Barodontalgia during hyperbaric oxygen therapy of an 8-year-old male: A case report.

Barodontalgia, barometric pressure-induced dental pain, may occur during hyperbaric oxygen(HBO2) therapy due to pressure changes. This case report presents an 8-year-old male patient with barodontalgia. The patient declared a severe toothache during HBO2 therapy. The diving medicine specialist referred the patient to the dental clinician immediately. On clinical examination, the pain was thought to be caused by caries lesions of the deciduous teeth in the left maxillary molar region. Tooth extraction was suggested. After extraction, the patient continued hyperbaric oxygen therapy sessions without any pain. The patient was recommended for an intraoral and radiographic examination session one week after the extraction. In conclusion, caries lesions and faulty restorations should be examined before hyperbaric oxygen therapy sessions. Even though barodontalgia is a rare phenomenon, dental examination is essential to avoid these kinds of pain-related complications. All carious lesions and defective restorations must be treated, if necessary. Removal of faulty restorations and management of inflammation as part of the treatment is suggested before exposure to pressure changes.

Relationships among barodontalgia prevalence, altitude, stress, dental care frequency, and barodontalgia awareness: a survey of Turkish pilots.

Background: Gas expansion in body cavities due to pressure changes at high altitudes can cause barodontalgia. This condition may compromise flight safety. Aim: To investigate relationships among barodontalgia awareness, dental visit frequency, and barodontalgia prevalence in civilian and military pilots operating at high altitudes. Materials and Methods: Civilian pilots from Turkish Airlines and military pilots from the Turkish Air Force, flying between November 2022 and January 2023, participated in this study. A 20-question survey was administered to 750 pilots, covering topics such as barodontalgia awareness, dental visit frequency, breaks after dental treatments, in-flight pain, and pain type and severity. The voluntary surveys were distributed by email. Results: Of the 750 pilots, 526 completed the survey; 61% were aware of barodontalgia, and 81% of pilots who had experienced it reported pain at altitudes <2000 feet. The study revealed higher barodontalgia awareness among pilots who had experienced it, with the highest prevalence among jet pilots. Pilots with barodontalgia also showed a higher frequency of dental visits (p < 0.001). Additionally, this group reported more frequent interruption of flight due to dental treatment (IFDT), more problems experienced in flights after treatment (PFAT), and higher instances of bruxism or teeth clenching during flight, suggesting stress and anxiety (p < 0.05). Conclusions: Barodontalgia, a type of pain linked to stress, significantly impacts pilot performance, and can threaten flight safety, even at lower altitudes. Thus, there is a need to educate pilots about stress management, barodontalgia awareness, and the importance of regular dental check-ups.

The effect of atmospheric pressure on the bond strength of composites.

Background: In the current study, we investigated the effect of atmospheric pressure change on the microtensile bond strength of direct and indirect composite restorations to the teeth. Materials and Methods: A total of 16 extracted teeth were prepared after crown cutting and randomly divided into four groups. The study groups included: 1) direct restoration (Filtek™ Z250 Universal Composite Restorative System, 3M, United States) at constant pressure (control); 2) direct restoration in variable pressure; 3) indirect restoration (Z250 composite) at constant pressure (control); and 4) indirect restoration at variable pressure. Then, samples were subjected to thermal cycles. Variable pressure groups were pressurized to 0 to 5 atmospheres for 96 cycles inside the hyperbaric chamber, followed by measuring the microtensile bond strength of the specimens. Results: The mean of microtensile bond strength in both direct and indirect variable-pressure groups was significantly lower than their counterpart control groups. There was no significant difference between direct and indirect restorations in constant and variable pressure. The failure mode of the samples in the control groups was often mixed, while in the pressure groups, it was dominated by adhesive. Also, microscopic examination of restoration interfaces showed that the number and volume of voids in variable pressure groups were much more than the control groups. Conclusion: Regardless of the type of restoration, changing the atmospheric pressure is effective on the bond strength of the restorations to the teeth.

Orofacial problems in scuba diving: prevalence and prevention-a large-scale survey among civilian divers in France.

