From the June, 2008 issue of Scuba Diving Magazine. Topic #4: Dental Issues

At DAN we get a surprising number of questions about dental issues and diving. The truth is, fears surrounding diving and dental problems are far more common than the actual occurrences, and most problems can easily be prevented with proper oral hygiene. Here we'll take a look at some of the most common dental issues that come across our Medical Information Line and what they mean for divers.

The Big Squeeze

A tooth squeeze happens when an air bubble forms at depth--in this case, inside a tooth or under a filling--and can't escape as the air expands on ascent. Untreated cavities, worn-out fillings and cracks in the teeth themselves are the most likely causes of a tooth squeeze situation, but this phenomenon is extremely rare. More worrisome is the chance of water entering the cracks or cavities, coming in contact with the nerves and putting pressure on the internal workings of the tooth, which can cause long-term dental pain. An even greater risk is bacteria entering and infecting the tooth, which can exert pressure on the internal nerves and blood vessels, possibly impairing blood flow and killing the nerve.

If you think you have a cavity, get it filled before you go diving. Also, visit your dentist on a regular basis to ensure that your teeth and fillings are in good shape, and follow your dentist's recommendations for having them fixed or replaced over time.

The 411 on TMJ

Temporomandibular joint syndrome, more commonly known as TMJ, is an inflammation of the jaw just in front of the ear. It can be caused by abnormalities of occlusion (the way your teeth come together), which can happen naturally (genetic) or artificially (an external incident). It may also indicate a misalignment with the lower jaw.

The chief symptoms are jaw pain, muscle spasms and pain in the ears, even when your ears appear normal upon examination. TMJ can show up in divers--especially novices--who clench their teeth and tend to bite through mouthpieces. But clenching alone doesn't cause TMJ. It only exacerbates it in divers with a pre-existing jaw occlusion problem.

Treatment of TMJ includes a jaw or bite adjustment, management of contributing dental problems and the use of orthodontic or molded mouthpieces while diving. You should be able to hold the mouthpiece lightly between your teeth and still keep your regulator in place; if you can't, talk to your instructor or local dive center about recommendations for gear adjustments.

Oral Surgery Dos and Don'ts

Oral surgery--a root canal, for example--usually involves temporary fillings, crowns and other solutions to prevent the patient from experiencing pain or discomfort during the days, weeks or months it may take to complete the procedure. DAN does not recommend diving with any type of temporary dental work in place, as these fixtures are not designed to withstand the rigors of extreme pressure and they will likely fail, allowing air and/or bacteria into the tooth's nerve canal.

In addition to infection, there's a diving risk to consider. When undergoing dental procedures like root canals and dental implants, your jaw and gum tissues are often tender and sore. This can impede your ability to hold a regulator mouthpiece in place, which can lead to the aspiration of water and even drowning, and the process of biting down creates constant pressure on the surgery site that can lead to tissue damage and disrupt the healing process. Here are a few basic post-surgery guidelines to follow before getting back in the water:

• Wait a minimum of four to six weeks or until the oral tissue has sufficiently healed to minimize the risk of infection or further trauma.


• Narcotic prescription pain medications should be discontinued. If you shouldn't drive on 'em, you shouldn't dive on 'em.


• Make sure you can hold the regulator mouthpiece without pain or discomfort for a period of time sufficient to perform a planned scuba dive.

The Ups and Downs of Tooth Pain

Sometimes tooth pain has nothing to do with teeth at all. As a general rule, tooth pain in the lower jaw is likely an actual tooth squeeze. But pain in the upper jaw is probably from a squeeze in the maxillary sinuses. The nerves of the upper teeth pass through the maxillary sinus, so swelling and inflammation within the sinus cavity can cause pain in the teeth, or even numbness of the cheeks, lips and gums. Numbness is rarely indicative of a tooth squeeze, and if it happens after a dive, you should see a doctor.

As with so many things in diving, a little common sense and some preventative action go a long way toward intercepting problems even before they occur. Diving and dental issues are no exception. Visit your dentist on a regular basis to maintain good dental hygiene, and give yourself sufficient time to heal when problems do arise. Trust us, it'll make your post-dive smile all the brighter.