Muscle and Joint Pain
Dry Socket and
Root Canal and
Because of Boyle's Law, (as
volume decreases and vice versa), diving with air-filled spaces in
cause problems because spaces inside teeth cannot decrease in size and
increase in size in proportion to the depth under the surface. Because
we are already functioning at one ATM of pressure on the surface, a
to 99 feet would increase the pressure inside the cavity to 4 atm
a pressure of 58.6 lb/sq. in.
This increase in pressure would
cause pain or barodontalgia
and can severely limit a diver from functioning underwater.
Conditions that can allow air to
enter into the
interior of the tooth can cause barodontalgia, including caries,
margins of restorations, periodontal abscesses, maxillary sinus
pulpal lesions and endodontic therapy.
Teeth that have been opened for
and temporarily sealed have been known to explode from air trapping and
expansion on surfacing. This is referred to as odontocrexis and is
to be more common in deep divers using a heliox mixture. Full porcelain
crowns can also shatter from relatively shallow dives of 65 feet. It is
suspected that trapped air is a very efficient crown remover in teeth
the cement bond is failing. Meticulous oral health is advised for
actively engaged in scuba diving and to avoid barodontalgia, all
lesions should be restored, ill-fitting crowns replaced, active
lesions treated and all endodontic therapy completed.
and Joint Pain
Many divers experience headache and
pain from the continuous jaw clenching that is required to maintain the
mouthpiece of the regulator in proper position. The typical mouthpiece
is made of neoprene or silicon rubber and is held in place by bite tabs
that fit into the dentition of the canines and bicuspids. The average
is 40-60 minutes and requires rather constant pressure on the jaw
resulting in fatigue if not pain. Those individuals with "TMJ
(painful temperomandibular joints), find this to be so painful as to
diving at all.
Extending the bite tabs to cover the
balances the weight of the regulator and relieves the stress on the
There is a commercially available
by an Orthodontist, Dr. Randall Moles, known as "SeaCure" that is heat
moldable and covers the posterior teeth. This is available through dive
shops for about $30.
Edentulous and Partially Edentulous Diver
One should avoid wearing full or
prostheses while diving as they can be dislodged and aspirated easily,
especially partial dentures. To completely eliminate the possibility of
dislodgment, a custom mouthpiece must be made., using a silicon rubber
mouthpiece ("Comfo-Bite" from U.S.Divers) for the impression. Full arch
impressions are taken with the patient holding the putty in the roof of
the mouth until it is set, then mounted in a hinge articulator and sent
to the lab with the silicon putty impression. This custom made
mouthpiece will allow the diver to participate with no chance of
of a dental prosthesis.
Socket and Diving
A "dry socket"
occurs when the
blood clot is lost from an extraction site prematurely, exposing the
bone and fine nerve endings. The loss of the blood clot also allows
bleeding and retards the healing process. The situation is very painful
but essentially harmless, usually responding to impregnated gauze packs
every 2-3 days over a two week period. Subsequent formation of
clot allows for eventual healing to take place, usually in about two
Rinsing with non-alcoholic fluids twice a day for two weeks after
mandibular third molar removal significantly reduces the incidence of
osteitis or dry socket.
occurs in about
5% of tooth extractions, but in 33% of extractions in women on oral
control pills, when the extraction is in the first 3 weeks of the
In addition, there are some activities which may increase the
for dry socket formation... smoking, drinking carbonated beverages in
first 24 hours after surgery, spitting or drinking through a straw in
same time period. This latter Venturi effect of clot removal might also
come into play with divers sucking air through a snorkel or regulator.
Loculated air pockets do not seem to be an important factor, as is the
case with an incomplete root canal
one would suppose that a diver could return to the sport anytime
two and eight weeks - depending upon the rate of healing, lack of
and absence of pain as determined by his/her oral surgeon.
Canal and Diving
by Larry Stein,
A root canal
the removal of the nerve tissue from within the offending
Many patients think that roots are being removed which is not
If you have
an infected tooth
or the dentist finds pus (infected material) inside the nerve
and canals, he may perform the procedure in stages--usually 2
In the last few years it has become customary to try to finish a
root canal in 1 visit, time permitting, if the tooth is NOT
Not infected does not mean you don't have pain.
don't hurt--during the procedure or afterwards. HOWEVER,
are a few cases that create the fearful reaction of patients when
they hear that they need this treatment.
most root canal specialists (Endodontists) will place a cotton
and a temporary filling into the pulp chamber. This is done
whether the canal is treated in one or more visits. The tooth
then have a post, core and a cap as a final restoration.
the canal and chamber must be closed airtight with either a permanent
or a permanent filling. No cotton should be left in the chamber
no airspace should remain.
filling or a permanent
filling should only be considered temporary. If no cotton is placed and
a TEMPORARY filling is used, it will leak. Leakage from the mouth into
the root canal space is one of the leading causes for root canal
A temporary crown place over a core or post and core should cause no
but in the week or two after the crown preparation, while you are
for the permanent crown, sometimes the temporary crown comes off.
Don't lose it--put it back on and get back to your dentist.
There is one
the diving with a temporary cap rule. If your restorative dentist
has prepared the tooth for a cementable, metal post and core which will
be placed at the time the crown is cemented, then THERE WILL BE AN AIR
SPACE WITHIN THE TOOTH. In this case it is possible for the tooth
to implode. So ask the endodontist to place a core or your
dentist to place a core at the time of crown preparation. No air
space, no problem.
Some teeth in
need of root
canal therapy are fractured. The fracture cannot be seen on an
The fractured portion of the tooth can constitute a potential site for
compressed gas to accumulate. Root canal teeth are also more
than vital teeth and can be broken more easily--that is the reason for
the cap recommendation.
1-2 visits to the specialist and 2 visits to the restorative
If the root canal procedure is multi-visit then wait until it is
and has a solid core inside. Your pool classes
shouldn't be a
any open water dive could be. Stay away from the deep end of the
pool if the root canal is not complete.
The actual root canals are filled with
called gutta percha. It is a rubbery like substance which flows under
and pressure. It is compressed into the canals just to the
part of the nerve canal(s). Filling a canal short may leave room
for debris, dead tissue and bacteria to accumulate. This may lead
to a future retreatment. It is also a potential area for
gases from the bloodstream to accumulate. Since there is no
blood supply to the area short of a complete fill, the accumulated
gases will expand on ascent and cause
In fairness to dentists who perform
treatments, it can be difficult to see the actual end of the
Some specialists now have operating microscopes and fiber optic devices
they can thread into the canals and actually see the end of the root
within. This is now becomming the "Standard of Care". I
suggest a specialist with fiber optic instruments and
if the tooth is a molar. Recent research has shown that nearly
of molars may have an extra canal that escapes detection
That untreated canal can be a cause for future failure of the tooth.
Larry Stein, DDS
to Diving Medicine Online
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*Some material adapted from William
E. Stein D.D.S., Aitkin, Minnesota.