- *Diving-Related Toothache

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 Although not a common ailment in scuba diving, tooth pain can be a troublesome side effect of this sport.
Perhaps the most troublesome part of diving is the continuous need to avoid the consequences of pressure changes associated with depth. The physical effects of pressure are described by Boyle's Law, which defines the relation between pressure and volume. Boyle's Law states that the product of absolute pressure and volume of a gas is constant: P¥V = Constant. If air pressure in body spaces cannot equilibrate with ambient pressure on descent, the forces produced will reduce the volume by squeezing surrounding tissues into the space. On ascent, air in the lungs must be allowed to vent or overinflation will occur. Tissue injury caused by Boyle's Law effects is called barotrauma or squeeze.Barotrauma is tissue injury caused by a change in pressure, which compresses or expands gas contained in various body structures.

Dental Barotrauma (Tooth Squeeze): Pressure in the air spaces at the roots of teeth or next to fillings can cause toothache or damage teeth.

Air spaces inside the teeth owing to decay, associated with a filling or an abscess, change volume as pressure changes during diving. An air pocket under a filling may expand on ascent and push the filling out of the tooth, while an air pocket may be distorted during descent and cause a severe toothache. If you get a toothache during ascent, there is little you can do but continue your ascent. Pain medication will help on the surface.

In tooth fillings, fractures, cavities it increased pressure during scuba diving and allowed the accumulation of gases into the tissues that no longer had a good blood supply to help eliminate the gas buildup. The result was an expansion of the tooth through the fracture line and --pain.

When the tooth is injured or when bacteria are trapped within the chamber, pressure begins to build. When the internal tooth pressure exceeds the blood pressure, blood flow in that area essentially ceases: removal of blood, nutrients, oxygen or carbon dioxide cannot occur. The endodontist, or root canal specialist, performs a root canal procedure to vent the pressure and remove the dead nerve.

Divers awaiting final treatment for root canal and replacement of a crown should avoid both diving and flying.

sources: - Alfred A. Bove, MD, PhD - Fred Bove, M.D., Ph.D. - Laurance Stein, DDS

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