Self-contained underwater breathing apparatus (SCUBA) diving is becoming widely democratized among hobbyist practitioners. It can cause orofacial problems, mostly linked to pressure changes. The aim of this study was to assess the prevalence of these problems and to analyze civilian divers' behavior about their dental prevention in France, via a cross-sectional study. Data from 1015 French civilian divers were collected via a nationwide online questionnaire in which participants indicated information concerning orofacial experienced problems during their diving activity, and their medical preventive habits. As results, oral manifestations were experienced by 25.2% of the divers, including barodontalgia (10.8%), mouth syndrome (13.4%), gum pain (2.8%) and dental fractures caused by barotrauma (3.7%) or shocks (1.9%). Mouth syndrome was more frequent among women (18.6%) and divers aged between 18 and 34 years (18.9%). The prevalence of dental fractures increased significantly with age. High diving level was associated with more frequent barodontalgia (17.5%), gum pain (7%) and barotrauma (7.6%). Among respondents, 43.5% completed a dental examination before a diving season and showed fewer oral problems during their scuba diving practice than those who did not. In conclusion, oral problems in scuba diving represent frequent events that can compromise the safety of divers. Despite awareness rising, there is a lack of recourse to the dentist. This leads to incomplete information, especially concerning the preventive means available to divers.

Barotrauma y barodontalgia en la aviación / Barotrauma and barodontalgia in Aviation / Barotrauma e barodontalgia na aviação

Introducción: se ha estudiado ampliamente la importancia de los cambios de presión y sus consecuencias en el cuerpo humano. De esto se desprenden dos conceptos importantes: el barotrauma que se define como el daño producido por cambios en la presión atmosférica; y la barodontalgia que se define como el dolor dentario producido por variaciones de presión barométrica, por ejemplo cuando existen gases atrapados en restauraciones o en la cámara pulpar y/o conducto radicular. Estos conceptos se fundamentan en las leyes de los gases: la Ley de Difusión Gaseosa, la Ley de Dalton, la Ley de Boyle, la Ley de Charles y la Ley de Henry. Discusión: el estudio y prevención de la barodontalgia es de suma importancia, ya que aunque no tiene alta prevalencia entre los aviadores, su aparición es súbita y de alta intensidad, lo que puede provocar en el piloto una incapacidad física y mental, que aumenta el riesgo de accidentes. Conclusiones: en esta revisión, se reúnen las estrategias recomendadas para prevenir su aparición.

Introduction: the importance of pressure changes and their consequences on the human body has been widely studied. Two important concepts arise from this: barotrauma, which is defined as the damage produced by changes in atmospheric pressure; and barodontalgia, which is defined as dental pain produced by variations in barometric pressure, for example when gases are trapped in restorations or in the pulp chamber and/or root canal. These concepts are based on the gas laws: the Law of Gaseous Diffusion, Dalton's Law, Boyle's Law, Charles' Law and Henry's Law. Discusion: the study and prevention of barodontalgia is of utmost importance, since although it is not highly prevalent among aviators, its onset is sudden and of high intensity, which can cause physical and mental incapacity in the pilot, increasing the risk of accidents. Conclusions: this review brings together the recommended strategies to prevent its occurrence.

Introducão: a importância das mudanças de pressão e suas conseqüências sobre o corpo humano têm sido amplamente estudadas. Dois conceitos importantes podem ser derivados disto: barotrauma, que é definido como o dano produzido por mudanças na pressão atmosférica; e barodontalgia, que é definida como a dor dental produzida por variações na pressão barométrica, por exemplo, quando os gases estão presos em restaurações ou na câmara de polpa e/ou canal radicular. Estes conceitos são baseados nas leis do gás: a Lei de Difusão Gasosa, a Lei de Dalton, a Lei de Boyle, a Lei de Charles e a Lei de Henry. Discusion: o estudo e prevenção da barodontia é de suma importância, pois embora não seja muito prevalente entre os aviadores, seu início é repentino e de alta intensidade, o que pode causar incapacidade física e mental no piloto, aumentando o risco de acidentes. Conclusões: esta revisão reúne as estratégias recomendadas para evitar sua ocorrência.

A diving physician's experience of dental barotrauma during hyperbaric chamber exposure: case report.

Previous cases of dental barotrauma have been reported in pilots and divers. We report a case of dental barotrauma and barodontalgia in a diving physician accompanying patients during hyperbaric oxygen treatment, and due to pressure changes in the hyperbaric chamber. The physician developed sharp pain localised to the right maxillary molars but radiating to the face, ear and head during decompression from 243 kPa (2.4 atmospheres absolute). The pain intensified following completion of decompression and was consistent with irreversible pulpitis. Clinical examination and panoramic radiography suggested fracture of a heavily restored tooth due to barotrauma. This was managed by tooth extraction. The physician subsequently discontinued accompanying the patients during their hyperbaric oxygen treatment sessions. Dentists and maxillofacial surgery specialists suggest waiting for a minimum of four weeks or until the tooth socket and/or oral tissue has healed sufficiently to minimise the risk of infection or further trauma before exposure to further pressure change. Although seemingly rare, and despite the comparatively slow pressure changes, dental barotrauma can occur in hyperbaric chamber occupants.

