Reported StoryI had made several decompression dives on a rebreather using a scooter in the horizontal plane without any problems that week. My maximum diving depth was 154 fsw (47 msw). On my last dive I felt a short, dull pressure and pain in my teeth during descent. The pain vanished very quickly; I dismissed it and proceeded with my dive.
When I began my ascent after 30 minutes at 135 fsw (41 msw), I experienced pain again, but this time it was sharp and severe. It affected several of my teeth, and after ascending only 6-7 fsw (2-3 msw) I felt a sensation that several fillings in my teeth were loose. Within a few feet, two fillings just fell apart, and the pain became even more severe and intense.
I halted my ascent for a few minutes until the pain subsided to a manageable threshold. I switched from my primary closed circuit on my rebreather to my secondary open-circuit unit to bail out at a depth of approximately 98 fsw (30 msw) to spit out the debris of my fillings. I was mostly afraid that the broken fillings could damage the important dive surface valve (DSV) on my rebreather and cause me further complications. Even the smallest object that becomes lodged in the DSV could cause a leak in the loop and allow for a carbon-dioxide breakthrough.
I returned to the closed-circuit loop for optimal decompression and to conserve gas. Throughout my ascent, the feeling I had in multiple places in my mouth is best related to a dentist placing a needle in the nerves of my teeth. Everything in my mouth hurt with excruciating pain. My dive buddy was extremely good and noticed in seconds that I was in trouble. He took care of my scooter and reel, which made my task load lighter for the moment. I stayed for 10 minutes at 95 fsw (29 msw) to prevent the other fillings from hurting and to allow myself to get a grip on the situation to eventually ascend and complete the dive.
I had no problems with my sinuses before, during or after the incident. I did have multiple root canals and some other major dental work in the months prior to this event. Four days after the incident, I returned to my dentist in my home country. My dentist suggested that I had been biting too hard on my mouthpiece. An X-ray showed that amalgam fillings in five cavities had been loosened or had fallen out completely, and in one of my teeth there was evidence of nerve damage. The dentist replaced the damaged and missing fillings. To my dismay, I continued to experience tooth pain during the descent when I returned to diving after a while.
I decided to change dentists. My new dentist took an X-ray, which showed a visible gap in four of my teeth, including the two most recent fillings that I had replaced. The affected teeth were all bottom molars. One had nerve damage, as my previous dentist had placed the filling directly onto a nerve. I got one new crown, and all loose fillings have been replaced with new composite fillings. I have made multiple dives since then without pain, but I have not yet dived to the depth at which my incident had occurred.
CommentsThis painful incident described by the diver is an example of barodontalgia, which is defined as pain or injury affecting teeth due to changes in pressure gradients. The pressure gradient experienced in diving is a contributing factor of barodontalgia and is not considered the origin of the problem.
Literature supports the claim that the source of most cases of barodontalgia occurring while scuba diving is most closely correlated to the overall dental health of the diver. When a tooth is incompletely filled, air can enter behind the faulty filling during ascent and become trapped between the filling and the tooth with no means of escape. Therefore, this trapped air pushing against the filling results in tooth pain. As demonstrated in the reported story, air becoming trapped against an inadequate filling can occur months after having a tooth filled. In this diver's case, this was proven by subsequent dental procedures.
The pain on descent this diver reports on his later dives may be attributed to pockets of air remaining under an incomplete filling. The unusual element found in this case was that five teeth were affected on the same dive. It turned out that all five molars had imperfect fillings from the same source.
Out of the 347 total cases of barotrauma reported in the 2008 edition of the DAN Annual Diving Report , two cases were categorized as barodontalgia. Although considered a rare occurrence, barodontalgia should not be dismissed, because it can present potential safety risks to scuba divers. These safety risks may include rapid ascents and impaired judgment during a dive due to severe pain.
Research suggests that the incidence of barodontalgia occurring in divers may be underreported. It is important to note that this diver reported having major dental work and multiple root canals done months prior to when this incident of barodontalgia occurred.
The Federation Dentaire International (FDI) recommends an annual dental checkup for divers in addition to refraining from flying in nonpressurized cabins or scuba diving within 24 hours of a dental treatment requiring anesthetic, as well as waiting seven subsequent days after an oral surgical procedure.
Maintaining good clinical oral health practices such as having annual dental checkups and daily brushing and flossing teeth is supported by research as the most effective way to avoid and prevent barodontalgia from occurring during a dive.
— Brittany Trout, DAN staff
SourcesAnnual Diving Report. (2008). (p. 139). Durham, NC. Retrieved from http://www.DAN.org/medical/report/2008DANDivingReport.pdf.
Robichaud, R. (2005). Barodontalgia as a differential diagnosis: symptoms and findings. J Can Dent Assoc. 71(1), 39–42.
Stoetzer M, Kuehlhorn C, Ruecker M, Ziebolz D, Gellrich N C, and Von See C. Pathophysiology of barodontalgia: a case report and review of the literature. Case Reports in Dentistry, 2012, 453415. doi:10.1155/2012/453415.