Urgent Advise Needed: Dental Issues with Diving

[Hotcakes]

Hi all,

I had experienced a bad toothache while decending but still fought the pain and continued with my dive. It wasn't bad when I was underwater or acending. Mainly when I decent only. When I got back, I got a X-Ray with my local dentist and she said I had a bad tooth decay under my filling. So she removed my filling entirely and did a "Open Drain" on my tooth and now it's totally empty(no filling). She say it was painful when I dove as there was bacteria and gas trapped underneath, leaving the tooth open is better as the tooth is already dead and if i did a temporary filling, it might cause more pain. I'll do a root canal once I'm back from my year end diving trip.

My question is, can I dive a week later with my tooth that is totally empty "open drain" without any filling? It doesn't hurt at all. Will it cause any complication whole diving? I'm thinking since its hollow, air bubble can't get trap so it should be fine right?

 

[Steve_C]

Open wound could be a source of infection.

I have dove with a temporary. If done right there is no air.

Personally I would rather dive with a temporary then risk a serious infection but I am not a dentist and that is just my opinion.

 

[Laurence Stein DDS]

Bad idea!

First, while opening the tooth to drain it may create immediate relief, it also creates a two way pathway for bacteria...not only can they drain out from the tooth, bacteria and food debris from the mouth can also be introduced INTO the tooth and then into the bone...and remember, you are allowing this inward entry while breathing compressed gas. Which way would you expect the oral gunk to go?

Next, often opening the tooth to drain it may not involve removing the decay which created the problem. Your tooth could still be rotting away. By the time you finally get around to completing the root canal procedure you could have little to no tooth available to restore or restoration might require additional surgery to expose sufficient sound tooth to restore.

Finally, is there any other part of your body that you would get a serious infection that you undergo drainage and then put off definitive treatment in order to finish your up coming dive trip? At least START the root canal procedure and have the dentist place some temporary medication/stopping and then place a temporary filling. You should then be able to go away for a brief period. Keep in mind that while this could be done safely, sometimes temporary fillings come out...that's because they are "temporary."

Keep in mind that some of the venous structures of the head lack the one way valves commonly found throughout the rest of your body. Once a tooth infection gets into the bone and surrounding tissues it may have direct access to the brain...and can result in a cavernous sinus thrombosis OR dental infections can also extend downwards into the neck and chest. Both scenarios can have serious consequences. At that point, antibiotics may not be effective!

Use common sense and put your medical health before your vacation or vocation.

Sincerely,

Laurence Stein, DDS

 

[Hotcakes]

Bad idea!

First, while opening the tooth to drain it may create immediate relief, it also creates a two way pathway for bacteria...not only can they drain out from the tooth, bacteria and food debris from the mouth can also be introduced INTO the tooth and then into the bone...and remember, you are allowing this inward entry while breathing compressed gas. Which way would you expect the oral gunk to go?

Next, often opening the tooth to drain it may not involve removing the decay which created the problem. Your tooth could still be rotting away. By the time you finally get around to completing the root canal procedure you could have little to no tooth available to restore or restoration might require additional surgery to expose sufficient sound tooth to restore.

Finally, is there any other part of your body that you would get a serious infection that you undergo drainage and then put off definitive treatment in order to finish your up coming dive trip? At least START the root canal procedure and have the dentist place some temporary medication/stopping and then place a temporary filling. You should then be able to go away for a brief period. Keep in mind that while this could be done safely, sometimes temporary fillings come out...that's because they are "temporary."

Keep in mind that some of the venous structures of the head lack the one way valves commonly found throughout the rest of your body. Once a tooth infection gets into the bone and surrounding tissues it may have direct access to the brain...and can result in a cavernous sinus thrombosis OR dental infections can also extend downwards into the neck and chest. Both scenarios can have serious consequences. At that point, antibiotics may not be effective!

Use common sense and put your medical health before your vacation or vocation.