A retrospective study of oral pathoses in Israeli military divers and non-divers: 2011-2020.

BACKGROUND/AIM: Self-contained underwater breathing apparatus (SCUBA) diving has grown tremendously as a recreational sport over the past decade. The pain divers experience due to barometric changes is referred to as barodontalgia, and it is known to cause various oral pathoses. Furthermore, divers suffer more frequently from temporomandibular disorders than non-divers. The aim of the study was to characterize oral pathoses between military divers and military non-divers. MATERIAL AND METHODS: Data from the dental files of healthy Israel Defense Forces (IDF) soldiers aged 18-40 years were collected retrospectively for the years 2011-2020. The data for subjects exposed to diving were compared to commando and special forces soldiers. RESULTS: The study population was composed of 6398 soldiers, which included 1036 divers and 5362 non-divers. All participants were male, with a median age of 22 years (mean = 22.1 years). Overall, higher rates of faulty dental restorations were seen among divers than non-divers (9.3% vs. 6.7% p = .006). Temporomandibular disorders were more prevalent among divers, specifically Disc Displacement Without Reduction (DDWOR) (0.4% vs. 0.1% p = .003). While dental fractures showed no significant difference between divers and non-divers (3.8% vs. 3.5% p = 0.8), other oral injuries were nine times more prevalent among divers versus non-divers. CONCLUSION: Military divers are, overall, at a higher risk of oral pathoses than non-divers. This may be related to the characteristics and intensity of their military service.

Odontocrexis / Odontocrexis / Odontocrexis

Los cambios en la presión atmosférica pueden ocasionar patología odontológica en personas que presentan dientes con caries, obturaciones deficientes o temporales y en todas aquellas lesiones cavitadas donde puedan quedar albergadas burbujas de aire.Se presenta el caso clínico de un buceador de la Armada Española que acude al servicio de odontología de la Jefatura de Apoyo Sanitario del Arsenal de Cartagena, por presentar fractura dental completa, “odontocrexis”, derivado de la expansión volumétrica de los gases en el ascenso a la superficie terrestre durante la realización de un ejercicio de buceo militar. (AU)

Changes in atmospheric pressure can cause dental disease in people with decayed teeth, poor or temporary fillings, and in all cavitated lesions where air bubbles can be lodged.The clinical case of a diver from the Spanish Navy who attends the dentistry service of the Sanitary Support Headquarters of the Cartagena Arsenal is presented, due to presenting a complete dental fracture, “odontocrexis”, derived from the volumetric expansion of the gases during the ascent to the ground during a military diving exercise. (AU)

Mudanças na pressão atmosférica podem causar patologia dentária em pessoas com dentes cariados, obturações deficientes ou temporárias e em todas as lesões cavitadas onde bolhas de ar podem se alojar.É apresentado o caso clínico de um mergulhador da Marinha Espanhola que frequenta o serviço de odontologia do Quartel de Apoio Sanitário do Arsenal de Cartagena, por apresentar uma fratura dentária completa, “odontocrexia”, decorrente da expansão volumétrica dos gases durante a subida ao solo durante um exercício de mergulho militar. (AU)

Dental and Orofacial Barotraumas among Saudi Military Naval Divers in King Abdul Aziz Naval Base Armed Forces in Jubail, Saudi Arabia: A Cross-sectional Study.

BACKGROUND: The aim of this study was to assess dental as well as orofacial pain under atmospheric pressure in military divers. MATERIALS AND METHODS: Cross-sectional study was conducted in King Abdulaziz Naval Base Armed Forces (KANB) in Jubail, Saudi Arabia involving 216 Saudi military divers. Questionnaire was formulated to assess the prevalence and factors associated with dental as well as orofacial pain among divers. RESULTS: Of total 216 participants, 35.6% participants dive 10-50times/year; whereas 52.8% dive in more than 20 m depth and 67.2% dive in the atmospheric pressure of >1.5bar. Majority (81.9%) used compressed air when diving. Sudden pain during or after diving was experienced by 67.1% in head or facial area, 69.2% in nose and paranasal sinuses, and 52.3% have experienced dental injury. Statistically significant associations were found between pain during diving with a frequency of diving, diving depth, and atmospheric pressure with P < 0.001, 0.001, and 0.011, respectively. CONCLUSION: Through this study, we concluded that dental and orofacial pain were experienced by more than half of the military divers at least once during their dive. Factors like increased frequency of diving, deep divers, and increased atmospheric pressure increases the extent of pain. Findings of this study suggested that more studies focusing on diving centers should be performed to realize the complete range of the issue.

