Some of the most overlooked factors of the medical standards required for divers to be deemed fit to dive are dental issues – faults with your fillings, cracks in your molars. Compared to a broken bone, or high blood pressure, a dental filling seems almost insignificant to an eager diver prepared to vault any minor medical hurdle to descend into the blue. But a new pilot study, led by dentist Dr Vinisha Ranna of the University at Buffalo in New York, finds that the matter should be taken a little more seriously.
The research found that 41 percent of divers experienced dental symptoms in the water, from tooth squeeze to jaw pain – factors that could severely affect the entire diving experience, and even force some to abort the dive.
“There have been some incidents of tooth fillings fracturing during ascents,” says Ranna. “And one rather gory account of a broken tooth that was pried out with a dive knife. [Although] I have learnt to take some of the anecdotes with a pinch of (sea) salt.”
From a conversation that Ranna had with other divers after she realised that her “teeth felt funny” during her first dive, and due to the lack of research on the topic, she decided to design the study. A survey posted to online social media platforms, asking divers questions on their dental health and experiences, formed the data for the team to analyse.
“Of the divers that participated in this study, 42 percent reported tooth squeeze (barodontalgia) as the type of problem, 24 percent experienced pain from holding the regulator too tightly, 22 percent reported jaw pain, five percent noted loosening of crowns placed on teeth, five percent reported pain in the gums, and two percent reported a broken dental filling.”
For inexperienced divers, jaw pain (from gripping the regulator too tightly with their teeth) was the most frequent problem experienced – probably for fear of the device popping out of their mouth. These painful symptoms can continue: Ill-fitting regulators can be responsible for sustained temporomandibular joint (TMJ), or jaw joint, pain. “In the present report, almost [a quarter] of the divers experienced TMJ pain associated with diving.”
But it’s not always about the depth: “The maximum pressure variation during descent into a dive occurs in the first 10 metres, where pressure doubles from one bar atmosphere at the surface to two bar atmosphere at 10 metres.
“It has been shown [that] frogmen, who spent greater [time] at shallower depths had the highest deterioration of teeth over time compared to naval divers and submariners, in spite of having better dental health than at baseline. (Goethe et al.)
“It is likely that dive instructors are more prone to barometric trauma as they spend greater time at shallower depths, assisting inexperienced divers with equalisation of the ears and sinuses. Although instructors were the second largest group surveyed, they had the highest prevalence of dental symptoms associated with diving as well as persistence of these symptoms after diving.”
But there are ways to prevent dental trauma. Letting your dentist know that you’re frequently diving is a good start, so that if you require any treatment, they know which materials to use – materials that could perform better underwater.
“It might 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 TMJ discomfort during a dive.
“Considering that the air supply regulator is held in the mouth, any disorder of the oral cavity can jeopardise the divers’ safety and potentially increase the divers risk of injury.”
To combat jaw ache, Ranna goes on to suggest that a “custom fabricated mouthpiece may alleviate pain during diving”. It might also be worthwhile for divers experiencing persistent jaw pain to consult with a dentist for further evaluation and fabrication of a customised bite piece.
The findings of this study have already begged the question that dive certifying bodies need to consider, the adjustment of medical requirements to include dental issues.
“This study suggests that a high proportion of recreational divers may experience dental symptoms during a dive. A visit to the dentist may avert an underwater dental disaster.
“This being said, there are large gaps in the dental literature on specific diving-related dental symptoms experienced by divers, the possible causes and management of these symptoms. With this in mind, I have designed a more comprehensive survey attempting to answer some of these questions.
“If you are a certified diver, please fill out this survey. Until we have more data on the mechanism of diving-related dental injuries, it would be difficult to make recommendations for dental health prerequisites for divers. It does make sense to have any unhealthy teeth treated before a dive.”
Ranna then adds, “After all, 100 feet underwater is the last place anyone would want to be with a toothache.”
Goethe WH, Bater H, Laban C. Barodontalgia and barotrauma in the human teeth: Findings in navy divers, frogmen, and submariners of the Federal Republic of Germany. Mil Med 1989; 154: 491–495.