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Dentistry

ISSUE 15 ARCHIVE - DIVING DENTIST

Celehte Fortuin

In the interest of safety and in line with my personal HSE Executive, I have decided to steer clear of the water. This includes a non-intentional, self imposed dry zone around my dry suit since early 2011 which, btw, has miraculous self-rotting, disappearing wrist seals. Who knew you could make your own Black Witch? Now, before the usual remarks relating to unsavory and unsociable Eau de la Pong flood the Ed‘s inbox, personal hygiene is excluded from this ban.

This ban is due to a simple, but beautiful side effect from drinking (and being in close proximity to) local water and scuba divers – the sprouting of awesomely cute, adorable, near-edible little human beings in the arms of almost all my girlfriends. These same girls were the ones diving to unfathomable (well, nearly... you know, around 5m or so) depths, rocking it up till the wee early hours alongside some hardcore diver dudes! Apparently some of these same dudes have also managed to dupe their lovely ladies into drinking some of this water. After falsely claiming that diving is safe and that water is our friend. Call me paranoid; go ahead, I’ve heard worse. But for now, the DD ain’t doing water. And on that note... somebody find me a vat of tequila please!

Q: I got back from a diving holiday about a month ago, during which I experienced a lot of pain and pressure on my upper left hand side jaw during and after my third dive of the holiday. The pain was quite intense and, following this, I had numbness that lasted for a few days along the upper left teeth which also spread to my cheek. This lasted about one week, during which the pain decreased upon descents, especially past ten meters. Two of my upper left molar teeth were filled about one year ago and these were the teeth that I felt were the origin of the pain, but due to the numbness and pain spreading along my top jaw, I cannot be sure. I took painkillers on the flight home, but I still felt some discomfort top left, even though the numbness had gone away. Could you shed some light on this matter? Regards, Laura.

DD: Following the long and winding road Laura and I walked to solve the mystery of the diving-induced numbness; I will quickly run through our mission impossible with kind consent from Laura.

Laura’s diving (which got me so mouthwateringly jealous I nearly got me back in the pretty-baby-sprouting water again) and teeth symptoms really put us through our paces. Following a battery of high end, scientific testing (a bit of tapping around here and there, some air, some water, some really cold spray thingy that made Laura jump) and a series of x-rays that made us glow in the dark (joking), I came to the conclusion that some of the existing fills needed replacing. This was also deduced following some intense eagle-eyed-ness – having had a good look-see at some fills. It has to be mentioned that the tests revealed all teeth were indeed vital, the nerves truly alive, judging by Laura’s reaction to them and it was decided to try and preserve the nerves as best we could.

Besides the tenderness on the upper left side following the routine tests, we managed to narrow it down to the two suspect teeth (referring back to previous article where the hint to the diagnosis is in the patient’s symptoms and concerns) that Laura had filled nearly a year before her diving. Unfortunately, to throw a spanner in the works, I also diagnosed the two opposing teeth on the lower left arch that needed refilling due to the fillings and teeth chipping away. Knowing that in some cases, referred pain can cause confusion, we duly made sure (with appropriate scientific methods) these teeth were not the cause of the problem. We set about a treatment plan to refill these teeth and eliminate the pain in a systematic way – theoretically.

I also recommended Laura contact the London Diving Chamber to put them through their paces too (it seemed only fair).

A few days following the initial consultation, Laura was back with the exact same pain as on holiday and the mystery numbness had returned as well. Removing the filling I found no evidence of a hairline fracture, but the fill was deep and close to the nerve. In an effort to save the tooth we applied a medicated dressing and filling, proceeded to redo the rest of the defective fillings and placed the final fillings on the troublesome molar eight weeks later. And we lived happily ever after... only in fairy tales.

Laura returned six months later when the Tooth Fairy’s favorite tooth flared up again. This time no numbness, but for us, the typical symptoms of a nerve in it’s final death throes was clear. Diligently following the required technological and scientific testing and in light of Laura’s symptoms, that now included throbbing pain; heat sensitive; cannot eat or touch the tooth and a very poor nerve response, we had to make our final decision to remove the nerve.

The long and winding road had come to an end. A couple of dives had set off a chain reaction in a seemingly previous ‘healthy’, deeply-filled tooth. Was it micro leakage in the old filling that caused the initial numbness and pain upon dives? Was it inclusions of bubbles in the filling that got compressed and forced into what appears to be a dense, impenetrable tooth root structure ending in a deep bony socket? Unless we take the tooth out and have a look under some really fancy microscopic equipment, we won’t know for sure. Diving can have some unexpected effects on our whole body, and the enamel-like growths in our jaws are certainly no exception. All we know for sure is that, right now, Laura is living happily with a pain free tooth.

Have a great diving year and happy flossing.

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