high risk due to systemic factors affecting oral health.