barodontalgia Help from dentist Please??

[itsmenicol]

I am new to scuba diving I am just getting my open water certificate in the next couple weeks. I am worried, I have a tooth in which a root canal was half-done. I haven't had it finished due to well, reasons. I am going to try and get it taken care of, but how likely is it that I will have a problem if it isn't?? The tooth is completely hollowed out I believe. Thank you for any help, I appreciate it!

 

[iiii]

"barodontalgia"

interesting word, is it yours? ;-0

 

[itsmenicol]

Barodontalgia
Because of Boyle's Law, (as pressure increases, volume decreases and vice versa), diving with air-filled spaces in teeth cause problems because spaces inside teeth cannot decrease in size and increase in size in proportion to the depth under the surface. Because we are already functioning at one ATM of pressure on the surface, a dive to 99 feet would increase the pressure inside the cavity to 4 atm absolute, a pressure of 58.6 lb/sq. in.

This increase in pressure would cause pain or barodontalgia and can severely limit a diver from functioning underwater.



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Conditions that can allow air to enter into the interior of the tooth can cause barodontalgia, including caries, defective margins of restorations, periodontal abscesses, maxillary sinus congestion, pulpal lesions and endodontic therapy.

Teeth that have been opened for endodontic treatment and temporarily sealed have been known to explode from air trapping and expansion on surfacing. This is referred to as odontocrexis and is found to be more common in deep divers using a heliox mixture. Full porcelain crowns can also shatter from relatively shallow dives of 65 feet. It is suspected that trapped air is a very efficient crown remover in teeth where the cement bond is failing. Meticulous oral health is advised for divers actively engaged in scuba diving and to avoid barodontalgia, all carious lesions should be restored, ill-fitting crowns replaced, active periodontal lesions treated and all endodontic therapy completed.

Credit:
http://www.scuba-doc.com/dendiv.htm

 

[Laurence Stein DDS]

I am new to scuba diving I am just getting my open water certificate in the next couple weeks. I am worried, I have a tooth in which a root canal was half-done. I haven't had it finished due to well, reasons. I am going to try and get it taken care of, but how likely is it that I will have a problem if it isn't?? The tooth is completely hollowed out I believe. Thank you for any help, I appreciate it!

Hi Itsmenicol,

I see you have a good idea of what barodontalgia is and the mechanics behind the condition.

The actual probability that your tooth will be a problem on any particular dive cannot be accurately determined. Barodontalgia is a rather rare condition...although I will say that through my contact with DAN, ScubaDoc and Scubaboard, I believe it is more common than reported.

You have set yourself up for a potential serious problem. Even if you weren't diving, a partially treated root canal can become a serious infection. The longer it remains incomplete, the poorer the prognosis of success for the treatment and the final restoration.

It turns out that the most frequent reason for root canal failure is the failure to properly restore the tooth following the procedure. Even a delay of a month may make a difference. You can bet that germs from the mouth have managed to get past the temporary in your tooth because of the delay and unless treated to completion, soon, you will likely have no choice but to lose the tooth.

Now, if you dive, you have the potential to force all kinds of nasty stuff past the temporary into the open chamber and canals. If you are lucky, the temorary ISN'T sealed....this would allow gases to equilize within the chamber and avoid pain from a pressure differential. On the other hand, if there is a complete or partial seal, then pressure can create a differential and anything from pain to a imploded/exploded tooth. Should this occur, then the potential is high that contaminated material is forced directly into the jaw bone....well,....I think you can see where this is headed.

Please try to complete the root canal before diving. At least, have the tooth cleaned out, remedicated with a calcium hydroxide paste to temporarily fill the canals and sealed with a solid temporary. That way there is no air space and no remaining germs and mouth crud inside. Then complete both the root canal AND the permanent restoration as quickly as possible, making sure that there is no air space remaining inside the tooth.

If you cannot do this in a timely manner....for whatever reasons....consider extraction. This advice has nothing to do with diving. A tooth that needs a root canal can ONLY be treated that way... or extraction. Period. If you cannot do one then do the other. Deal with the missing tooth later with a fixed bridge, implant or denture.

If you have more questions feel free to ask.

Regards,

Laurence Stein, DDS

 

[itsmenicol]

Thank you for your reply and help! I do have one more question, if I were to have the tooth extracted would I have to have an implant right away?? I don't know anything about teeth and I am afraid if I have the tooth extracted quicky (my first class is next weekend) and dont put in an implant right away that I will have some kind of damage to my teeth, going crooked or the like.

I am so appreciative of your time. Thanks!

 

[Laurence Stein DDS]

No, an implant doesn't have to placed at the time of extraction. Most implants are NOT placed at the same time. Before considering the implant, you first must meet with the surgeon and the restorative dentist to make sure you are a candidate for the procedure. You should also be given the different treatment options available from a fixed bridge to an implant to a partial denture.

If you are an implant candidate and you decide to replace the lost tooth this way, there is actually a healing advantage to waiting on the placement for about 3 months AFTER the extraction. The healing socket has reached maximum osteoid potential then and the site may actually be better for the implant then.

Keep in mind that if you do have an implant insterted, you should keep biting forces or pressure off the healing implant site until your dentist tells you it is ok to do so. This includes pressure from a scuba regulator in the back of the mouth. If it makes contact, it may cause micro-movement in the healing implant and that could result in the premature loss of the fixture.

If you only do an extraction, you should wait a week or two (for a simple extraction) till you dive again. Longer waits are needed for more complex "surgical extractions".

Please do not rely on any information you might receive from me or anyone else on the board or the Internet for making your decision. This is something you do with your dentist and any surgeon that may be involved.

Hope this helps.

Laurence Stein, DDS