Sincerely,

Laurence Stein, DDS

thank you so much for your advise! You've been an amazing help!
I went back to my dentist and told her what you told me, she just shake her head and say my tooth is already dead. If I wanna get a filling she will start on the root canal treatment and fill it with a temporary filling. But she's all booked for the week.

Dr Stein, will it be too late if I start on my root canal treatment after my vacation instead? If I dive with the open drain tooth, will I still experience a tooth squeeze? There is no pain no swell at all so my dentist day anti biotics is not necessary but gargling my mouth with antibacterial mouthwash is a must daily.

 

[Steve_C]

Bad idea!
be introduced INTO the tooth and then into the bone...
Once a tooth infection gets into the bone and surrounding tissues it may have direct access to the brain...and can result in a cavernous sinus thrombosis OR dental infections can also extend downwards into the neck and chest. Both scenarios can have serious consequences. At that point, ****antibiotics may not be effective!****

It is a gamble. You might get away with it. The gargle will not sterilize your mouth. The worst possible outcome is VERY bad. Unless you are over 70 you have many vacations ahead. Your choice. You asked for advice and got it.

If your tooth was only bone there would not be a need for a root canal. The root canal removes areas that can get infected. At least that is my nonmedical trained understanding.

 

[tsuyoshi]

This is a tough one. Most dentist would want u at least finish the root canal. Can u go see an endodontist?

"Open & drain" does not remove vital innervations & source of infection in roots. Even if partially completed, u may have small dead space in the root that cannot be equalized if u have a temporary filling sealing the top.

That may create pressure causing a squeeze to surrounding or remaining nerve in the root. Others here reported of toothsqueeze caused filling or tooth to "pop" loud enough to be heard but not always relieved.

Temp fills do prevent food trap causing further infection & decay. Was the initial squeeze just to the tooth itself or the whole area feeling like an ear squeeze? I'm very curious.

On very nasty infections w drainage, pus, some providers leave tooth open for just a short amount of time to relief pressure to the area. But that is immediately followed up to finish root canal once pain & swelling is improved.

Please report back & good luck.

 

[vincent54]

I agree with Dr. Stein.... leaving a tooth open, without initiating endodontic treatment, is a recipe for failure. Either endo or extract, then think of diving. If there is pus involved, it sometimes will require additional drainage and antibiotics. My favorite saying, "never let the sun set on pus"

It's not the tooth we worry about, but the tissues surrounding. Infection settling in the bone, at the very least is difficult to treat. If it spreads from the bone, it can be lethal. (as Dr. Stein eloquently noted) Cheers

Read this article and you will see why we treat abscessed teeth aggressively, Brain Abscess Secondary to a Dental Infection in an 11-Year-Old Child: Case Report | JCDA | Essential Dental Knowledge

 

[Phil_C]

I shall start by saying I'm not a dentist and you should defer and really consider the advice given above by those who are medically qualified. However if it helps you to make up your mind I can give you an example from my own experience.

The pain you experienced was a dental squeeze caused by the cavity and gases sealed within the tooth. Now that the tooth has been opened, and the gases/cavity allowed to drain to the open air you will no longer experience a dental squeeze. The issue that should concern you is that by having an open cavity, as has already been mentioned, you have an open conduit to allow bacteria into the body.

In my case I have a crown which is fitted on a post in my lower jaw. I experienced a similar problem with dental squeeze, and in fact shortly after the dives the Crown and post worked loose and then came out.

Anticipating the same potential problem as you may have, an open cavity that might let infection in, but being determined to keep diving, I went to a local pharmacy and bought one of these temporary filling/dental packing kits that you can buy for travelling, and effectively packed out the cavity I had with the temporary filling material. The net effect for me was that I no longer had the airspace causing squeeze, and I no longer had a cavity where the post should fit. When I went back to my dentist he simply had to clean out the temporary filling material before refitting my crown and post.

