Tooth Pain on Descents in Fiji

[Scubagolf]

I was in Fiji (Beqa Lagoon Resort) for a week last month, and on every dive I experienced tooth pain on descent. The pain was in my lower left first bicuspid and started when I was in about 10 fsw. The pain was fairly constant until I reached depth and then would go away for the duration of each dive, and did not occur on ascents.

This tooth, which I am pretty sure is causing the pain, has a 22-year old porcelain crown.

When I got home I did some research on Dental Barotrauma and made a quick appointment with my (non-diver) dentist. After an unremarkable exam, including x-rays, and a review of the literature I brought for him to read on Dental Barotrauma, he concluded the pain is probably caused by an air pocket created by decay under the old crown.

My dentist recommends that I have the crown replaced (for around $900.) The crown will probably need to be replaced in a few years anyway, but I am hesitant to do it now without a better indication of what is going on. I have never had this pain diving before. This year, I dived for a week in June and than for a day in late July prior to going to Fiji in October where this pain on descents first started. I am thinking about going to see a diving dentist for a second opinion.

Any comments or suggestions?

 

[DocVikingo]

Hi Scubagolf,

Based the description provided, barodontalgia ranks very high on the list of rule out diagnoses. While more common upon ascent, this discomfort also occurs upon descent, where an air pocket beneath crown creates a relative vacuum with accompanying pain.

Having the suspect crown replaced will accomplish this rule out and seems sensible given the anticipated need for such in the near future in any event.

Of course seeking a second opinion from a "diving dentist" is perfectly legitimate and prudent.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[trigfunctions]

I had a similar pain on descending once and thought it was a tooth squeeze. My dentist took x-rays and could see that I had strained the ligament holding the tooth. The inflamation was visible on the x-ray. I had probably chomped down on the mouthpice too hard or at a funny angle and caused the strain. It was a little sore for a while, but after a month or so it was back to normal and I have never had any problems like that since. I wonder if you could have a similar issue.

 

[DocVikingo]

I had a similar pain on descending once and thought it was a tooth squeeze. My dentist took x-rays and could see that I had strained the ligament holding the tooth.

The diver suffering from sprained tooth syndrome would be expected to experience discomfort for the duration of the dive and for some period afterwards, not only on descent after which the discomfort would stop when s/he "reached depth and then would go away for the duration of each dive, and did not occur on ascents."

The most common sign of such sprain is tenderness to tapping of the teeth, a procedure that almost surely would have been performed during the subsequent dental exam. Also, the OP indicates that the x-rays were read as negative.

But, anything is possible.

Regards,

DocVikingo

 

[shontellee13]

I too had extreme tooth pain as soon as I got to 20 feet and by 30 feet I thought I was going to die...However, my pain was upper left molar area. I was also having very sharp R eyebrow pain. I figured that I may have a cavity causing the tooth pain, but went to an ENT for the eyebrow pain (I figured it had to be some type of sinus squeeze). Found out on CT that I had a blocked R frontal sinus as well as a blocked L maxilla sinus. Point being--my tooth pain was caused by sinus polyps and had nothing to do with a bad filling/crown/or cavity...


By the way, I am planning a dive to Fiji and was considering diving in Beqa. How was your experience (besides the pain)?

 

[DocVikingo]

Found out on CT that I had a blocked R frontal sinus as well as a blocked L maxilla sinus. Point being--my tooth pain was caused by sinus polyps and had nothing to do with a bad filling/crown/or cavity...

Indeed, maxillary sinus issues (of the sinuses it is particularly prone to infection) can manifest as tooth pain.

However, as a look at the maxillary sinus shows, e.g., Illustrations. Fig. 1003. Gray, Henry. 1918. Anatomy of the Human Body. and Paranasal Air Sinuses - Medical Illustration, Human Anatomy Drawing, Anatomy Illustration, that discomfort is located in UPPER, not lower, teeth, most notably the upper rear teeth.

Regards,

DocVikingo

 

[Scubagolf]

By the way, I am planning a dive to Fiji and was considering diving in Beqa. How was your experience (besides the pain)?

The diving was very good, as is the Beqa Lagoon Resort. There is a very good recent trip report posted by Saspotato in the Pacific Islands section. http://www.scubaboard.com/forums/pacific-islands/306293-beqa-fiji-sept-2009-trip-report.html

The water is unusually cold this year, with the water temp all week 75-76 degrees. Here's a link to the NOAA page which actually shows the running daily surface sea temps taken from a buoy in Beqa Lagoon.
NOAA Coral Reef Watch Time Series Graphs

 

[Scubagolf]

I wound up having the 20 year old crown replaced last November, and I had no problem at all during a week in Cozumel earlier this month. Apparently there was sufficient decay under the crown to cause the pain on descents.

 

[DocVikingo]

I wound up having the 20 year old crown replaced last November, and I had no problem at all during a week in Cozumel earlier this month. Apparently there was sufficient decay under the crown to cause the pain on descents.

[11.16.09 -- QUOTE=DocVikingo;4855124]Hi Scubagolf,
Based the description provided, barodontalgia ranks very high on the list of rule out diagnoses. While more common upon ascent, this discomfort also occurs upon descent, where an air pocket beneath crown creates a relative vacuum with accompanying pain. Having the suspect crown replaced will accomplish this rule out and seems sensible given the anticipated need for such in the near future in any event.[/QUOTE]


Hi Scubagolf,

Thanks for the follow up. It helps us learn.

Good news that the problem appears to be solved.

Regards,

DocViking