question about a pressure in tooth upon ascent

[Nikodeepdiver]

problem is, that there is no filling in the tooth that is trapping gas!??!
when it finally clears, it clears out the back of the tooth

 

[Laurence Stein DDS]

hi everyone,

i have recently had a few dives where upon ascent i start feeling built up pressure in a tooth, like my tooth and head are going to explode. i cant get rid of it and finally i just suck it up and surface where for about 3 hours im in SERIOUS pain. im freaking out as i went to a dentist and he sees no decay of nerve damage. finally it releases and the pressure releases out the back of the tooth through the sinus, not out of the front, indicating a filling problem...any ideas?
thanks
niko

Hi Niko,

It's not till later in this post that you indicate that the tooth is not filled. Short of there being a fracture within the tooth or a tooth that underwent past trauma, eg. orthodontia, some sort of facial trauma, I would doubt that the tooth is the culprit.

You didnot say but is this an upper tooth? If so, my best guess would be a barodontalgia of maxillary sinus origin. It is also impossible for a presumably healthy tooth to feel a pressure relief "out the back of the tooth through the sinus."

Assuming for a moment that there is some sort of undetected pathology within a tooth, the amount of gas that causes the problem is actually microscopic and you and contained in an exceeding small space. I would seriously doubt that anyone would feel a sudden pressure relief like that. If there was pathology and it extended BEYOND the roots into the bone, then there might be enough volume to be noticed there....HOWEVER, such a volume would also be detectible by your dentist on x-ray.

You in fact state that you feel the pressure release through the sinus and that is perhaps key to solving this problem.

The upper molar teeth and sometimes the bicuspids (and even the cuspid)may protrude into the sinus cavity. In most cases, there is bone between the roots and the sinus but it can be as thin as tissue paper. Any pressure within the sinus can be transmitted to the root tips and stimulate the nerves as they emerge from the affected teeth. When this happens, it can be percieved as tooth or dental pain and you could swear your tooth is hurting.

I have seen this effect in patients who have gotten off and airplane and been in severe pain. By the time they get to the office, there is nothing to be found...no pain, normal responses to pressure, temperature, electrical stimuli and normal x-rays.

Sometimes there is a vague mention of a past cold or allergy some time before the flight.

So, I suspect that it is your sinus and not your teeth that caused the problem. If this fits your symptoms, then you might want to see the ENT to rule out a sinus problem. If you have just gotten over a cold, simply wait until you are no longer congested. Perhaps dive again (carefully)and see if the problem returns. If so, abort the dive and see the ENT next.

Laurence Stein, DDS

 

[Nikodeepdiver]

It's not till later in this post that you indicate that the tooth is not filled. Short of there being a fracture within the tooth or a tooth that underwent past trauma, eg. orthodontia, some sort of facial trauma, I would doubt that the tooth is the culprit.

YOU ARE RIGHT, NO SIGN OF FRACTURE, NO FACIAL TRAUMA (ALTHOUGH I HAD ORTHOSCOPIC SURGERY TO TEAR AWAY SCAR TISSUE FO A TMJ PROBLEM) NO ORTHODONTIA

You didnot say but is this an upper tooth? If so, my best guess would be a barodontalgia of maxillary sinus origin.

YES, UPPER TOOTH BEHIND CANINE, FEELS LIKE WHOLE UPPER SIDE THOUGH

It is also impossible for a presumably healthy tooth to feel a pressure relief "out the back of the tooth through the sinus."

Assuming for a moment that there is some sort of undetected pathology within a tooth, the amount of gas that causes the problem is actually microscopic and you and contained in an exceeding small space. I would seriously doubt that anyone would feel a sudden pressure relief like that. If there was pathology and it extended BEYOND the roots into the bone, then there might be enough volume to be noticed there....HOWEVER, such a volume would also be detectible by your dentist on x-ray.

You in fact state that you feel the pressure release through the sinus and that is perhaps key to solving this problem.