If you are adamant that you want to dive then I would suggest you see if you can get a temporary filling pack from your local pharmacist and pack it into the tooth. That should close the cavity off which will reduce or negate the risk of infection, and if you combine that with an antiseptic dental wash you should be good to go. However if you do choose to go down this route make sure that you have appointment booked to remove and clean out the temporary filling fairly soon because the temporary filling in itself can seal in decay and lead to further problems if you don't. Th likelihood is that you will not be scrupulously clean when you put the packing material in, so don't want to leave it too long.

So if you have a holiday booked and want to dive, but can't get an appointment before you go, book an appointment for as soon as you get back and use a temporary dressing if you can get one. It will not be entirely risk-free but in all likelihood you will probably be okay. Phil.

 

[vincent54]

NEVER place a temporary filling in a decayed tooth or even for cementing back a crown, unless it is an implant, unless it has not been properly cleaned and evaluated. Even an endodontically treated tooth is a risk when recementing a post or crown. Root fractures in endo teeth are common, and sealing the post crown on one of these failures won't work. It is similar to placing a bandage on a dirty cut. In some cases, you'll get one heck of an anaerobic infection within hours. Seek dental tx asap, so it can be cleaned properly.

Sometimes, prevention is the answer. Go for the annual checkups and radiographs so that unwelcome surprises don't occur. Plus, we need the money for more dive vacations..

 

[Hotcakes]

This is a tough one. Most dentist would want u at least finish the root canal. Can u go see an endodontist?

"Open & drain" does not remove vital innervations & source of infection in roots. Even if partially completed, u may have small dead space in the root that cannot be equalized if u have a temporary filling sealing the top.

That may create pressure causing a squeeze to surrounding or remaining nerve in the root. Others here reported of toothsqueeze caused filling or tooth to "pop" loud enough to be heard but not always relieved.

Temp fills do prevent food trap causing further infection & decay. Was the initial squeeze just to the tooth itself or the whole area feeling like an ear squeeze? I'm very curious.

On very nasty infections w drainage, pus, some providers leave tooth open for just a short amount of time to relief pressure to the area. But that is immediately followed up to finish root canal once pain & swelling is improved.

Please report back & good luck.

the initial pain happened when I was diving in Perth, Rottnest Island. I thought it was the cold water temperature causing the pain as it only happened when I decent. I wasn't sure was it only that particular tooth but the pain was dull but intense. Naturally I bite on my mouthpiece to see which part is causing the pain and realize when I'm down below the pain is gone.. So I continued diving and there wasn't any issue when I ascend. The next incident was at East Malaysia, Perhentian Island and with tropical water I still felt the pain when I decend, this time I tried to equalize and I mind have exert too much force, I came up to the surface with a little bloody mucus/snot. The bloody mucus went on fpr awhile. I took painkillers(non-drowsy formula) to get me by and completed my dives over the next 2 days. To add, the pain wasn't excruciating that I had to abandon my dive. It was manageable.

I came back and went to a ENT for nose scope as I mentioned to my doctor about the bloody mucus/anot and he said the scope turns out my sinus area is perfectly clear and fine. I went to the dentist to get a X-Ray scan turns out one particular tooth that has a 6 year old filling was decaying, and it probably emit bacteria gas that trapped in the air space.

So i went back to my dentist after Dr Stein advise me to get started on my root canal treatment and she told me it's too much of a rush to start on any root canal treatment now as I'm leaving soon. She said it wouldn't be much of an issue with diving least the main concern is there wouldn't be any pain now. She added 90% of patient who has a open drain get away fine only 10% would have bacteria infection within a few days as the infection were gonna start anyways it's a matter of time only. So she advise me to not fill it as it will cause pain and swell and just leave it till I'm back from my LOB and get started on my root canal. Currently I experience no pain no sensation no nothing and gargle my mouth with antibacterial mouthwash after every meal. I just hope it will be fine till the end of my trip as I'm really looking forward to my LOB.

I know I should have see into this matter way sooner than to rush through the last min, i see how I should have taken care of this now and I will def take precaution before any dive trip now! Truly appreciate all advise given here and you guys have been a great help to me!!! :kisses