Apical surgery as cystic lesion treatment for barodontalgia prevention: a case report / Cirugía apical como tratamiento de lesión quística para prevenir la barodontalgia: informe de caso

ABSTRACT Barodontalgia is not a pathology but a symptom of a subclinical oral problem that, although rare, may affect patients subjected to atmospheric pressure changes and have an influence on flights. This paper aims to discuss the clinical characteristics of pathologies related to the etiology of barodontalgia, as well as differential diagnoses, treatments, and prevention. This paper reports a case of a Brazilian air force officer who went to the Santos Dumont Air Force Dental Clinic reporting pain in the anterior maxillary during a flight. An endodontic treatment followed by periradicular surgery was performed, in order to quickly seal the bone lesion and to avoid new cases of barodontalgia. This work demonstrated a successful approach of a periradicular lesion solved by surgical treatment in order to avoid new cases of barodontalgia during flights. In addition, this paper highlights the importance of deepening knowledge on this event and the need for periodic oral and dental assessment, as well as conclusive treatment in aircrew members in order to prevent aircraft accidents.

ABSTRACT La barodontalgia no es una patología en sí misma, sino un síntoma de un problema oral subclínico que, si bien es poco frecuente, puede afectar a pacientes sometidos a cambios en la presión atmosférica y afectar la seguridad de los vuelos. Este artículo pretende analizar las características clínicas de las patologías relacionadas con la etiología de la barodontalgia, así como los diagnósticos diferenciales, los tratamientos y la prevención. Se presenta el caso de un agente de la fuerza aérea brasileña que acudió a la Clínica Dental de la Fuerza Aérea Santos-Dumont reportando dolor en el maxilar anterior durante un vuelo. Se realizó un tratamiento de endodoncia seguido de cirugía perirradicular, con el fin de sellar rápidamente la lesión del hueso y evitar nuevos casos de barodontalgia. Este trabajo describe un procedimiento acertado para una lesión perirradicular resuelta por tratamiento quirúrgico para evitar nuevos casos de barodontalgia durante los vuelos. Además, destaca la importancia de profundizar en el conocimiento sobre este evento y la necesidad de llevar a cabo no solo una evaluación bucodental periódica de los miembros de las tripulaciones, además de ofrecerles tratamientos definitivos, con el fin de prevenir los accidentes aéreos.

The influence of pressure changes on the retentive force and coronal microleakage of different types of posts in endodontically treated teeth during simulated dives.

OBJECTIVES: We assessed the influence of a simulated diving environment on the interfacial microleakage and retentive forces of different post types in root-canal-filled teeth. MATERIALS AND METHODS: One-hundred-and-twenty extracted, single-rooted teeth were endodontically treated and were randomly divided into three groups according to the post and cement used: ER Post/Harvard cement (Titanium), CeraPost/DentinBuild Evo (Zirconia), DT Light Post/Calibra (FRC). Each group was randomly divided into two equal subgroups, a control group, and an experimental group, subjected to simulated dives to 456 kPa in a diving chamber. For 10 specimens of each subgroup the pull-out strength and the coronal microleakage were measured. RESULTS: Significant differences in the linear coronal penetration were observed between the Titanium and FRC groups (experimental group P ≤ 0.001; control group P = 0.02). Diving simulation had no significant impact on the microleakage for the three post types. The FRC groups showed significantly higher retentive strength values compared to the Titanium and Zirconia groups before and after simulated diving. The pull-out strength of the titanium experimental group was significantly less than the control group (P = 0.008). CONCLUSIONS: Following root canal treatment the combination of fibre-reinforced posts and resin cement should be preferred for patients requiring retention for tooth restorations using posts that are likely to be exposed to hyperbaric conditions.

