barodontalgia

Friday, April 7, 2023Friday, April 7, 2023 11

BarodontalgiaBarodontalgia


FormatFormat

Introduction Introduction DefinitionDefinition EtiologyEtiology ClassificationClassification DiagnosisDiagnosis ManagementManagement ConclusionConclusion


IntroductionIntroduction


Barodontalgia refers to the dental pain Barodontalgia refers to the dental pain experienced during air travel or deep experienced during air travel or deep sea diving.sea diving.


It was reported first during second It was reported first during second world war and was termed then as world war and was termed then as airodontalgia.airodontalgia.

This is an attempt to have a birds This is an attempt to have a birds eye view of the conditioneye view of the condition


Results from environmental pressure Results from environmental pressure changes.changes.

Previously described as airodontalgiaPreviously described as airodontalgia Incidence is more when the cockpit is Incidence is more when the cockpit is

not pressurisednot pressurised Very frequent among deep sea Very frequent among deep sea

divers, marine biologist,scuba diversdivers, marine biologist,scuba divers


– Baropressure pain affects air crew ,and Baropressure pain affects air crew ,and passengers and also under water divers passengers and also under water divers mainly due to the difference in the mainly due to the difference in the pressure gradientspressure gradients


Boyle’s Law

States that “at a given temperature, the volume of a gas is inversely proportional to the ambient pressure,” may be used to explain barodontalgia.


EtiologyEtiology



As atmospheric pressure decreases during ascent, trapped gases may expand and enter dentin tubules, which can stimulate nociceptors in the pulp or cause the movement of pulp chamber contents - through the apex of the tooth, thereby causing pain.


The same law applies if a person climbs to high altitudes (in flight); in this case, outside pressure decreases, permitting the volume of gases to increase.

As a person descends deeper and deeper below the water surface, pressure exerted on the diver by the water increases and reduces the volume of gases in enclosed spaces such as teeth and sinuses.


A problem arises when the enclosed spaces containing gases cannot expand or contract to adjust the internal pressure to correspond to

the outside pressure.


Possible conditionsPossible conditions

Acute or chronic peri-apical infection Caries Deep restorations dental cysts Sinusitis History of recent surgery


Incidence is more in posterior teethIncidence is more in posterior teeth

Maxillary teeth is more affected than Maxillary teeth is more affected than mandibular teeth mandibular teeth

More incidence reported in restored More incidence reported in restored teethteeth


Effect of barodontalgiaEffect of barodontalgia

Full porcelain crowns can also shatter Full porcelain crowns can also shatter from relatively shallow dives of 65 from relatively shallow dives of 65 feet. It is reported that trapped air is feet. It is reported that trapped air is a very efficient crown remover in a very efficient crown remover in teeth where the cement bond is teeth where the cement bond is failing. failing.


ClassificationClassification


The Fédération dentaire internationale (FDI) has classified barodontalgia into 4 groups according to its signs and symptoms;

acute pulpitis, chronic pulpitis, necrosis of the pulp periapical abscess or a cyst.


Rauch’s classificationRauch’s classification

According to the chief complaint.According to the chief complaint.

Class I- If the patient has pulpitis, he Class I- If the patient has pulpitis, he

will have pain on ascent- sharp will have pain on ascent- sharp momentary pain in acute pulpitismomentary pain in acute pulpitis

Class II- dull throbing pain in case of Class II- dull throbing pain in case of chronic pulpitischronic pulpitis


Class III -If the pulp is necrotic, a dull Class III -If the pulp is necrotic, a dull throbing pain on descent throbing pain on descent (compression) and asymptomatic on (compression) and asymptomatic on ascent (decompression)ascent (decompression)

In case of periradicular abscess or In case of periradicular abscess or cyst, severe persistant pain (class iv) cyst, severe persistant pain (class iv) occurs with both ascent and descent.occurs with both ascent and descent.


Barodontalgia and Scuba Barodontalgia and Scuba divingdiving



Physical properties of the gas mixture used during deep sea diving may contribute to barodontalgia.

In scuba tanks, oxygen’s natural diluent gas- nitrogen, is replaced by helium, resulting in a gas of lower viscosity.

This gas can enter tissues, including teeth, and can sometimes become trapped in closed spaces, such as the pulp chamber and root canal.


There are 2 mechanisms by which gases can be trapped in spaces:.

If there is a space between a tooth and its restoration, gas may be forced into it during an increase in pressure;

dissolved gas may diffuse from tissues into spaces as pressure decreases.


OdontocrexisOdontocrexis


Refers to the physical disruption of tooth during diving,descent or ascent.

This is due to trapped gas-which will expand and the resulting stress cause tooth fracture


Teeth that have been opened for Teeth that have been opened for endodontic treatment and endodontic treatment and temporarily sealed have been known temporarily sealed have been known to explode from air trapping and to explode from air trapping and expansion on surfacing. This is found expansion on surfacing. This is found to be more common in deep divers to be more common in deep divers using a heliox mixture. using a heliox mixture.


Barodontalgia and Barodontalgia and MicroleakageMicroleakage


Lyons and coworkers compared Lyons and coworkers compared types of cements and their role in types of cements and their role in barodontalgia.barodontalgia.

The results showed that micro The results showed that micro leakage was greater in cast crowns leakage was greater in cast crowns that were luted with zinc phosphate , that were luted with zinc phosphate , followed by Glass ionomer cement followed by Glass ionomer cement and the least was observed with and the least was observed with Resin cementsResin cements


It is thought that the porosities that It is thought that the porosities that occur during the mixing of zinc occur during the mixing of zinc phosphate and glass ionomer cement phosphate and glass ionomer cement could be responsible for micro could be responsible for micro leakage.leakage.

These porosities may contract or These porosities may contract or expand along with pressure changesexpand along with pressure changes


They further suggest that micro leakage may not have occurred in the resin cement group because the dentinal tubules were obstructed by resin tags and flexibility of the cement.


Barodontalgia Vs Barodontalgia Vs BarosinusitisBarosinusitis


Barosinusitis is distinguishable from barodontalgia, as the former will always occur on descent, whereas the latter always begins on ascent.


ManagementManagement


The placement of a zinc oxide eugenol (ZOE) base was found to prevent barodontalgia when reversible pulpitis was the underlying cause. This is attributed to the well-known sedative affects of ZOE.


Another study suggested that when treating people who are subjected to large pressure changes, it is best to avoid procedures such as pulpectomy and capping of an exposed pulp. Rather, endodontic treatment is indicated.


conclusionconclusion

To sum up the present day dental To sum up the present day dental clinicians should be in a position to clinicians should be in a position to diagnosis and treat situations diagnosis and treat situations which ,require interventions which ,require interventions especially for those who very especially for those who very regularly take to flight and those regularly take to flight and those who are in to the deep see who are in to the deep see diving,sports .diving,sports .


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