Filling or Sinus???

[Windknot]

Help....PLEASE!!!!!

History:

1. I was in my drysuit class today in 12 feet of water.
2. I had a sudden onset of pressure/pain during one descent maybe 4-5 on a scale of 10 in or near my upper right molar that is second from the back (sorry dont know his name...so I will call him Mike the Molar)
3. Mike the Molar continued to hurt for the next several minutes. The pain was unaffected by depth (relative to the pool that I was in at least) as far as I could tell.
4. Task loading (keeping the feet first ascents to a mininmum) made me forget about Mike the Molar and soon the pain disappeared.
5. Only moments before....I had trouble equalizing on that side.

Physical:

1. Mike the Molar has a big...old nasty silver type filling in it that has never given me any trouble whatsoever.
2. Never had similar pain on previous dives.
3. I have been nursing a cold over the last several days. OTC decongestants are contraindicated due to mild anti-hypertensive therapy (dang it!!)


Disclaimer:

I am not looking for a diagnosis nor am I attempting to initiate a Dr./patient relationship with anyone. Just looking to whine for a while and maybe get some info to take to someone I CAN enter into a Dr./Pt. relationship with.


Question:

Originally I assumed that I had a tooth related type of barotrauma and then I read a post on another board (compliments of Doc V) that had similar symtomology that was (according to all those who replied) assumed to be sinus related.

I'm wondering if there is any way to distinguish whether it was one or the other? Who shoud I see? My DDS or an ENT? OR....should I wait till the cold runs it's course and try it agian and see if it comes back?

There was lots of information on rootcanals and caps and the like as related to diving, but I didnt find anything on fillings/sinus.

Thanks in advance

 

[John Reinertson]

Tooth squeeze and sinus squeeze are the two most likely culprits for pain in the upper teeth occurring on descent, especially if relieved by ascent.

Tooth squeeze usually involves substantial depth (greater than forty feet as a rule of thumb).

The fact that this occurred at a relatively shallow depth and occurred on the same side that you had trouble equalizing on and occurred when nursing a cold all suggest (but don't conclusively prove) that this was sinus squeeze.

Air pockets in teeth are relatively small, compared to a sinus. Some of the compression can be compensated for by local tissue swelling and blood vessel stretching within the cavity. The amount of compression that can be compensated for depends on the proportion of tissue to air pocket.

A sinus has a modest amount of tissue for a big air pocket, and squeeze is felt sooner.
A tooth usually has a small air pocket and a moderate amount of tissue, so it takes more compression to cause pain.

Either way, pain is pain and takes a lot of the fun out of a dive, plus risking injury.

It's always good to go back up and try equalizing again when you have pain, and don't force it.

John

 

[ymy]

Windknot,

I had something similar happen to me. During descent (I think this is key) I felt quite a bit of pain around the jaw and teeth on one side of my face. This was a while back during my OW certification. I stopped for a while to think about it. I had read about tooth barotrauma, but that it happens during ASCENT. This was from compressed air being forced into an improperly filled tooth cavity and expanding on the way up. I figured at that time (probably stupid) just to push on as there was nothing I could do about it one way or the other. If my tooth exploded, so be it (I was really hooked on diving already !). Didn't quite understand why my tooth should hurt during descent.

Anyway, it cleared after a short searing pain. On ascent however I found there was some bloody mucousy (sp ?) discharge on my face. My instructor said it was because I had suffered some sinus barotrauma.

Thinking about the incident later this is what I think happened. I had gotten pretty good at equalizing (my ears) simply by swallowing. Didn't need to pinch and blow. I think what had happened was I was equalizing my ears but not my sinuses. Now I know better and whenever I feel the sensation again, I rise a few feet to equalize my sinuses.

 

[Laurence Stein DDS]

Hello Windknot,

Sounds to me like a sinus squeeze because you are nursing a cold or its after affects. Sinuses are the leading cause of barodontalgia. The short duration of pain is also more typical of a sinus problem.

Mike the molar's big filling could be a factor. As fillings wear out, the swell laterally--caused by corrosion under the filling. This leads to "leaky" fillings, fractured teeth, bacterial invasion into the nerve and recurrent decay.

When examining a dental patient for a toothache, we look for tenderness in a tooth, percussion sensitivity (tapping), cold sensitivity, hot sensitivity, sweets sensitivity and mobility of the tooth. The gums around the molar tooth should be checked as well, an abscess between the roots of a molar can create problems too.

We also evaluate if the tooth is sensitive to pressure applied only by the bite or if an object is inserted between that tooth and the opposite tooth. Pain on biting with food is usually the sign of a fractured tooth or cusp. There may also be "rebound" sensitivity--when you release you feel a sudden pain. Usually, you can't quite localize which tooth it is when it is fractured. There are no position sensing nerves (proprioception).

Biting pressure discomfort without food between teeth usually means that the membrane supporting the tooth is inflammed. This membrane, the periodontal ligament, will swell and it has position sensing ability--you most likely can point to the exact tooth.

Sensitivity to cold only may simply be an irritated nerve which may reverse itself. Sensitivity to hot and cold is more likely a dying nerve. Some authorities downplay hot sensitivity but it works for me.

An abscessed tooth may throb for days or only when you are applying pressure to it. In the worst case, the pain becomes unbearable at night and you wake up your dentist at 3 in the AM.
Please, I'm begging you find another dental provider!

Sinus inflammation in molars and bicuspids (just in front of the molars may result in pressure being applied to the roots of these teeth and they are forced into the mouth just enough for you to start clenching on them. That makes them even more sore.

Finally, to ymy, tooth pain can occur either descending or ascending. It is usually worse within the first 30-40 feet. In general, pain on ascent can be a chronic abscessed tooth, a fractured tooth or a tooth with an irreversible pulpitis (it's gonna die). Pain on descent or both descent and ascent is more likely in an acutely abscessed tooth--and you shouldn't be diving.

Placing thumb pressure on the cheeks below the pupils may elicit a soreness if the sinuse is involved. Tipping your head forward and tapping your teeth or jumping up and down may allow you to feel the congestion within the sinus--you may hear a change in the sound of the tapping teeth or you may feel the fluid moving aroung in your head.

While you may have to be careful with nasal sprays and decongestants, topical steroid nasal sprays may work well. If you are having a yellow or greenish discharge from the nose, anantibiotic may be necessary as well.

Who should you see first??? If you are having no symptoms now, you might have to dive again (in the pool) and see if it repeats. If it does, and the pain again deminishes quickly, I would suggest an ENT. If your teeth continue to hurt, you could be looking at doing a root canal treatment and a crown for the big, Mike the molar tooth.

Good luck,


Laurence Stein DDS


:doctor: