Urgent advice needed: Dull aching wisdom tooth - can I still dive?

[Laurence Stein DDS]

Hi Digger54,

I just couldn't let you have the last word when what you said was so incorrect that it was scary.

First, forget the mouth. If you have an infection in any organ of the body don't dive. I'm not talking a pimple or a splinter here. If you have pus, pain, inflammation, fever, etc, you've got something that is affecting or has the potential to affect your entire body. Bacterial infections can make you very sick because of the infection itself, endotoxins the bacteria may secrete, and tissue damage that they cause. Infections may also cause physiologic changes within your body and its chemistry that may preclude diving or other vigorous activity.

If you have an intestinal infection, you may become dehydrated and that can increase the possibility of decompression sickness. If you have a respiratory infection, you cannot breathe properly to exchange gases and run the risk of a perforation of the lung and/or pneumothorax, arterial gas embolism,... not to mention that you simply can't breathe or catch your breath.

If you have a staph infection of the skin (yes the skin is an organ!) you may in fact, have MERSA (methacillin resistant Staphylococcus Aureus). It is also known as the "flesh eating infection" It is potentially very serious. It can be fatal even with aggressive medical treatment.

Typically, external infections are kept DRY and covered. What part of keep it dry and diving in the great blue ocean seems to go together? These infection may also be contagious. Personally, I wouldn't want the infection secretions from my dive buddy getting all over me on the bumpy ride to the dive site.

Back to the mouth... The worst thing you can get from an infection is not sensitivity to cold air but rather, you can get a cellulitis where an infection spreads into the interstitial structure of the skin and underlying connective tissues. Instead of pus in an abscess, you have the equivalent of pus spread out within the soft tissues... there is no discrete pocket of pus or infection. Instead, it is diffuse and disseminated and that is actually worse than a walled off pocket of pus.

To make matters worse, should infected material be forced (under hyperbaric conditions or constant movement) into "potential spaces" within the head and neck, the infection can spread from the mouth down into the chest. Another avenue of potentially deadly oral infection is something called a cavernous sinus thrombosis. Infection gets into veins supplying the head and can then travel unobstructed into the brain. The veins within the head do not have valves like most other veins in the extremities. Blood can flow in both directions under the right conditions.

If you are having pain, fever, pus, limitation of movement or are seeing a doctor for an infection or receiving antibiotics to treat an infection you darned well better get clearance to dive before getting into the water.

While these potentially serious outcomes may be rare, they can and do happen... especially to people who don't take these infections seriously.

Finally, I meant no disrespect to you here. Good advice is good advice whether it comes from a doctor or your buddy. That is the reason Scubaboard exists. However, when you make the statement you did in your last post, you are doing everyone a disservice! Let's face it, you really didn't know what you were saying.... Right?

Now, DON'T MAKE ME COME AND SPANK YOU!

Respectfully, and with a little humor,

Laurence Stein, DDS

 

[Digger54]

Larry, Larry, Larry... You read waaay too much into my statements. I was referring to a tooth that had decay only in it. You know, the kind that zings you when you take a sip of iced tea or eat something sweet. The most likely problem a scuba diver would encounter diving with a simple decayed tooth ( I bet at least half the divers out there have dental decay to some degree) Would in fact be discomfort from the very dry and relatively cool air that a diver breathes. Divers will also feel dental discomfort when breathing cool dry air from area that are not decayed where the gingiva has receded and dentin is exposed on root surfaces ( I experience a little of that myself). The good thing about that is maybe it will cause some of them to seek a dental professional.

And the soft tissue infection I was speaking of was dental and your typical dental infection. You turned it into the equivalent of pneumonia or a brain abscess, or peritonitis . There are tons of divers out there diving with severe periodontal disease and periapical lesions that have no suspicion that they have them and do not and will not suffer any dive related side effects. Certainly there are individuals out there that can have dental infections that would hardly be noticed by otherwise healthy individuals, but become life-threatening. Often because of predisposing factors. Diabetes comes to mind first, then patients that would be immunosuppressed for some reason.

Now if you are exhibiting a cellulitis or an outright abscess associated with dental or any other infections, no, as a matter of fact Hell no! Do not go diving.

The most significant thing that I said and concluded with is SEE A PROFESSIONAL. For indeed accurate and reliable remote diagnosis is dang near impossible.

At least your response to my innocent post gave you an opportunity to show off the depth of your education and vocabulary to the uninitiated on these boards.

You said, " I mean no disrespect to you " and , "Respectfully"?-- I say not. And, "You really don't know what you're saying"-- I am a bit insulted.

Don't make me come and spank YOU! I'll use my diploma, which is also a D.D.S. And it's mounted on a plaque, so it would be more like a paddling.

Can I submit this lecture you gave for some C.E. Credit, I wonder? I am so glad I have now been educated about MRSA and cavernous sinus thrombosis.

Dr. Moderator: I suppose you'll kick me now? Or delete my post(s)?

I've got to go see a patient now, bye.

Douglas E. Hunter, D.D.S.
UTCHS Class of 1980
Private Practice for 28 years.
Nashville Dental Society Board Member
PADI Divemaster (applied for, awaiting final word from PADI)
Nashville, TN

 

[Laurence Stein DDS]

Hey Digger,

OK, I see your point. You are indeed correct... there are lots of people diving with dental decay, impacted wisdom teeth and gum infections that haven't been detected or treated. The vast number of times these problems turn serious during a dive is miniscule.

