Tooth problems and diving

[jaynea]

I am due to get my Open Water Dive Certification in the Maldives in a week and a halfs time after completing all my theory and pool diving here in the UK. One problem - this weekend just gone I was diagnosed with a tooth root infection / abcess and prescribed standard antibiotics for one week, the dentist said that there shouldn't be any need for any dentistry to correct the problem and the antibiotics should clear it up. I'm due to finish the course of medication one week before I start diving.

I am now scared of having problems whilst diving, reverse block etc and was wondering if anyone can give any advice as to whether I should be worrying! Is it safe for me to dive and is there anything I can do to minimise problems?

 

[Saturation]

I am not a dentist, but typically a tooth abscess will require dental work. Typically you should be on antibiotics first for 7-10 days to settle the infection before they can begin dental work. Now, if the infection is elsewhere and not on the tooth, no dental work may be necessary.

 

[sprange]

Generally any infection that involves the root originally started as a cavity, leaky filling, previous root canal treatment that was not successful, or a cracked tooth. These conditions will require further treatment after antibiotics (if the tooth can be restored). There are other infections of the gingiva that can have the same symptoms but usually aren't referred to as 'root infections'. If your tooth has had previous treatment and there is a crack or 'cavity' visible that might cause some trouble for diving. You didn't state whether your abscess was evident as a fluctuant swelling, or simply picked up by your dentist on an X-ray. I can't say for sure if you need to worry based on what you have provided. That said, I'm sure many divers out there have undiagnosed infections/cavities and yet we hear little about it.

Sean

 

[jaynea]

I haven't had any work on the tooth, there are no cracks, and he definitely said no other dental work would be necessary so maybe it isn't an abcess - he did say an infection. I had pain over the weekend and had an emergency appointment so he took some X-rays and made his diagnosis.

Hope this makes things a little clearer!

 

[Laurence Stein DDS]

Hi Jaynea,

To most dentists, a diagnosis of a "tooth root infection" is meaningless and at best, ambiguous.

A tooth with an endodontic infection (infected nerve), a periodontal infection (infection of the gum and bone around a tooth or infection of a tooth associated with a fractured root (the bacteria cause an infection by penetrating the root and then either affecting the surrounding bone below the outer surface of the bone or the nerve within the tooth.

In all of these cases, the root is in close proximity to the "root". Better diagnoses would be a periapical abscess, periodontal abscess, pericoronitis, endodontic abscess, acute or chronic apical periodontitis, etc.

I suspect (but cannot be sure) that your dentist was diagnosing some sort of periodontal or gum infection that was within a pocket that had formed next to a tooth root.

If you have a simple, soft tissue infection with no bony involvement, an antibiotic may actually solve the problem. If it returns, you have to look further into the etiology of the problem.

While an antibiotic may resolve the problem temporarily, if it involves the underlying bone, it almost always will return. Typically, the dentist will also scale and/or root plane the affected area. He may apply some topical antimicrobials and Rx an antibiotic.

Often, if there is one area of periodontal disease in a person's mouth there is likely other places...not always...but usually. Treatment consists of a thorough debridment, root planing, re-evaluation and possible surgery to eliminate pockets.

Now, on the other hand, of you had an abscessed nerve within the tooth, then the only sure treatments are root canal therapy or extraction. An antibiotic may temporarily stop the infection and pain but it is guaranteed to return. Usually, in days or weeks but on rare occasion, months to years. The longer you take to recieve definative treatment, the poorer the prognosis.

A fractured tooth can allow bacteria to enter the tooth's nerve area, the surrounding bone or both. Not all fractures can be seen in the mouth AND THEY ALMOST NEVER ARE REVEALED ON AN X-RAY! Some fractures can produce endodontic abscesses, other may cause pocketing and a periodontal infection.

Either periodontal or periapical infection can have diving implication...although of low probability. Unfortunately you cannot tell who will be affected so treatment is the best option...before diving.

I'm hoping that you dentist is, indeed correct. If you problem was soft tissue only and if it clears up with the antibiotic, you may be able to dive. If you have any problems during the dive, signal your divemaster/instructor and discontinue the dive and don't dive again until the problem is resolved. Why not contact him one more time and find out if there is a minor gum problem, a major gum problem or a root canal problem.

Hope this helps.

Laurence Stein, DDS

 

[jaynea]

Thanks for your help. I really appreciate it!

Just phoned the surgery and unfortunately the dentist is not there but there is definitely no further treatment required and antibiotics are expected to clear it completely. Unfortunately all the receptionist would say, on checking my notes, is that 'abcess' was written on my notes but she was very definite that I did not need to go back in and no root canal work was needed.

So, I guess in some ways things are no clearer but I am reading between the lines that this is not a major gum problem or a root canal problem and hence I should be fine to dive.

As you suggest I will just let the instructor know before I dive and also ensure that I signal any problems at all early on.