Diving & your teeth & sinus

[thethumper]

Hey Folks,

It's been awhile since I've been on line but I wanted to let those who knew I had a bit of DCI in January, which I found out what happened.

The reverse block I had was caused by a totally opacified Right maxillary sinus. The pressure that tried to leave that sinus cavity to equalize on the way back up had to find the path of least resistance. Unfortunately, it was my 2nd upper right molar. I had a filling in the outer side of the tooth. "HAD" is the prime word here. Not only did the pressure push out the filling, it took nearly 2/3 of the side of my tooth w/it. While the maxillary sinus is now clear, I now have to have a root canal & crown. Yea for me. At least they won't have to "Roto-Rooter" out my sinus.

Anyway.... Wanted to let those know what happened & say thanks.

David

 

[lucid]

sounds painful.

 

[Northeastwrecks]

Glad to hear that you're OK now.

FWIW, I have a cantilever bridge on the upper right side of my mouth. Once the pain from the procedure abated, it felt fine and I have not experienced any problems diving.

 

[Laurence Stein DDS]

Hi Thethumper,

Scubadoc alerted me to your problem. I've got a feeling that perhaps you have the "cart before the horse".

A clouded sinus can be caused by any number of reasons--mostly related to sinus infection, URI's, allergies and, very rarely, an abscessed tooth or a devitalized/abscessed as a result of a fractured root.

The fracture could well have been both the source of the opacified sinus and the blockage of the sinus. The only way for pressure to release would be through the tooth. An exploded tooth is called odontocraxis.

I have never seen one and this scenerio is a long shot but it seems to fit

Try to avoid an cantilevered bridge--especially if the unsupported tooth is at the back end of the bridge--this creates a lever that can ruin those teeth supporting the bridge in front of it. If it is your only choice, then that's it--except for an implant.

I assume that the remaining tooth was removed. At the time of removal, was there a sinus exposure or opening into the sinus and was it possible to biopsy any tissue located in or near the sinus. The results would be interesting.

Clouded (opacified) sinuses are not a cause of tooth breakage but could be a reactive process that might indictate dental (or other pathology).

Let me know how you heal up...I'll be interested.

Regards, be safe,

Laurence Stein DDS
:doctor:

 

[BillP]

thethumper once bubbled...
I wanted to let those who knew I had a bit of DCI in January...

DCI? In diving, that abbreviation usually means "decompression illness". In your January post at:

http://www.scubaboard.com/showthread.php?s=&threadid=21118

that you titled "DCS? Reverse Squeeze?" and in your post above, you seem to describe a sinus squeeze. A sinus squeeze is not a "decompression illness" as that term is usually defined.

The term "Decompression Illness" (DCI) refers to Decompression Sickness (DCS) and/or Arterial Gas Embolism (AGE). DCS (the "bends") is a condition where gas that is dissolved in solution at depth comes out of solution on ascent and forms bubbles in the blood stream or tissues causing problems. AGE is a condition where gas from an airspace in the body (lungs, sinus, etc.) enters the circulation, travels with the blood, and causes problems by obstructing important blood vessels. A sinus squeeze in and of itself is neither of those.

Did something else happen besides just your reverse sinus squeeze?

Glad you're getting to the root of the problem you had.

Bill

 

[thethumper]

BillP once bubbled...


DCI? In diving, that abbreviation usually means "decompression illness". In your January post at:

http://www.scubaboard.com/showthread.php?s=&threadid=21118

that you titled "DCS? Reverse Squeeze?" and in your post above, you seem to describe a sinus squeeze. A sinus squeeze is not a "decompression illness" as that term is usually defined.

The term "Decompression Illness" (DCI) refers to Decompression Sickness (DCS) and/or Arterial Gas Embolism (AGE). DCS (the "bends") is a condition where gas that is dissolved in solution at depth comes out of solution on ascent and forms bubbles in the blood stream or tissues causing problems. AGE is a condition where gas from an airspace in the body (lungs, sinus, etc.) enters the circulation, travels with the blood, and causes problems by obstructing important blood vessels. A sinus squeeze in and of itself is neither of those.

