>To avoid further complications and prevent the dental-filling debris from damaging the bailout valve of his rebreather, he switched to his backup open-circuit unit and spit out the filling fragments. He then returned to the closed-circuit loop to conserve breathing gas. His dive buddy was attentive and assisted him with his scooter and reel throughout the ascent. The diver stayed at 95 feet for 10 minutes to deal with the excruciating pain he felt throughout his lower teeth before proceeding with a safe ascent to the surface.
>The dentist replaced the damaged fillings, but the diver continued to experience tooth pain when diving. He sought a second opinion from another dentist, who identified through further X-rays that there were problems with the fillings of four teeth and recommended replacement. The diver had the fillings replaced and returned to diving without experiencing tooth pain. This was a case of barodontalgia (tooth pain caused by change in ambient pressure), also known as dental barotrauma.
>In this case, the diver had tooth pain on ascent due to defective fillings, which subsequent dental diagnostics confirmed. The unusual aspect of this case was that a total of five teeth appeared to have been affected on the same dive, two of which were confirmed to have lost fillings during the dive. Barodontalgia generally originates with poor oral health, neglected dental maintenance and/or ineffective dental treatments. 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; it can lead to potential safety risks such as rapid ascents and impaired judgment during a dive due to severe pain.
>This case, in which as many as five teeth were affected by barodontalgia during the same dive, is extreme. However, it serves as a reminder that being fit to dive is holistic and includes dental health. It is not necessary to seek a dentist specifically trained in dive medicine for dental checkups; rather it is important to routinely visit a dentist that provides quality care so you can be confident your dental health is maintained. The FDI World Dental Federation advises that divers have regular dental checkups, refrain from diving (or flying in nonpressurized cabins) within 24 hours of any dental treatment that requires anesthetic and wait seven days after an oral surgical procedure before returning to diving.
>Fillings are prone to deterioration over time. Semiannual dental exams allow the dentist to inspect existing fillings for damage and to detect and treat tooth decay in a timely manner. By maintaining good oral health, divers can avoid barodontalgia and smile easily after diving.
>© Alert Diver —Winter 2014