Ondontecrexis--the effects of rapid decompression on restored teeth

Relationships among barodontalgia prevalence, altitude, stress, dental care frequency, and barodontalgia awareness: a survey of Turkish pilots

Background

Gas expansion in body cavities due to pressure changes at high altitudes can cause barodontalgia. This condition may compromise flight safety.

Aim

To investigate relationships among barodontalgia awareness, dental visit frequency, and barodontalgia prevalence in civilian and military pilots operating at high altitudes.

Materials and Methods

Civilian pilots from Turkish Airlines and military pilots from the Turkish Air Force, flying between November 2022 and January 2023, participated in this study. A 20-question survey was administered to 750 pilots, covering topics such as barodontalgia awareness, dental visit frequency, breaks after dental treatments, in-flight pain, and pain type and severity. The voluntary surveys were distributed by email.

Results

Of the 750 pilots, 526 completed the survey; 61% were aware of barodontalgia, and 81% of pilots who had experienced it reported pain at altitudes <2000 feet. The study revealed higher barodontalgia awareness among pilots who had experienced it, with the highest prevalence among jet pilots. Pilots with barodontalgia also showed a higher frequency of dental visits (p < 0.001). Additionally, this group reported more frequent interruption of flight due to dental treatment (IFDT), more problems experienced in flights after treatment (PFAT), and higher instances of bruxism or teeth clenching during flight, suggesting stress and anxiety (p < 0.05).

Conclusions

Barodontalgia, a type of pain linked to stress, significantly impacts pilot performance, and can threaten flight safety, even at lower altitudes. Thus, there is a need to educate pilots about stress management, barodontalgia awareness, and the importance of regular dental check-ups.

Barodontalgia and Dental Barotrauma Among Scuba Divers

INTRODUCTION: Barometric pressure variation during dives may induce barodontalgia and barotrauma. Barodontalgia refers to oral pain resulting from a change in ambient pressure. The aim of this study was to investigate the occurrence of barodontalgia and dental barotrauma among French civilian scuba divers.METHODS: A nationwide cross-sectional internet-based survey was conducted among French scuba divers over 18 yr of age registered by the French Federation of Underwater Sports (FFESSM). The online questionnaire was distributed from October to December 2020. It contained questions regarding general characteristics of participants, barodontalgia and dental barotrauma occurrences, and relationship of the diver with his/her dentist.RESULTS: There were 684 scuba divers (65.4% men; aged 48 ± 12 yr) who participated in the study. Barodontalgia was reported by 18.7%, with some respondents reporting more than one episode. Most barodontalgia affected posterior (81.2%) and upper teeth (55.2%) with dental filling (50.0%). At least one dental barotrauma was reported by 10.1% of respondents, including mainly loss or fracture of a dental filling (4.2%). The occurrence of dental barotrauma was significantly higher among men (12.3%) than women (5.9%) and increased significantly with the age, the years of diving and the diving qualification.CONCLUSION: Information should be provided to divers on the importance of routine dental checkups.Kougeon K, Yasukawa K, Baudet A. Barodontalgia and dental barotrauma among scuba divers. Aerosp Med Hum Perform. 2022; 93(5):421-425.

A retrospective study of oral pathoses in Israeli military divers and non-divers: 2011-2020

BACKGROUND/AIM

Self-contained underwater breathing apparatus (SCUBA) diving has grown tremendously as a recreational sport over the past decade. The pain divers experience due to barometric changes is referred to as barodontalgia, and it is known to cause various oral pathoses. Furthermore, divers suffer more frequently from temporomandibular disorders than non-divers. The aim of the study was to characterize oral pathoses between military divers and military non-divers.

MATERIAL AND METHODS

Data from the dental files of healthy Israel Defense Forces (IDF) soldiers aged 18-40 years were collected retrospectively for the years 2011-2020. The data for subjects exposed to diving were compared to commando and special forces soldiers.

RESULTS

The study population was composed of 6398 soldiers, which included 1036 divers and 5362 non-divers. All participants were male, with a median age of 22 years (mean = 22.1 years). Overall, higher rates of faulty dental restorations were seen among divers than non-divers (9.3% vs. 6.7% p = .006). Temporomandibular disorders were more prevalent among divers, specifically Disc Displacement Without Reduction (DDWOR) (0.4% vs. 0.1% p = .003). While dental fractures showed no significant difference between divers and non-divers (3.8% vs. 3.5% p = 0.8), other oral injuries were nine times more prevalent among divers versus non-divers.

