Dental issue related to root canal and diving?

[SadiesMom]

I had a root canal 3 weeks ago that has been giving me problems - saw an endodontist Tuesday who discovered that I had an infection at the base of one of the roots and he performed a trephination. I'm on amoxicillin and did hot salt water rinses every hour for 20 minutes all yesterday. The pain is *much* better today.

Unfortunately, however, my endodontist went on a 2 week vacation yesterday morning, so he's unavailable to ask (and I forgot to ask him ). I'm scheduled to do a New Year's Day Dive - and I'm a little leary about doing that with a hole going into my jaw from my mouth into the area around the root of my tooth...(albeit under the gum line). I called my regular dentist and he said if my tooth didn't hurt, it would be OK, but I'm still a bit concerned about the possibility of an air embolism...am I being overly concerned? Or am I correct in thinking that diving only 5 days after a trephination is too soon?

I mean, I'd love to do the dive, but not if it means I'm risking my health...

I'm just looking for any opinions here - I'll be calling DAN as well...

 

[Dive-aholic]

I'm not a dentist and don't know much about dentistry, but I'd probably wait (as much as it would pain me not to dive). If air does find its way in there and can't find its way out, the pain will probably be much worse than you've experienced so far. I'd also think you'd be okay on the descent. It's the ascent where you'd find out whether it was a mistake to dive, when you can't do anything about it.

 

[SadiesMom]

I'm not a dentist and don't know much about dentistry, but I'd probably wait (as much as it would pain me not to dive). If air does find its way in there and can't find its way out, the pain will probably be much worse than you've experienced so far. I'd also think you'd be okay on the descent. It's the ascent where you'd find out whether it was a mistake to dive, when you can't do anything about it.

Thanks, Rob - that's a concern for me as well. In fact, I did call DAN and they said that air embolism wasn't a concern, but that dental squeeze was probably the biggest concern - for the exact reasons you mentioned. I think diving is going to be out for me this weekend . Ah well. Better not to risk it.

 

[Dive-aholic]

Thanks, Rob - that's a concern for me as well. In fact, I did call DAN and they said that air embolism wasn't a concern, but that dental squeeze was probably the biggest concern - for the exact reasons you mentioned. I think diving is going to be out for me this weekend . Ah well. Better not to risk it.

Good call. Happy New Year!

 

[drbill]

Agree that air embolism should not be a problem. As a long time diver with a pot of gold, silver (and mercury) in my mouth, I've had a number of occasions where air pockets in cavities have popped fillings loose upon ascent. I think I spent as much on root canals as I have on equipment in 45 years of diving!

 

[Laurence Stein DDS]

Hi SadiesMom,

A trephination is where a hole is put through the overlying skin and then into the bone to allow a drainage channel for infection/pressure. Generally, the soft tissue begins to close over in 24-48 hours. Even salt water rinses won't keep the opening patent if there is nothing to drain.

I would have no real concerns about you diving but I do have reservations about a completed root canal requiring trephination three weeks after the completion of the procedure. In my book this indicates that the procedure may not be successful and should be retreated if possible or the tooth should be extracted if re-entry into the tooth is impossible.

Another treatment option is the removal of the root tip or tips that fail to respond to conventional root canal therapy. This can be accomplished by a procedure called an apicoectomy (with or without a retrograde filling). Typically a retrograde filling is also done at the same time.

With the high success rates of dental implants, and since the apicoectomy procedure must sacrifice some bone to access the root tips....and by doing so reduces available bone for implant placement and may require you to have some sort of bone augmentation before a contemplated implant procedure, you might be well advised to consult with your restoring dentist as to whether it would just be better to forgo any apical surgery and simply extract a failing root canal tooth so that the site is better suited for implant placement.

BTW, in a small number of cases, the trephination may result in a successful outcome of the root canal procedure and if so, do nothing until it becomes necessary.

Laurence Stein DDS