La barodontalgia como entidad clínica / Barodentalgia as Clinical Entity

Con el creciente número de pasajeros y tripulaciones, tanto civiles como militares, los odontólogos pueden encontrar ciertos fenómenos patofisiológicos causados por los cambios de presión atmosférica. Entre estas entidades figuran las barodontalgias y los barotraumas. A su vez, debido a la importancia de la seguridad aeronáutica, se hace necesario obtener los conocimientos necesarios en esta aérea en aras de crear planes preventivos eficientes. Es por ello que el presente artículo recoge una revisión de la literatura actualizada con el objetivo de ampliar los conocimientos en lo referente a la barodontalgia como entidad clínica(AU)

Clinical dentist may encounter physiological and pathological phenomena caused by the changes in atmospheric pressure in the increasing number of air passengers, flight attendants, leisure pilots, as well as military and airline pilots. These include barodontalgias and barotraumas. In turn, due to the importance of aeronautical safety, it is necessary to obtain the necessary knowledge in order to create efficient preventive plans. This is why the present article includes a review of the updated literature with the aim of expanding knowledge regarding barodontalgia as clinical entity(AU)

Intracanal molar barometric pressure differentials at simulated altitude conditions - proof of concept study.

AIM: To evaluate whether objective data could be obtained regarding internal pressure conditions of a molar tooth with canals prepared but not filled exposed to reduced barometric pressures that could be experienced by aircrew. METHODOLOGY: The root canals of five mandibular molars were prepared but not filled. Root apices were sealed with a resin-modified glass-ionomer liner and root surfaces sealed with a dental adhesive. The sealed root surfaces were then coated with a polyvinylsiloxane (PVS) adhesive and the teeth inserted into cylinders of PVS impression material to the level of the cervical enamel junction. Barometric pressure transducers were placed in the pulp chambers with the endodontic access sealed with cotton and a provisional restoration. The specimens were then subjected to a manually controlled, atmospheric altitude challenge consisting of a slow ascent and descent to a simulated 25 000 feet above sea level followed by a rapid altitude climb and descent. The real-time difference between intracanal and simulated atmospheric pressures were recorded and correlated (Pearson's, P = 0.05). RESULTS: No tooth material fractured, and there was no failure of the provisional restorations. Barometric pressures inside the closed prepared molar canals and the ambient atmospheric pressure were found to correlate (r(2)  = 0.97-0.99; P < 0.0001), but pressure equalization lags were observed. However, no differences greater than six pounds per square inch (310 torr) were noted. CONCLUSION: This pilot study established a protocol that demonstrated that objective data regarding barometric pressures within the prepared canals of molars can be obtained at simulated altitude conditions.

Aviation dentistry.

With the rapid expansion of the airline industry in all sectors, dentists should pay special attention to crews and frequent flyers, due to change of pressure in-flight, that cause different types of oro-facial pain. Aviation dentistry deals with evaluation, principles of prevention, treatment of diseases, disorders or conditions which are related to oral cavity and maxillofacial area or adjacent and associated structures and their impact on people who travel or on aircrew members and flight restrictions. Dentists should prevent the creation of in-flight hazards when they treat aircrew members and frequent flyers.

Crown Cementing Strategy for Naval Divers.

BACKGROUND: A large number of personnel working in hyperbaric environment such as divers and submariners during escape drills report to the out patient department with split teeth, displacement of restoration and pain during ascent after diving. These symptoms are probably attributable to dental barotraumas. Therefore, a need was felt to undertake a study in this area, with a specific interest for treating these patients. METHODS: Sixty extracted single rooted premolar teeth were prepared and full cast crowns were cemented. Out of these, 20 were prepared with zinc phosphate, 20 with glassionomer and 20 with resin cement. After seven days of storage, each of the teeth in experimental group was pressure cycled 15 times to 3 atmospheres after which the force required to dislodge the crowns was tested on an Instron testing machine. RESULT: A significant difference was found (student's t test p value < 0.01) between the force required to dislodge the crowns with zinc phosphate cemented control group (141.70 ± 38.62) and experimental group (16.92 ± 10.13). Similarly a significant difference was observed in the glassionomer cemented control group (184.33 ± 25.33) and experimental group (90.50 ± 34.07). On the other hand, no difference was found between the resin cemented control group (289.15 ± 81.48) and experimental (279.43±87.48) group. CONCLUSION: Within the limitations of this study and based on the results, it was concluded that environmental pressure cycling affected the retention of crowns cemented with zinc phosphate and glassionomer cement. Panavia resin cement used in this study appeared to be unaffected by environmental pressure cycling. On the basis of the results of this study, dental surgeons should consider cementing fixed prosthesis with resin cements for patients who are exposed to marked variations in environmental pressure, such as divers and submariners during escape drills.