CONCLUSION

Military divers are, overall, at a higher risk of oral pathoses than non-divers. This may be related to the characteristics and intensity of their military service.

The Effect of Scuba Diving on Microleakage of a Class II Composite Restoration: An In-Vitro Study

Persistent pressure change is a common phenomenon within scuba diving with various medical and dental sign side effects. This study evaluates the effect of simulated pressure change due to scuba diving on the microleakage of class II composite restoration. In our methodology, a total number of 150 intact bicuspids are divided into two main groups (A and B), and prepared for a class II composite restoration. The samples of each main group are divided into five subgroups to be prepared with different liners. Then samples are restored with the same resin composite material. The teeth in group A are thermocycled under the normal atmospheric pressure, while group B are thermocycled under simulated scuba diving conditions. The gingival microleakage is assessed based on dye penetration. The group B teeth show a significantly higher microleakage score than their equivalents in group A (p < 0.05). The subgroups without a liner have a higher microleakage score than the other subgroups (p < 0.05). The flowable composite shows the leased leakage scores followed by Nano ionomer, Resin Modified Glass Iononomer, GIOMER, and linerless groups (p < 0.05). Scuba diving could increase the risk of microleakage development beneath class II, a composite restoration.

Dental and Orofacial Barotraumas among Saudi Military Naval Divers in King Abdul Aziz Naval Base Armed Forces in Jubail, Saudi Arabia: A Cross-sectional Study

Background:

The aim of this study was to assess dental as well as orofacial pain under atmospheric pressure in military divers.

Materials and Methods:

Cross-sectional study was conducted in King Abdulaziz Naval Base Armed Forces (KANB) in Jubail, Saudi Arabia involving 216 Saudi military divers. Questionnaire was formulated to assess the prevalence and factors associated with dental as well as orofacial pain among divers.

Results:

Of total 216 participants, 35.6% participants dive 10-50times/year; whereas 52.8% dive in more than 20 m depth and 67.2% dive in the atmospheric pressure of >1.5bar. Majority (81.9%) used compressed air when diving. Sudden pain during or after diving was experienced by 67.1% in head or facial area, 69.2% in nose and paranasal sinuses, and 52.3% have experienced dental injury. Statistically significant associations were found between pain during diving with a frequency of diving, diving depth, and atmospheric pressure with P < 0.001, 0.001, and 0.011, respectively.

Conclusion:

Through this study, we concluded that dental and orofacial pain were experienced by more than half of the military divers at least once during their dive. Factors like increased frequency of diving, deep divers, and increased atmospheric pressure increases the extent of pain. Findings of this study suggested that more studies focusing on diving centers should be performed to realize the complete range of the issue.

Impact of various pressures on fracture resistance and microleakage of amalgam and composite restorations

BACKGROUND

Pressure changes can influence dental restorations especially among divers. The aim of the current study was to evaluate the fracture resistance and microleakage of mesio-occluso-distal (MOD) amalgam and composite restorations undergoing pressure changes via diving and aviation simulation.

METHODS

For the fracture resistance test, 60 sound maxillary premolar teeth were randomly allocated to two groups. Each group was then divided into three subgroups (n = 10) for simulating scuba-diving (pressure cycle to 203 kPa, 2 bar), flight (50.6 kPa, 0.5 bar), and control (atmospheric pressure). The teeth underwent pressure cycles for one month and then the fracture resistance test was conducted on them using the Instron testing machine. Microleakage scores were afterwards recorded by using a 2% methylene blue dye for 24 hours.

RESULTS

Composite restorations showed significantly higher fracture resistance values compared to the amalgam group (P < 0.05). The control group had significantly higher fracture resistance values compared to the dive group, whereas there was no significant difference between the control group and the flight group (P = 0.083). No significant difference in the level of microleakage was observed between restoration materials or pressure cycles (P > 0.05).

CONCLUSIONS

Composite restorations showed better fracture resistance compared to the amalgam group. However, diving pressure cycles demonstrated adverse effects on the fracture resistance values of both restorative materials.

