Another issue that has a significant impact on dental erosion is gastroesophageal reflex disorder (GERD). Significant increases in severe erosion are seen in the older population, and between 10 to 20% experience gastric acid symptoms.40 In 2015, over 113 million prescriptions for antacid medications were written, representing over $13 billion in sales.41 Even more worrisome is silent GERD. A recent study found over one-third of patients may have silent GERD, where the reflux actually gets up into their mouth but the patients are asymptomatic.42 This can have a significant impact on dental erosion. Controlling GERD has been shown to have a positive impact on dental erosion. In one study, patients who had dental erosions that were recorded as active lesions were prescribed proton pump inhibitors (PPIs) to help manage their gastric reflux issues. In 86% of cases, progression of the erosive lesions was stopped.43 These results demonstrated that by suppressing the gastric acids, the incidence of erosion was reduced; and the progression of dental erosion was effectively managed.