Did something else happen besides just your reverse sinus squeeze?

Glad you're getting to the root of the problem you had.

Bill

First let me start with how I was corrected by the good DR’s from DAN & the Deco Chamber techs & Drs. DCI (Decompression Illness) is broad spectrum. It includes most physiological injuries attributed to diving. DCS is a term that has been somewhat discontinued as a diagnosis. A reverse squeeze, is considered a form of "DCI". If I weren't a diver & wasn't diving, than I wouldn't have had a Reverse squeeze (or DCI). That's where the medical industry stands as I was told.

The reverse squeeze caused the nitrogen bubble to find the path of least resistance, which ended up being a filling in my 2nd molar. It pushed the filling out & took part of the tooth with it.

The dentist is sending me to have a root canal & 3 weeks later will do a build up & crown to repair it.

 

[Laurence Stein DDS]

Thethumper,

I'm with BillP on this nomenclature. I see where you are going with this--any illness caused by barometric change is a "decompression illness"

Where you go wrong is that it reverse squeeze is NOT the nitrogen bubbles within the tooth causing the problem. It is air--either through a carious defect, bad filling, fracture or through the root apical opening. The air can be directly injected by means of a communication or by diffusion from the blood stream.

In fact a reverse squeeze can occur without diving--as in flying in an airplane that is pressurized to 8-10 thousand feet. Reverse squeeze also often refers to a reverse SINUS squeeze. You can also get a reverse squeeze from you mask as you ascend and fail to exhale into the mask...you're gonna have some bloodshot eyes!

So nitrogen content really has nothing to do with it nor does diving.

Every few years a group of specialists get together and decide to rename a condition in order to make it more specific. For me DCI was not ambiguous but I can see where a fine line can be drawn between DCI, an illness caused by any form of a failure to decompress all parts of a body following exposure to compressed gas and DCS which in all likelyhood ONLY refers to the BENDS.

For me, DCI and DCS are the same thing as is the old name Bends.

In a few years we will have a new name...how about DCA...decompression arthralgia, DCM...decompression myalgia and DCN...decompression neuropathy. The list could be endless.

In your description, you state that it was your sinus that actually experienced the reverse squeeze and it blew out a tooth in your mouth. Technically you had a barotrauma of the maxillary sinus with extension to a tooth.

I hope you see the point I'm trying to make and perhaps BillP's as well. The doctors you spoke to may well have told you exactly what you related but common usage usually assumes DSI is the Bends. To assume differently, literally makes for a myriad of potential conditions that have to be sorted through to make an actual diagnosis.

This is like one training agency (I won't mention the name) calling your spare regulator the SSS or Safe Second Stage. Except all other agencies used the common name, octopus, to refer to the exact same piece of equipment. Not only that, but calling and octopus a "Safe Second Stage" is an oxymoron...it gets the least use, most gunk build up inside and is often not serviced at the same time as your primary. I'm not so sure it's "safe".

Laurence Stein DDS
:doctor:

 

[DocVikingo]

Seems that this thread is having a bit of a go around about the terms decompression sickness (DCS) and decompression illness (DCI). As words are important, and especially so in medicine, I'd like to pursue this potentially confusing situation a bit.

The fact that these terms are sometimes not clearly defined or used correctly, even by professionals, understandably can lead to uncertainty. There are, however, generally accepted usages within the dive medicine community as a whole. IMHO, it is in our best interests to maintain the distinctions until broad consensus leads to a tidier terminology.

Let me open by asserting that the term DCS has not yet been somewhat discontinued, but rather is alive and well in the current dive medicine literature and in conversations among dive medicine experts. And, to the best of my knowledge, DCS and DCI have not become mutually interchangeable.

The distinction in BillP's post above has a long history that still obtains today. DCS is a specific condition, one that occurs when nitrogen dissolved in blood and tissues enters the free-gas phase due to changing barometric pressure such as occurs upon ascent from a dive. If the resulting bubbles are large or numerous enough, they can produce signs & symptoms by compressing nerves, blocking venous circulation and causing harmful chemical reactions in the blood.