Here's mine:

The original post is from someone who is already experiencing symptoms from an undiagnosed (most likely dental condition). She did not ask about diving with a non-symptomatic cavity or a painless periodontal condition. She didn't report a sweet tooth or one that was sensitive to cold air from her regulator. She didn't know if she really had a cavity. The only accurate information she reported was some a dull ache when she stretched her mouth open and that the dentist she contacted by phone really couldn't tell her if she had a problem (diving or otherwise).

She had pain albeit possibly minor and wanted to know if she could dive. The answer really should have been "I don't know, it depends. You should have a dentist examine the area along with an x-ray."

In you 28 years of practice I'll bet that you have seen many occasions in which a patient (usually at 4:30 PM on Friday) calls and tells you they have a toothache and they don't think they can make it through the weekend. They then tell you that they have had the toothache since Monday but it seemed minor and they "thought it would go away"

When you finally see them, they have a "hot tooth" possibly with swelling that they cannot even touch with their tongue and anesthetic is useless. The same story can be told substituting a gum infection or a pericoronitis. Yes, I'm using my dental vocabulary because that is the correct terminology... what's the problem with that?

I cannot tell you the number of times that I have had a PM from a Scubaboard member telling me a similar story... vague pain, put off treatment, booked a non-refundable air fare and dive trip to Timbuktu, now it's starting to bother them more... Can I still dive? What do you suppose I have to tell them?

Neither you no I know which "run of the mill" dental infection they might have had during their initial experience... was it a "minor" infection or was it the tip of the iceberg, a dental infection about to become acute.

Your statement: "If you do have some sort of infection or inflammation in soft tissue going on, it's probably not an issue as far as diving is concerned," really concerned me. It is NOT correct statement since neither you nor anyone else has examined the patient and know for sure that the underlying condition is not serious. Remember "probably not an issue" also means could possible be an issue.

I have written articles for DAN on situations just like that so I know it happens.

You are absolutely correct. I did equate serious infections to pneumonia, brain abscess etc. because dental infection can be that (rarely) serious. I have never seen those worst case scenarios. I have seen cellulitises that have extended into the neck and Vincent's Angina. But having no more information I could not come to the informed conclusion that this diver was not dealing with something potentially more serious.

You are also correct when you say that many people are diving all around the world with decay and periodontal infections already present. You and I know that these people should be examined and treated for health reasons that are unrelated to scuba diving. We also know that a percentage of these people will experience an acute infection related to these untreated chronic conditions and an even smaller percentage will experience an acute infection during or in proximity to scuba diving.

Let me ask you? If someone walks up to you at a party and says "Hey, I know you're a dentist and I have a tooth that's bothering me occasionally. I think it's nothing. I'm planning to take a trip of a lifetime to (fill in 3 weeks in the Amazon or 2 weeks on safari or perhaps climb Mt. Everest) or how about, "Another slight complication is that the earliest appointment I can make is next Friday as I have to fly to another country to see him if I seriously need to get this treated before my diving." This diver isn't even in her home country with the dentist she presumably trusts.

Are you then going to tell them don't worry, there's no need to check out the problem until you return—everyone has an occasional cavity or gum infection... and by the way there isn't a well trained dentist for 3000 miles in any direction. Or are you going to tell them it would be a good idea to have the problem looked into before they leave or at least before they dive? Dealing with a dental problem on vacation, miles from home with a strange doctor is not fun.

Perhaps their most likely problem is a little cavity but it doesn't have to be. Most cavities don't hurt until they are approaching or have already entered the dental pulp. What professional advice would you give?

That was the motivation behind my answer and why I didn't feel comfortable with someone... anyone telling a stranger that everything is going to be OK.

Your advice, had it come from a non dentist (You make no mention of your vocation that in your public profile), was not particularly good. Your advice now, from a professional is, well... If I embarrassed you—it couldn't be helped. If you're upset with me, I understand. Let's just call it a professional disagreement.

If I look like a jerk for turning a mole hill into a mountain so be it. I would suggest that to err on the side of safety is a good thing.

I wouldn't think of editing or deleting anything anyone has written in this thread. You said what you said and I said what I said. Neither of us used any bad words. Don't you think it would be unprofessional of me as Dr. Moderator to remove something either you or I said?

Sincerely,

Laurence Stein, DDS

 

[flots am]

Hi everyone!

I am hoping a dentist who is also an experienced diver can help me quickly. Is it ok for someone with a tooth decay to dive?

The reason why I am asking is because I am a beginner to diving (having only dived once ever). However, I have finally made arrangement to have my PADI Open Water Licence on 24th July ~ 27th July.

The short, 100% accurate and completely not-what-you-were-looking-for answer is that nobody can diagnose you over the internet.

No dentist in the world can tell you what's wrong without seeing you.

You need to go see an actual dentist, in person.

Sorry.

On a related note, your instructor should be happy to reschedule your Open Water dives, because nobody wants to have a student who comes pre-loaded with a potential problem.

1. Get your teeth fixed
2. Go diving

(in that order)

flots.

 

[Candyice]

Hi everyone,

I do appreciate all the great input from ever single one of you! It has really helped to provide some much needed advice and guideline. I had succefully received my Open Water Diving Licence and experienced no pain at all! I will also be extracting my wisdom tooth out this weekend

Thanks to EVERYONE once again for the wonderful and informative input!!

Candyice

 

[Laurence Stein DDS]

Hurrah Candyice!

Flots am. You said it better than me!