The effects of pressure in vitro on three methods of root canal obturation

INTRODUCTION

The seal of root canal fillings depends on the anatomy of the root canal system and on the properties of filling materials and their bond to the walls of the root canal. Alterations in pressure may influence these properties. The current study investigated and compared microleakage in a tapered single-cone method versus lateral and vertical condensation after diving simulation.

METHODS

One hundred and thirty five extracted single-rooted teeth were used. Following instrumentation and irrigation to #30.06 Mtwo rotary system, obturations were performed in three groups of 45 teeth: Group 1, tapered single-cone with Endoseal MTA sealer; Group 2, lateral condensation with AH26 sealer; Group 3, vertical condensation with AH26 sealer. Then all specimens were divided into three groups and incubated at ambient room pressure (101.3 kPa), 203 kPa or 304 kPa for 120 minutes respectively 20 times over one month to simulate diving conditions. Microleakage quantitative analysis was recorded by using a 2% Methylene blue dye for 24 hours.

RESULTS

The amounts of microleakage increased with increasing pressure in all obturation groups; however, the differences were not statistically significant (P > 0.05). At all three pressures, the least microleakage was recorded in Group 3, vertical condensation. Although the differences between vertical condensation, lateral condensation, and tapered single-cone methods were statistically significant (P < 0.001), the vertical condensation and lateral condensation groups did not differ from each other (P > 0.05).

CONCLUSIONS

Vertical condensation may be the best technique, based on sealing ability, for people who frequently experience pressure alterations.

Effect of a hyperbaric environment (diving conditions) on adhesive restorations: an in vitro study

Objectives No recent study has addressed the effect of diving conditions (pressure increase) on adhesive restorations. We evaluated the impact of a simulated hyperbaric environment on microleakage of the dentine-composite resin interface. The ultimate aim was to propose recommendations for restorative dentistry for patients who are divers to limit barodontalgia (dental pain caused by pressure variations of the environment) and may lead to dangerous sequelae.Methods We bonded 20 dentine disks by using an adhesive system (Scothbond Universal) to ten intact composite cylinders and ten composite cylinders with porosity (Ceram X mono). For each group, the samples were divided into two subgroups, one submitted to a simulated hyperbaric environment and the other to an ambient environment. All samples were immersed in a silver nitrate solution to evaluate microleakage at the interface after analysis with a camera.Results Dye percolation for groups in the hyperbaric environment was greater than groups in ambient environment. For each subgroup, dye percolation was greater for samples with than without porosity.Conclusions High percolation percentages demonstrate that our simulated hyperbaric condition led to loss of sealing at the dentine-composite resin interface, especially with porous composites.Clinical significance Respect of the protocol and the quality of condensation for adhesive restorations are important in all clinical situations, especially for patients who are divers. A more interventionist approach must be adopted with these patients.

Prevalence of dental problems in recreational SCUBA divers: a pilot survey

Objective To determine the prevalence of dental symptoms in recreational scuba divers and describe the distribution of these symptoms on the basis of diver demographics, diving qualifications and dive conditions during the episode of dental pain.Design A survey was designed and distributed through online social media platforms dedicated to scuba diving. A convenience sample of 100 recreational divers was obtained by this method.Main outcome measures The outcome measures of interest were: diver demographics, diving characteristics (level of certification, number of dives completed), occurrence of dental problems during a dive, and details of the episode.Results Forty-one percent of the respondents experienced dental symptoms during a dive. Barodontalgia was the most frequently experienced dental symptom during a dive.Conclusion Within the limits of the small sample size and online method of recruitment, the findings of this study suggest that a high proportion of recreational divers may experience dental symptoms during a dive. It would be meaningful to ensure that dental decay and damaged restorations are addressed before a dive and that the mouthpiece design be evaluated in case of complaints of temporomandibular discomfort during a dive.

