BARODONTALGIA

INTRODUCTION

Barodontalgia , commonly known as teeth squeeze was earlier called as aerodontalgia. During World War 2 it was noticed that the air crew members used to complain tooth pain during flight , so the term aerodontalgia was given . Later it was observed that the sea divers used to complain the same tooth related pain. So a broader name was given as barodontalgia.

WHAT IS BARODONTALGIA?

Barodontalgia is described as the pain or trauma affecting teeth due to variations in pressure gradients. It commonly affects the air crew and aircraft passengers and underwater divers. It is a symptom that flare up the chances of preexisting sub clinical oral disease. 

ETIOLOGY

The most common etiologic pathologies for in flight pain  reported as possible sources of barodontalgia are dental caries, faulty dental restoration ,pulpitis, pulpal necrosis , apical periodontitis , impacted teeth , mucous retention cyst , recent ongoing dental treatments followed by barosinusitis. Reports have also documented external otitis barotrauma and dental barotrauma to have caused barodontalgia.
External otitis barotrauma is the ear pain caused by rapid changes is pressure.
Dental barotrauma is a condition in which change in barometric pressure  causes damage to the dentition.
Barosinusitis are generated from pressure changes rather than pressure related flare up of pre existing condition.

BARODONTALGIA DURING FLIGHT

When a person reaches high altitudes in unpressurized airplane cabins, as the outside pressure decreases , the volume of the gases increases. This creates a problem in tooth chambers and canals, since the gases cannot expand or contract in a manner needed to adjust the internal pressure to match the external pressure. Its reported that during flying barodontalgia occurs at altitude as low as 5000 feet and as high as 35000 feet , but common between 9000 to 27000 feet.

According to pulpal condition and symptom , barodontalgia during flight  is classified into 4 classes :

CLASS 1: Reversible pulpitis
                  Shows sharp transient pain on
                   ascent.

CLASS 2 : IRREVERSIBLE PULPITIS
                   Dull throbbing pain on ascent.

CLASS 3 : NECROTIC PULP
                   Dull throbbing pain on
                  descent.

CLASS 4 : PERIAPICAL PATHOLOGY
                   Severe persistent pain on
                    ascent and descent.

Barodontalgia is also classified as direct and indirect barodontalgia.

Direct barodontalgia includes pulp related disease with or without periapical involvement. It appears as pulpitis and periapical periodontitis. Pulpitis pain usually occurs during take off/ ascent. Periapical periodontitis pain is usually at high altitude during ascent or landing. The history includes recent dental treatment or recent dental sensitvity. The clinical findings are faulty restoration, extensive carious lesions or acute pain on cold and percussion test.

Indirect barodontalgia includes barosinusitis and barotitis media. In this the pain  occurs during landing and continues on ground. The symptoms include toothache in upper premolar or molar region. The history includes present acute upper respiratory infection or past sinusitis. Clinically there is pain on sinus palpation and radiographically you can see opacity on maxillary sinus.

BARODONTALGIA IN DIVERS

Scuba diving is one of the most growing sports in todays world. The divers are the victims because in deep dives pressure can increase by several atmosphere.
The most common complaint experienced by dentist is of dental squeeze , also known as barotrauma of descent. This is due to the condition associated with exposed dentinal tubules or pulpal tissue. When the divers descent, air is forced into the pulp due to increased pressure of the inspired air. The pain experienced  is related to the divers depth and  improves when the diver ascends by relieving the pressure. This is seen in patients with tooth decay ,dental infection or leaking restorations.

But sometimes the divers experience pain during ascent , this type of pain is known as barotrauma of ascent. This is caused by the compressed air that has been trapped in an enclosed space and expands when the diver ascends. This kind of injury is seen in incomplete root canal treatments or neglected restorations. In severe cases the pressure build up in a tooth leads to the explosion of tooth called as odontecrexis.

Pulpitis is the another common reason for dental squeeze. This is due to the recent dental treatment. When the dental treatment is done there is slight degree of inflammation resulting in a tooth being sensitive for few days. When pressure is applied on the inflamed tissue , gases formed due to inflammation  are compressed and increases the pressure in pulp cavity which results in pain.

TREATMENT

The treatment option for barodontalgia are numerous depending upon the chief complaint, clinical finding and diagnosis. If you experience such kind of pain during these activities contact your dentist and get your dental exam. Your dentist can identify and treat any sign of decay or infection.

PREVENTION

 It is recommended that annual checkups to be done of air crew members and divers with oral hygiene instructions​ with dentist . After a dental treatment the patients are instructed not to dive or fly in non pressurized cabins. Screening panoramic radiographs are recommended for them at 3-5 years interval. Special attention is required for periapical pathogenesis, faulty restorations, secondary carious lesion and sign of attrition.

PREVENTION IS BETTER THAN CURE !

   
                       DR. ANJUSHA SHARDA