DCI, which covers the whole range of gas bubble-related problems, subsumes the term DCS. But, DCI also subsumes arterial gas embolism (AGE), a condition where air trapped in bodily spaces, most commonly the lungs, enters the bloodstream and occludes an arterial vessel(s).

Damage from a sinus squeeze is an injury known as a barotrauma, also a form of DCI. This is harm that occurs when air trapped in a bodily space undergoes sudden contraction or expansion, damaging the structure that contains it. The type of barotrauma is specified by the location in the body where the immediate injury takes place, such as the ear, lungs or GI tract. The condition that "thethumper" described would most properly by diagnosed as dental barotrauma, and, as Dr. Stein has indicated, it is caused by trapped air, not a nitrogen bubble.

As regards the term "bends," it has occasionally been carelessly applied to mean all DCS, but most accurately refers only to the signs & symptoms (primarily pain) occurring when nitrogen bubbles lodge in or near a joint. The word has largely fallen into disuse, and in today's nomenclature Type I DCS, which may include skin and lymphatic system involvement as well as limb pain, comes closest to its meaning.

Best regards.

DocVikingo

 

[Laurence Stein DDS]

Thanks DocVikingo

I learned something from what you said. My own understanding of DCS and DCI are now better.

Regards,

Larry Stein

 

[thethumper]

DocVikingo once bubbled...
Seems that this thread is having a bit of a go around about the terms decompression sickness (DCS) and decompression illness (DCI). As words are important, and especially so in medicine, I'd like to pursue this potentially confusing situation a bit.

The fact that these terms are sometimes not clearly defined or used correctly, even by professionals, understandably can lead to uncertainty. There are, however, generally accepted usages within the dive medicine community as a whole. IMHO, it is in our best interests to maintain the distinctions until broad consensus leads to a tidier terminology.

Let me open by asserting that the term DCS has not yet been somewhat discontinued, but rather is alive and well in the current dive medicine literature and in conversations among dive medicine experts. And, to the best of my knowledge, DCS and DCI have not become mutually interchangeable.

The distinction in BillP's post above has a long history that still obtains today. DCS is a specific condition, one that occurs when nitrogen dissolved in blood and tissues enters the free-gas phase due to changing barometric pressure such as occurs upon ascent from a dive. If the resulting bubbles are large or numerous enough, they can produce signs & symptoms by compressing nerves, blocking venous circulation and causing harmful chemical reactions in the blood.

DCI, which covers the whole range of gas bubble-related problems, subsumes the term DCS. But, DCI also subsumes arterial gas embolism (AGE), a condition where air trapped in bodily spaces, most commonly the lungs, enters the bloodstream and occludes an arterial vessel(s).

Damage from a sinus squeeze is an injury known as a barotrauma, also a form of DCI. This is harm that occurs when air trapped in a bodily space undergoes sudden contraction or expansion, damaging the structure that contains it. The type of barotrauma is specified by the location in the body where the immediate injury takes place, such as the ear, lungs or GI tract. The condition that "thethumper" described would most properly by diagnosed as dental barotrauma, and, as Dr. Stein has indicated, it is caused by trapped air, not a nitrogen bubble.

As regards the term "bends," it has occasionally been carelessly applied to mean all DCS, but most accurately refers only to the signs & symptoms (primarily pain) occurring when nitrogen bubbles lodge in or near a joint. The word has largely fallen into disuse, and in today's nomenclature Type I DCS, which may include skin and lymphatic system involvement as well as limb pain, comes closest to its meaning.

Best regards.

DocVikingo

Thank you for the clarification.=-) I'm no doctor. I can only go by what the "professionals" tell me. All I know is that when I went down I was fine, when I came back up, my tooth started to hurt like hell. What ever the term it was related to my dive & I don't care to experiance it again. All I want to do is Dive PAIN FREE.