ITS LIKE A SMALL WHEEZE THAT I FEEL BEHIND THE TOOTH, AND THEN A TINY (FEELS LIKE ) PUFF OF AIR OUT THE NASAL PASSAGE

The upper molar teeth and sometimes the bicuspids (and even the cuspid)may protrude into the sinus cavity. In most cases, there is bone between the roots and the sinus but it can be as thin as tissue paper. Any pressure within the sinus can be transmitted to the root tips and stimulate the nerves as they emerge from the affected teeth. When this happens, it can be percieved as tooth or dental pain and you could swear your tooth is hurting.

I have seen this effect in patients who have gotten off and airplane and been in severe pain. By the time they get to the office, there is nothing to be found...no pain, normal responses to pressure, temperature, electrical stimuli and normal x-rays.

Sometimes there is a vague mention of a past cold or allergy some time before the flight.

So, I suspect that it is your sinus and not your teeth that caused the problem. If this fits your symptoms, then you might want to see the ENT to rule out a sinus problem. If you have just gotten over a cold, simply wait until you are no longer congested. Perhaps dive again (carefully)and see if the problem returns. If so, abort the dive and see the ENT next.

THE PROBLEM IS THAT IT HAS HAPPENED ON AND OFF FOR 2 YEARS, SOMETIMES PRESSURE RELEASING DURING THE DIVE, SOMETIMES RIGHT AFTER THE DIVE, SOMETIMES 2 HOURS AFTER THE DIVE. I WENT TO AN ENT A YEAR AGO AND HE SAW NO SIGNS OF SINUS PROBLEM. AFTER READING YOUR THOUGHTS, I DO THINK THAT IT MIGHT BE A SINUS PROBLEM, BUT AM STILL IN A QUANDRY, I GUESS O GO BACK AND SEE ANOTHER ENT?

THANKS AGAIN DOCTOR, I REALLY APPRECIATE ALL YOUR THOUGHTS!

Laurence Stein, DDS[/QUOTE]

 

[DrSteve]

Just a thought (and I'm not an MD) is that you have some degree of chronic sinus congestion. I have had this in the past and when the mucous gets all jammed up, it causes pressure on the roots of my upper canines and (pre)molars causing some discomfort. When the pressure is relieved I have felt a mvoement in my sinus and feel the air coming out of my nose (it usually smells a bit too). But I suspect Lurence said that in his post already.

 

[Stilsam]

deleted the DDS covered it

hi everyone,

i have recently had a few dives where upon ascent i start feeling built up pressure in a tooth, like my tooth and head are going to explode. i cant get rid of it and finally i just suck it up and surface where for about 3 hours im in SERIOUS pain. im freaking out as i went to a dentist and he sees no decay of nerve damage. finally it releases and the pressure releases out the back of the tooth through the sinus, not out of the front, indicating a filling problem...any ideas?
thanks
niko

 

[pasley]

Intresting.

Simular, but slighlty different experience. I recently did a dive followed by the worse pain I have ever had in my life right under my left eye and above the teeth. Now having had lots of sinus infections over the years, I guessed it to be either sinus or tooth as the location could be either. Nothing helped. 10 days of Amoxicillin (1000mg 3x day), with progressively worse pain. Vicadan did not even phase the pain by the end of the 10th day. Dentist checked and said, not dental, doctors checked and said not sinus. Doc shot me full of Demerol and sent me home,ending the pain cycle. The pain is mostly gone now, just a very dull ache (two weeks later). Go figure. ENT looked at the CAT Scan they did the day of the most intense pain and said, maybe tooth. If you look at the attached CAT Scan excerpt on the left side of my face (your right) bottom, you will see a small lump where the root of a tooth is close to, or into the sinus cavity and there is some "mucus" there according to the ENT(see arrow pointing). The pain has not occurred on subsequent dives. It could be I have a root canal in my future and it has just not progressed along enough to show on the x-ray.

I am not a doctor and I don’t play one on TV. But maybe a CAT scan would show more and better than the X-ray. I am just providing the attached image from the CAT scan as an illustration of what the good DDS is talking about.