|Year : 2016 | Volume
| Issue : 3 | Page : 158-161
Barodontalgia: More light on less known
Yogita Khalekar1, Amit Zope2, Lalit Chaudhari1, Ujawal Brahmankar1
1 Department of Oral Medicine and Radiology, ACPM Dental College, Dhule, Maharashtra, India
2 Department of Orthodontics and Dentofacial Orthopaedics, ACPM Dental College, Dhule, Maharashtra, India
|Date of Web Publication||22-Aug-2016|
Department of Oral Medicine and Radiology, ACPM Dental College, Dhule, Maharashtra
Source of Support: None, Conflict of Interest: None
Changes in ambient pressure occur during flying, diving, or hyperbaric oxygen therapy and can cause different types of pathophysiological conditions and pain including a toothache known as barodontalgia. Barodontalgia is a symptom that reflects a flare up of pre existing sub clinical oral disease. Deep sea divers, aircrew members, and passengers are at increased risk of experiencing barodontalgia due to exposure to increased air pressure. The key to avoid barodontalgia is good oral health. Hence, it is important for dentists to understand the etiology and features of barodontalgia to prevent it. Clinicians must pay close attention to areas of dentin exposure, caries, fractured cusps, the integrity of restorations, and periapical pathology in those at.risk. This article reviews the literature regarding barodontalgia, its etiology, features, prevention, and focuses on those untouched aspects of barodontalgia which are to be paid attention.
Keywords: Barodontalgia, diving, etiology, toothache
|How to cite this article:|
Khalekar Y, Zope A, Chaudhari L, Brahmankar U. Barodontalgia: More light on less known. SRM J Res Dent Sci 2016;7:158-61
| Introduction|| |
The term “aerodontalgia” was first coined during the era of World War II. It was the tooth pain experienced by air crew during flight. However, as this tooth-related pain was also observed in divers, a more appropriate term, barodontalgia was subsequently given to this phenomenon. The phenomenon can be explained on the basis of Boyle's Law which states that “at a given temperature, the volume of gas is inversely proportional to the ambient pressure.” Barodontalgia is also defined as an oral (dental or nondental) pain caused by a change in barometric pressure in an otherwise asymptomatic organ.
| Etiology and Pathogenesis|| |
In most cases, barodontalgia reflects as a flare up of pre existing oral disease; hence, most common oral pathologies have been reported as possible sources of barodontalgia. The common etiologic pathologies for pain were faulty dental restorations and dental caries without pulp involvement (29.2%), necrotic pulp/periapical inflammation (27.8%), vital pulp pathology (13.9%), and recent dental treatment (“postoperative barodontalgia;”11.1%). Barosinusitis was the main cause of pain origin in 9.7% of cases. Kallman proposed three hypothesis for barodontalgia first, expansion of trapped air bubbles under a root filling or against dentin that activates nociceptors; second, stimulation of nociceptors in the maxillary sinuses, with pain referred to the teeth; and third, stimulation of nerve endings in a chronically inflamed pulp. Among these, the last two hypotheses were strongly supported with histological evidence.
| Barodontalgia in Pilots|| |
At high altitudes, during air travel, 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. During flying, barodontalgia has been reported to occur across a broad range of altitudes, having been reported at altitudes as low as 5000 feet and as high as 35,000 feet but is more common between 9000 and 27,000 feet  when pain is caused by periapical disease, it has been reported to the last as long as 3 days.
| Barodontalgia in Divers|| |
In the present world, self-contained underwater breathing apparatus (SCUBA) diving is one of the popular sports. Thus, it is important for dentists to be aware of dental-related problems that may arise for SCUBA divers. Pain has been reported to appear at depths ranging from 33 feet to 80 feet. Pain due to barodontalgia in diving conditions affects more commonly the upper teeth than lower teeth, and the vast majority of episodes appeared on descent. The pain experienced is according to the diver's depth, and usually improves when the diver ascends, thereby relieving the pressure. As the diver descends, air is forced into the pulp due to the increased pressure of the inspired air. Compressed air reaches the dentinal tubules or the pulp through primary caries, recurrent caries along the margins of restorations, or leaking restorations.
The second type of barodontalgia is referred to as barotrauma of ascent and is caused by compressed air that has been trapped in an enclosed space and then expands as the diver ascends. This kind of injury is seen in teeth with incomplete root canal treatments or neglected restorations. During descent, compressed air slowly enters these teeth due to a poor physical seal between the tooth and restoration, but cannot escape quickly enough during ascent. As the diver's depth decreases, there is pressure build-up within the tooth due to the expansion of the trapped air, leading to severe pain, and sometimes even fracture. Displacement of the intracanal medicaments through the root apex has been reported. In severe cases, the pressure build-up in the tooth may lead to an explosion of the tooth called odontecrexis.
| Classification|| |
Widely accepted the classification of barodontalgia was given by Ferjentsik and Aker in 1982 and is primarily based on the underlying causes and clinical symptoms [Table 1]. Barodontalgia is a symptom rather than a disease according to various authors it could have direct or indirect etiology.