Pathophysiology of barodontalgia: a case report and review of the literature

Changes in ambient pressure occur during flying, diving, or hyperbaric oxygen therapy and can cause different types of pathophysiological conditions and pain including toothache (barodontalgia). We report the case of a patient with severe pain in the region of his mandibular left first molar, which had been satisfactorily restored with a conservative restoration. Pain occurred during an airplane flight and persisted after landing. Radiology revealed a periapical radiolucency in the region of the distal root apex. Pain relief was achieved only after endodontic treatment. On the basis of this paper, we investigated the aetiology and management of barodontalgia. Dentists should advise patients to avoid exposure to pressure changes until all necessary surgical, conservative, and prosthetic procedures have been completed. The influence of pressure divergences should be noted at any time. Under changed environment pressures may be the changing perception of pathologies.

The influence of pressure changes on endodontically treated teeth during simulated dives

AIM

  To measure and evaluate pressure changes in the pulp chambers of extracted teeth exposed to hyperbaric conditions during root canal treatment.

METHODOLOGY

  A pressure sensor was inserted and sealed into the pulp chambers of extracted human molars (n = 6). The teeth were subjected to simulated dives to 4.5 bar in a diving chamber. During the simulated ascents and descents, the pressure within the pulp chamber was measured, and the difference between the pressure inside the pulp chamber and the pressure in the diving chamber was calculated. Each tooth underwent two dives with an intact pulp chamber, with a calcium hydroxide dressing, after root canal filling, and after adhesive sealing of the pulp chamber floor with a composite. Differences were analyzed statistically (P < 0.05) using one-way analysis of variance (anova).

RESULTS

  There were no significant pressure differences in teeth with an intact pulp chamber and teeth with a calcium hydroxide dressing. After root filling, however, the increase in pressure inside the pulp chamber was significantly lower (P < 0.05) than that in the diving chamber. After adhesive sealing of the pulp chamber floor with a composite, the pressure inside the pulp chamber was significantly lower (P < 0.05) than the pressure in the diving chamber.

CONCLUSIONS

  In root canal treatment, canal orifices should be sealed with an adhesively bonded composite filling before a dive. The use of a calcium hydroxide dressing after root canal preparation does not disqualify patients from diving.

Aviation dentistry: current concepts and practice

BACKGROUND

With the growing number of air passengers, flight attendants, leisure pilots as well as military and airline pilots, dentists may increasingly encounter flight-related oral conditions requiring treatment. Moreover, dentists should prevent the creation of in-flight hazards when treating aircrew members. The aim of this article is to introduce the concepts of aviation (aerospace) medicine and dentistry.

METHODS

Data were gathered to cover the following issues: head and facial barotraumas (barotrauma-related headache, external otitic barotrauma, barosinusitis and barotitis-media), dental barotrauma (barometric pressure-related tooth injury), barodontalgia (barometric pressure-related oro-dental pain), and dental care for aircrews.

RESULTS AND CONCLUSIONS

Special considerations have to be made when planning restorative, endodontic, prosthodontic and surgical treatment to an aircrew patient. This article supplies the dental practitioner with some diagnostic tools as well as treatment guidelines. Principles of prevention, periodic examination, dental-related flight restriction (grounding) and dental documentation (for forensic purposes) are described as well.

The Prevalence of Orofacial Pain and Tooth Fracture (Odontocrexis) Associated with SCUBA Diving

Aim

To assess the prevalence of orofacial complications associated with SCUBA (self-contained underwater breathing apparatus) diving. Main outcome measures were prevalence of orofacial pain and odontocrexis.

Method

Two hundred divers at four dive centres on the north-east coast of Australia were asked to complete a questionnaire that requested information regarding diving experience and facial pain and dental symptoms experienced during diving.

Results

One hundred and twenty-five completed questionnaires were returned (63% response rate). The prevalence of reported orofacial pain was 44%. Twenty-one per cent reported toothache, 27% sinus pain, 16% jaw pain, and 12% other pain. The prevalence of odontocrexis was less than 1%. Less than 1% had lost a filling when diving. No divers reported a crown or bridge being dislodged during diving.

Conclusion

Among those who returned questionnaires, orofacial pain in divers was common and odontocrexis was rare.

Dysbarism. A review

This review of dysbarism outlines the development of the knowledge of the effects of pressure changes on tissues and organs, which is related to a complex of physical, physiological and pharmacological changes. It also shows that with the ever increasing pressures to which man is subject the effects can be regarded as total body rather than the traditional concept of a few target organs.