ISSUE 20 ARCHIVE - DIVE DENTIST

Celehte Fortuin

So there I was in Santo (Vanuatu), minding my own business, bimbling along the deck of the Coolidge when I suddenly realised... I'm shark bait. OK, not quite, but it sets the scene for what happened on our dive.

Last dive dentist you joined me and a group of divers, varying in experience from discover scuba to experienced tech divers, now I found myself on a ten day diver's holiday in paradise.

What I never imagined was a front row seat to a complete diving dental dilemma during what was otherwise a fantastic dive!

Q. Is it safe or advisable to dive with temporary fillings or crowns?

A. The short version – no it is not advisable. But why stop there? Let me paint the whole picture.It is the end of our night dive and our group looks like a swarm of hyperactive bees buzzing over the deck with our dive torches swaying this way and that, trying to emulate the flashlight fish we've just seen in the cargo hold. We're excited after an awesome dive and we know we have to wait a minute or two to collect ourselves before the slow ascent into... well... darkness, so we're making the most of our "find and point" time. We get the signal from our guide who's been hovering over the abyss next to the wreck, illuminating our line up to the surface. Dutifully, we line up and start our ascent with me the last to leave the wreck, until... tug, tug, tug.

Picture it – pitch black around me, just gliding over the edge of the deck wondering what may lurk beneath me. Now, for those of you who know me and my active imagination on night dives, you'll know that by now I'm already slightly freaked out. Yes, I love caves, but they are confined spaces you see, not the vast open ocean giving a lot of space to all manner of unidentified scary things that your mind can imagine. Have you seen an angler fish with the light thingy dangling in real life!?

I'm wearing jet fins, so I know I've got power on my side. I abandon the frog kick and within two strong fin kicks, I stretch out to grab my buddy's calf when... tug tug, tug again... only this time with more force!! I scream, do a Matrix - like move whilst turning and get ready to kick when, my buddy, sensing my distress and recognising the UST behind me, pulls me away and holds out his hand to the UST. Confused and surrounded by a lovely warm feeling (you can imagine what happened), I come face to face with an equally wide eyed and bewildered member of our group called Mark, holding a little white crown for me to take whilst pointing to his cheek. Now, halfway up the line after a night dive, hovering in the black, is no place for a dental consultation! But with a few gestures and the evidence firmly tucked away, we established that this is not Titan the Triggerfish's tooth, but Mark's and that for now, he is in only slight discomfort. As a team of 3, we do a SAFE and SLOW ascent trying to keep him calm and his discomfort to a minimum.

What had happened was that a temporary crown on a root canal treated molar tooth had started hurting on our ascent out of the cargo hold onto the deck. It wasn't unbearably painful, but he heard a little pop and felt the plastic crown afloat in the mouth. The very fortunate part is that he did not aspirate and asphyxiate on the temporary crown. He is a competent enough diver to realise he had to stay calm and get the crown out of his mouth before he inhaled it or got stuck in his regulator. This was not the same as chewing a sweet whilst diving (which is not a great idea unless you're Darth Vader of the dive world and VERY comfortable underwater). It's a routine dive with an UNEXPECTED foreign object in your mouth. This, coupled with discomfort and pain at the end of a long day's diving, could have turned out very differently.

Temporary crowns are designed to be easily removed to allow us to fit the permanent crown. The cement used can either be powder, paste or a liquid. Both of these forms can incorporate air bubbles during the mixing and placement process. As a material, they can and will dissolve over time, causing more migration of bacteria and air between the tooth and the temp crown. As divers, we know Boyle's law on gases and by the sounds of it, it had come home to roost. Expansion of the air bubble upon ascent had caused the crown to come off.

Mark had also completed a root canal on the same tooth that had been bothersome for a while since his last dive trip. He remembers his dentist having a concern for a hairline fracture and the treatment plan was to eliminate the pain with root canal treatment and a crown. From the discomfort he experienced on the ascent I am also convinced that there is a hairline crack in the tooth, one which also seemed to have taken up air and was expanding as it was exiting the fracture. Unfortunately, Mark had not been back to have the permanent crown fitted.

Mark raised a valid question as to why he was symptom free on the flight over. Research and published articles have shown that, theoretically, cabin pressure changes are only between 1 and 0atm. Pressure changes under water are much more significant (1atm for every 10m), and therefore have a greater effect on bubble size and development and thus influence teeth and restorations greater than in flight. It is worth noting that pilots and flight crew have to undergo routine dental health checks as research shows the direct effects of pressure on the longevity of dental treatment. It may be worth noting that all divers be recommended and urged to do the same?