Scuba Diving and Oral Health

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Diving with air bottles, so known as Scuba (self-contained underwater inhaling and exhaling equipment), can be today’s extremely popular sport. Amount of it’s enthusiasts from the middle-20th century can be raising every year. With this raising number of enthusiasts its effect on general health also expands, hence increasingly engage doctors, dental practitioners, clinicians, and researchers who get excited about the field of sports activities medicine and research the physiology of scuba.

Even though technology that’s used in scuba can be nowadays much advanced and with the correct use is fairly safe, you may still find certain dangers to wellness to be studied into consideration. Proper identification of the dangers can prevent and/or decrease the adverse outcomes for human lifestyle and health. As a result, training in simple physiology of diving and protection is vital for both enthusiasts of the activity and for doctors and dentists. Medical ailments and disorders which are associated with scuba, which dental practitioners may encounter within their patients, include headaches, barosinusitis, barotitis-media, neuropathy of tripartite neural (trigeminal neural), facial neural (facial neural) neuropathy, baroparesis, oral barotrauma, barodontalgia, herpes infections, heightened gag reflex and temporomandibular joint dysfunction.

The precise epidemiological data on teeth’s health disorders among divers, especially professional ones, unfortunately do not exist since many cases go unreported. Professional divers are often not inclined to report oral and other medical problems from fear of losing a diving license.

Head and face barotrauma

Based on Boyle-Mariotte’s law the quantity of gas in a continuous temperature depends upon the background pressure. Adjustments in level of gas in the body cavity, connected with a big change in drinking water pressure, could cause negative effects known as barotrauma. Barotrauma may appear during diving, traveling or air therapy in hyperbaric chambers. Barotrauma in mind and face locations consist of barotitis-media, barosinusitis, headaches due to barotrauma, teeth barotrauma and barodontalgia.

Barotitis-media

Barotitis-media, or middle hearing barotrauma, can be an severe or chronic distressing inflammation of the center hearing due to the difference in stresses between your middle hearing cavity (tympanic cavity) and the encompassing atmosphere. Outward indications of middle hearing barotrauma can vary greatly from gentle uneasiness within the hearing canal to extreme earache, buzzing within the hearing, dizziness, nausea and hearing reduction. This disorder is normally one-sided and appears during or shortly after a dive.

Already existing inflammation of the upper respiratory system may prevent equalization of pressure through the Eustachian tube (a channel which connects the middle ear and throat) which predispose to the occurrence of barotrauma, and therefore may be a temporary contraindication for diving. Potential complications of middle ear barotrauma is a paralysis from the face nerve (face baroparesis) which may be caused by improved pressure in the centre hearing. The paralysis from the face nerve make a difference the flexibility of mimic muscle tissues and the feeling of flavor in leading from the tongue.

You can find number of instances described where in fact the disturbance in Eustachian pipe and middle hearing ventilation were connected with the teeth malocclusion (orthodontic anomalies). Fixing of the malocclusion would provide ventilation of the center ear towards the normalization and would prevent health issues after diving. Discomfort that occurs regarding middle hearing barotrauma could be used in the area from the mouth (indirect barodontalgia) and could erroneously be named a toothache, specifically of the top tooth. This should be used into account with regards to patients who’ve lately dived.

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Barosinusitis

Barosinusitis (sinus barotrauma) can be an severe or chronic swelling of one or even more from the paranasal sinuses occurring due to the difference in pressure (usually negative) between the sinuses and the surrounding atmosphere. The difference in pressure creates a vacuum which can cause edema of the nasal mucous membranes, increased secretion of saliva from the nose and even submucosal hematoma. All this may be accompanied with pain of varying intensity and bleeding from the nose. Sometimes branches of the tripartite sinus nerve in the upper jaw can be temporarily paralyzed. Sinus barotrauma is more regular during immersion than during introduction. Pain due to barosinusitis ought to be recognized from orofacial discomfort caused by additional cause.

Headache due to barotrauma

Headache due to barotrauma may be the headache occurring during immersion or introduction, and usually endures 15-20 minutes. It could be one-sided or two-sided, and provided the characteristics from the pain many of them are described as migraine, with whom they are often incorrectly replaced during diagnosis.

Dental barotrauma

oral Dental barotrauma can be defined as tooth fracture (Greek: odontos crexis) and fracture or loosening of dental filling caused by frequent changes of pressure. Separate parts of teeth or fillings will not only cause pain of various intensities, but can be a great danger when diving because they can be inhaled or ingested. Therefore, in such situations, the best solution is to temporary stop diving.

Scientific research has shown that in professional scuba divers, who annually spend more than 200 hours under water, there is an increased risk of dental barotrauma which their oral fillings and prosthetic substitutes have considerably shorter life. Because the primary causes are cited regular adjustments in pressure that take place when diving.

Predisposing elements for the incident of oral barotrauma are larger breaks or hairline breaks on existing fillings, and hidden and/or supplementary caries lesions on the teeth. In addition, regular adjustments in pressure within the microscopic atmosphere bubbles within the concrete, that was utilized to concrete oral crowns and bridges, can result in the increased loss of retention of the prosthetic substitutes, that could bring about their loosening and falling out in clumps. To this situation are particularly exposed prosthetic restorations cemented with zinc phosphate cement.

Consequently, all divers, and especially professionals, should always have repaired teeth without caries and bad or worn out fillings. Professional divers should alert the dentist about their occupation, especially when cementing crowns and bridges so the dentist can choose the appropriate cement in which the porosity occurs in the smallest percentage. Scuba diving with temporary fillings or temporarily cemented crown and bridge is not recommended because there is a high risk of their unwanted falling out, and thus other unintended effects.

