I have a rather serious question for a dentist experienced in dive medicine. I am a navy dentist who is new to diving. I treated a patient today suffering from an endodontic emergency. He had a necrotic pulp, with an acute apical periodontitis with mild swelling, and a draining sinus tract. I performed a pulpectomy (removed the nerve), placed CaOH, and placed him on antibiotics. The ideal plan would be to complete the root canal when the infection resolves. The only problem is the patient is a diver who is going on a remote excercise for two months in which he will be expected to carry out his duties in freezing waters and at excessive depths. This begs the obvious question as to the safety of his situation. He's basically walking around with a hollowed out tooth, covered only by a temporary filling (cavit). Is it right to be concerned about potential complications? Is it imperative that the root canal be completed before he dives?:boom:
Partial root canal/remote dive site
- Thread starter bobdent69
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FredT
Guest
I have dove with incomplete root canals.
A problem arises if gas is trapped under the temp on ascent. If there is a way to ensure no gas trapping it's cool. I had my dentist do a "soft" filling cap that was removeable on a complex molar canal to prevent that problem, and planned on replacing it with a temp compound before eating if it completely lifted. No problems though.
Even though Keflex is good stuff, it still takes time to work.
FT
A problem arises if gas is trapped under the temp on ascent. If there is a way to ensure no gas trapping it's cool. I had my dentist do a "soft" filling cap that was removeable on a complex molar canal to prevent that problem, and planned on replacing it with a temp compound before eating if it completely lifted. No problems though.
Even though Keflex is good stuff, it still takes time to work.
FT
DocRCH
Guest
The gas in the incomplete root canal can cause barotrauma. Antibiotics are not indicated in most situations (this is what newer, peer reviewed research is showing). A lot of dentists prescribe antibiotics, but they do little in taking care of the problem. Analgesics such as ibuprofen are effective.
Robert:doctor:
Robert:doctor:
kelpmermaid
Contributor
a former dentist told me that there does seem to be a dental version of Murphy's law - the more distant one is from a modern dental care provider, the more likely it is that something you should have taken care of before you left home will require attention. As in "Now, don't go off to Mount Everest without replacing that filling..."
Laurence Stein DDS
Medical Moderator
Dear Bobdent96,
I am a practicing dentist, PADI divemaster and a dental consultant for both DAN and Scubadoc.
The situation you discribe is potentially serious for the comfort and the safety of your diver. I have had the opportunity to examine several patients suffering from dental barotrauma.
In each case, pulpal pathology was present--either before the dive or became symtomatic following the dive--usually on ascent.
The unfilled space within the partially treated tooth has the potential to implode or explode--odontocraxis, create trauma on the periodontal ligament and soreness associated with the tooth. The temporary may be forced out.
The is no adequate way for dissolved gases that get into this space to offgas properly--especially if you have removed the nerve and medicated the canal.
One possible strategy would be to completely fill the canal with a thick paste of calcium hydroxide mixed with some barium sulfate for radio-opacity. A hard temporary filling would be inserted (zinc phosphage, Fuji LC or composite. No cotton should be used. The calcium should be packed to the apex and nearly dry. This will help temporarily occlude the space. No guarantee can be made that the calcium hydroxide will be dense enough to prevent gase build up within the canal and chamber.
The best advice is to fill the canal completely BEFORE the dive and temporize without the use of a cotton ball in the chamber.
I wish you and your patient luck. A reprint of my DAN article "Dental Distress" is available from the Scubadoc website
http://www.scuba-doc.com/steinaldiv.html .
Laurence Stein DDS
:doctor:
I am a practicing dentist, PADI divemaster and a dental consultant for both DAN and Scubadoc.
The situation you discribe is potentially serious for the comfort and the safety of your diver. I have had the opportunity to examine several patients suffering from dental barotrauma.
In each case, pulpal pathology was present--either before the dive or became symtomatic following the dive--usually on ascent.
The unfilled space within the partially treated tooth has the potential to implode or explode--odontocraxis, create trauma on the periodontal ligament and soreness associated with the tooth. The temporary may be forced out.
The is no adequate way for dissolved gases that get into this space to offgas properly--especially if you have removed the nerve and medicated the canal.
One possible strategy would be to completely fill the canal with a thick paste of calcium hydroxide mixed with some barium sulfate for radio-opacity. A hard temporary filling would be inserted (zinc phosphage, Fuji LC or composite. No cotton should be used. The calcium should be packed to the apex and nearly dry. This will help temporarily occlude the space. No guarantee can be made that the calcium hydroxide will be dense enough to prevent gase build up within the canal and chamber.
The best advice is to fill the canal completely BEFORE the dive and temporize without the use of a cotton ball in the chamber.
I wish you and your patient luck. A reprint of my DAN article "Dental Distress" is available from the Scubadoc website
http://www.scuba-doc.com/steinaldiv.html .
Laurence Stein DDS
:doctor:
DocRCH
Guest
I would finish the endo tx before he leaves. There are too many problems with a pulpectomy and diving.
Robert:doctor:
Robert:doctor:
Laurence Stein DDS
Medical Moderator
DocRCH
I absolutely agree with you. The suggestion of a calcium hydroxide treatment was only as a last ditch effort. In fact, if the doctor has the time to do the calcium hydroxide treatment, then he has the time to finish the root canal completely.
I have seen enough true dental barotraumas associated with incomplete root canal treatment, inadequate treatment and pulpal pathosis that it seems like playing Russian Roulette with a tooth and a divers health and safety.
Every patient to whom I have spoken to or examined with barodontalgia reports nearly excruciating pain. I know of one case that caused the patient to stop eating, get dehydrated, end up with a fungal infection of the mouth--which lead to even more complications. This person was NOT HIV positive nor diabetic. The sore tooth simply ran the immunity down so far that poor health, dehydration, pain finally forced the patient to return to the US early from a month long dive trip.
Regards,
Laurence Stein
Toothdoc :doctor:
I absolutely agree with you. The suggestion of a calcium hydroxide treatment was only as a last ditch effort. In fact, if the doctor has the time to do the calcium hydroxide treatment, then he has the time to finish the root canal completely.
I have seen enough true dental barotraumas associated with incomplete root canal treatment, inadequate treatment and pulpal pathosis that it seems like playing Russian Roulette with a tooth and a divers health and safety.
Every patient to whom I have spoken to or examined with barodontalgia reports nearly excruciating pain. I know of one case that caused the patient to stop eating, get dehydrated, end up with a fungal infection of the mouth--which lead to even more complications. This person was NOT HIV positive nor diabetic. The sore tooth simply ran the immunity down so far that poor health, dehydration, pain finally forced the patient to return to the US early from a month long dive trip.
Regards,
Laurence Stein
Toothdoc :doctor:
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