[Table 2] compares the pulp-related (“direct”) barodontalgia and barotitis/barosinusitis-induced (“indirect”) barodontalgia.
| Management and Prevention|| |
The Fédération dentaire internationale (FDI) has divided barodontalgia into four groups from moderate to severe and has listed out a description of clinical symptom, findings, and therapy [Table 3].
|Table 3: Fédération dentaire internationale classification of barodontalgia|
Click here to view
FDI also recommends that annual check-ups be done for divers, submariners, and pilots, with oral hygiene instructions from dentists. After a dental treatment requiring anesthetic or 7 days following a surgical treatment, patients should be instructed not to dive or fly in nonpressurized cabins for the next 24 h.
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. Endodontically treated teeth that have been open for endodontic treatment and temporarily sealed have been report to be explode on deep sea diving known as odontocrexis, full porcelain crowns have been reported to shatter at a dive of 65 ft; hence, meticulous oral health advice should be given to the divers, all carious lesions should be restored, all ill-fitting crowns should be replaced with a good cementing medium, active periodontal lesion treatment and completion of endodontic treatment should be done. It is sometimes recommended that if we are unable to complete the treatment before deep sea diving or flight, extraction may be the treatment of choice. Furthermore, removable dentures are not recommended rather an FPD or an implant is indicated.
Summary of dental care to prevent barodontalgia is explained in [Table 4].
| Conclusion|| |
According to the literature, barodontalgia is a rare phenomenon as the incidence of barodontalgia may be underestimated. Although rare, barodontalgia can cause serious risk to SCUBA divers, submariners, air crew, and passengers. This article described these conditions and provided the dentists with some useful tools and guidelines. It is important for dentists to understand the etiology and features associated with barodontalgia to help prevent it. Dentists can better tackle this phenomenon by adhering to the guidelines given by FDI. However, further efforts are needed for further augmentation of speculative as well as hands-on knowledge of barodontalgia.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Holowatyj RE. Barodontalgia among flyers: A review of seven cases. J Can Dent Assoc 1996;62:578-84.
Kieser J, Holborow D. The prevention and management of oral barotrauma. N Z Dent J 1997;93:114-6.
Zadik Y. Aviation dentistry: Current concepts and practice. Br Dent J 2009;206:11-6.
Zadik Y. Barodontalgia: What have we learned in the past decade? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e65-9.
Kollmann W. Incidence and possible causes of dental pain during simulated high altitude flights. J Endod 1993;19:154-9.
Robichaud R, McNally ME. Barodontalgia as a differential diagnosis: Symptoms and findings. J Can Dent Assoc 2005;71:39-42.
Zadik Y. Barodontalgia due to odontogenic inflammation in the jawbone. Aviat Space Environ Med 2006;77:864-6.
Jagger RG, Shah CA, Weerapperuma ID, Jagger DC. The prevalence of orofacial pain and tooth fracture (odontocrexis) associated with SCUBA diving. Prim Dent Care 2009;16:75-8.
Al-Hajri W, Al-Madi E. Prevalence of barodontalgia among pilots and divers in Saudi Arabia and Kuwait. Saudi Dent J 2006;18:134-40.
Goossens IC, van Heerden WF. Interpretation and management of oral symptoms experienced by scuba divers. SADJ 2000;55:628-31.
Zadik Y. Barodontalgia. J Endod 2009;35:481-5.
Kieser JA. “Diving in dentistry: Barotrauma and its dental implications”. Dent Update 1997b;10:19-21.
Rottman K. Barodontalgia: A dental consideration for the SCUBA diving patient. Quintessence Int Dent Dig 1981;12:979-82.
Goldhush AA. “Aviation dentistry”. Bureau of medicine and surgery. In: Aviation Medicine Practice. Washington, DC: United States Government Printing Office; 1955. p. 22-43.
Ferjentsik E, Aker F. “Barodontalgia: A system of classification”. Mil Med 1982;147:299-304.
Goethe WH, Bäter 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;154:491-5.
Gaur TK, Shrivastava TV. Barodontalgia: A clinical entity. J Oral Health Community Dent 2012;6:18-20.
[Table 1], [Table 2], [Table 3], [Table 4]