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In edentulous (toothless) divers installation of dental implants has priority over producing typical dentures. Although uncommon, occasionally for toothless sufferers dentist could make person diving inserts for the mouth area that are within their type and function complementary with dentures.

Barodontalgia

Barodontalgia may be the intraoral discomfort caused by adjustments in atmospheric pressure. Barodontalgia takes place in scuba, flying as well as other circumstances where there is a significant change in pressure. According to literature data, it occurs in 10 to 20 percent of the divers. The cases are described in which the severe pain caused by barodontalgia leads to dizziness and temporary disability, which may endanger the security of divers.

Although barodontalgia is certainly more an indicator than a true pathological condition, it’s history more often than not conceals some existing subclinical condition or disease from the mouth area and teeth. The most frequent are hidden and/or supplementary caries and dilapidated dental care fillings. Sometimes the cause may be necrotic pulp, chronic pulpitis and swelling in the periapical area which may possess medical symptoms. Postoperative barodontalgia may appear immediately after dental care procedures. In addition, it can occur due to barotrauma due to diving.

Barodontalgia could be immediate (the pain relates to the teeth or the teeth) or indirect (the foundation of pain isn’t related to one’s teeth).

Barodontalgia may appear in a depth of 10 meters, although frequently occurs in a depth of 18 meters and much more. In contrast to aeroplane airline flight where the top and lower tooth can be affected with barodontalgia equally, diving barodontalgia is definitely more common in the top tooth and during immersion, which is explained by the influence of sinus of the top jaw.

To prevent barodontalgia in divers periodic dental examinations should include documenting and evaluation of X-rays from the jaw. In addition they should include tests the vitality of tooth. In these inspections, unique attention ought to be concentrated to pathological adjustments in the periapical areas, poor and put on fillings and supplementary caries lesions. Environment the protective coating within the cavity when coming up with fillings can decrease the occurrence of barodontalgia. Much like barotrauma, diving with short-term fillings isn’t appealing. In repeated endodontic methods, when individuals dive between appointments and underlying canal isn’t filled, diving could cause subcutaneous emphysema along with the penetration of contaminated intracanal content within the apical cells.

The short-term ban on scuba diving after dental or oral surgery is the best way to prevent the occurrence of barodontalgia. It is recommended to avoid diving 24 hours after dental procedures (eg. tooth fillings, crowns and bridges), a week after oral surgery (including tooth extraction) and at least two weeks if there is suspicion of oroantral communication.

Conditions associated with diving mouthpiece

When scuba diving, divers in the mouth posture mouthpiece with the controller (regulator mouthpiece) that allows them to breathe underwater by bringing oxygen. The mouthpiece is usually made of silicone or soft acrylic resins, and considering the method of preparation can be commercial, semi individual and individual. During scuba diving divers hold mouthpiece firmly between the teeth of the upper and lower jaw, usually between canines and premolars. Therefore, total or partial tooth loss may be a contraindication for this type of diving, and too much compression of mouthpiece can cause damage to the hard dental tissues.

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The air that comes through the mouthpiece from the air tank may in presence of oral surgery wounds cause intraoral pain similar to that which occurs in barodontalgia. Therefore, the recommendation would be to prevent diving a minimum of one week following the mouth surgery to allow wound heals correctly. Additionally it is desirable the fact that dental practitioner examines the wound before diving. Furthermore, such air arriving under great pressure can additional shorten the life-span of worn-out fillings.

It really is thought that mouthpieces could cause herpes virus infections, especially throughout their regular adjustments among underwater divers. As a result, it is recommended that everyone uses his own mouthpiece and perform its regular cleaning. Divers need to inform their dentist of any changes in the gums in order to recognize the symptoms of herpetic gingivostomatitis (herpes simplex virus contamination) in time.

Although this issue is still a cause of many discussions, it is considered that diving mouthpiece can disrupt the functioning of the temporomandibular joint in divers, especially women. Studies have shown that from 24 to 68 percent of divers feel more or less interferences in the joint that may vary from joint clicking to severe pain. In comparison to the general populace in which this joint disturbances occur in approximately 25 percent of instances. Sometimes, with these forms of disorders, the name diving mouth syndrome is used which includes symptoms that happen in the temporomandibular joint such as muscle pain, joint pain, painful disc displacement and headaches. The intensity of these symptoms can be different, and may only be demonstrated during the dive, but also can become a long-term and chronic. Temporomandibular joint disorders caused by diving should be diagnostically distinguished from barotrauma of the middle ear. One possible cause of these disorders is usually protruded position of the lower jaw and enhanced bite force in order to preserve mouthpiece in the position. To be able to decrease muscle tension and steer clear of disturbance with temporomandibular joint, the usage of semi person or person mouthpieces which trigger smaller exhaustion of masticatory muscle tissues. Also the positioning of the low jaw is comparable to regular when there is absolutely no mouthpiece in the mouth area.

Bottom line

Scuba is sport that’s gaining increasingly more supporters. The increased amount of supporters oblige both dental practitioners and patients to take more care of the effect of this sport on oral health. This effect is multifaceted and may become manifested as dental care barotrauma, barodontalgia and diving mouth syndrome with disabilities in the temporomandibular joint. Applying appropriate preventive measures, many of these disorders can be prevented and/or mitigated. Divers should be aware that predisposing factors for the event of dental care barotrauma are bigger or hairline splits on existing fillings and concealed and/or secondary caries lesions.

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