Cen_Fla_Keith:
I searched the threads but could not find this exact issue.
I am VERY new to diving (in the middle of the SSI pool work) and having a blast.
Yesterday, the instructor was telling an ancedote about a friend of his who started experiencing tooth pain on ascent. This pain increased until the airspace under a filling expanded enough to blow out the filling. Apparantly, this was not new dental work.
As a 39 year old man with typical dental work (a few fillings, a crown or two, etc.) this concerns me. I visit my reputable dentist every six months. Haven't had any new work in 18 months.
Are airspaces under dental work (e.g., crowns and fillings) a real concern, or does it fall in the "getting to tell scary stories to newbies" category?
Thanks.
Cen_Fla_Keith,
OK. Here goes again.
The stories are true but the incidence is very low...rare even. Exploding teeth and crowns are even more rare. The most likely cause of tooth pain during diving is a sinus squeeze. The pain can refer to the upper molar teeth and can feel exactly like a toothache.
Air spaces are not all created equally. In experiments with Air Force pilots, defective fillings were placed with air spaces underneath. The was no greater incidence with these teeth than normal teeth. Air spaces that may be incorporated into the "body" of a filling do not pose a problem.
An air space left behind following a root canal procedure CAN cause problems...even odontocraxis (tooth blows up). Spaces under fillings that have detected or undetected decay MAY be a problem.
Problematic spaces include the space filled with a cotton ball following root canal treatment. A tooth with a "short filled" root canal can also have a "potential space" between the root canal fill material and the tip of the root. This space can accumulate diffused gas from the blood and cause pain.
A space under a filling that used to have a lining cement may be problematic. There is often decay withing the space that used to have the lining cement that goes undetected.
Potential spaces associated with gum disease can cause problems. A communication between the mouth and an unerupted wisdom tooth is another problem potential space.
There is some research that shows that most dental cements may become weakened by repeated cycles of pressure changes. This may lead to crowns popping off or coming loose.
Old silver fillings often fail by first leaking moisture under the edges and then corrosion expands the filling. This can lead to fractured cusps, broken teeth, marginal leakage and recurrent decay. Composite (porcelain or "white" fillings) may exhibit marginal leakage with time. They don't corrode but recurrent decay is actually a greater problem with these fillings than silver fillings.
It is wise to be up to date with your dental check-ups prior to scuba diving. Old restorations should be examined and replaced as necessary. Periodontal status should be ascertained and treated as necessary. Unerupted teeth, bony pathology, etc should also be evaluated and treated as necessary.
The chances that you will have a barodontalgia is extremely remote so other than getting routine dental treatment done, I wouldn't worry too much about a tooth squeeze or exploding tooth.
If you have more questions let me know. BTW if you do a search of the board, there are many references to barodontalgias, tooth fillings, spaces under root canal teeth that you should be able to find.
Regards,
Laurence Stein, DDS
