ISSUE 22 ARCHIVE - DIVE DENTIST

Celehte Fortuin

I am sitting quietly on my hands in the corner of my lounge grinning stupidly whilst staring out into the frosty darkness hoping for more snow. I have been banished into this corner by my housemates as I have become unbearably joyful at the prospect of going home to sunny SA for the Xmas holiday!

It comes with the territory of being a South African to bear jokes along the lines that I will naturally be riding the buffalo, giraffe, elephant or lions into town. I will roam freely into the wild African bush, their natural habitat by the way, and saddle one up (which of course we still do, but it's seriously frowned upon). And should one, out of pure curiosity, take a small bite to see what I am and inadvertently kill me, I will gather the troops and shoot blindly at anything four-legged! (I am man - hear me roar, or rather: I am woman, hear me purr). No I don't have a soap box (those things are far too slippery and if you fall, you could land in big trouble). But if I had one, this would have been the extent of my rant.

By the time this edition rolls out my warm sunny holiday will be a distant memory, the New Year will be a few months older, we will be coming out the other side of winter into, presumably, a lacklustre Spring and the headlines in the papers today, will be old news. If I had had one wish for Xmas? Shall we not forget the splendour and beauty of the watery world we enter into as divers? Shall we not forget who the tourists are, whose natural habitat it is we are enjoying.

To remember that the old wreck we brush up against, the coral we accidentally touch, and the fish we thought looked seriously weird are all beautiful and dangerous at the same time. Can we respect and fear in equal measure our beautiful oceans, because if we don't, nature will bite back. (Ok, so it was more than one wish, but you get what I mean).

Q:

I have recently been advised on dental implants to replace my missing adult teeth, instead of the denture I have been wearing the last few years. I was wondering how this will affect me as a diver as I also suffer severe Scuba withdrawal if I don't get wet at least once a month. Any advice?

DD:

Being a diver and denture wearer you are probably acutely aware of the discomfort caused by a removable prosthesis, especially during diving. An ill fitting denture can move, irritate and ulcerate the gums and cause problems keeping the regulator in position during diving. And let's face it; no one wants to loose a regulator on a dive! Dental implants are little titanium screws placed into the jaw bone in a position to replace the missing teeth. Not only are they the best option for stability and aesthetics, but they provide an excellent long term solution to an age old problem of removable dentures to fill in the gaps and restore function to patients.

The goal is to have this titanium screw and the natural bone knit together (Osseo integration), which can later be connected by a little connector-thingy (abutment) and further tinier screws, to carry the crown/bridge that will replace the missing teeth.

Basically Meccano for dentists. I won't go into the procedure for placing them, except to say they are a lot easier to place than other sort of implants (uh hmmm). The discomfort experienced is very little, especially if no additional surgery like bone augmentation, sinus procedures or soft tissue grafting is required.

During the initial healing phase, the interface between the bone and implant surface where this integration has to take place, is very fragile.

Any micro movement or disturbance (either through mechanical forces or through pressure related stress and strain) can have detrimental effects and lead to possible implant failure. If natural teeth are under pressure from diving, it follows that implants can be as well, after all, they are on their way to becoming an integral part of your body. So, as per general rule of surgery and healing physiology, we follow those guidelines and allow generous time for healing. The more intricate the procedure and bigger the wound, the longer we wait.

The time from placement to integration ranges from eight weeks to a few months, dependant on additional procedures needed prior, upon or after implant placement. But don't fret; this healing process takes place quietly inside the bone without you even knowing. Following roughly ten days of soft tissue/gum healing, you should be quite comfy and relatively pain free.

There are currently no studies or guidelines on how diving effects implants or how long the down time (or in your case, the dry time) is from placement of implants to diving again. We must certainly try to limit any factors that could complicate or delay healing and integration; I would suggest a minimum period of 3 months before diving. Once an implant has integrated and been successfully restored, treat it like you would any other tooth in the mouth by, you guessed it, brushing and flossing daily!

As for the severe dive dependency you have developed, I suggest you contact our Dr Oli or even Aunty Toomer. These withdrawals can be painful and frustrating and I would personally recommend you enlist the help of your whole dive club to alternate pouring buckets of water over you for the time you are not allowed to exceed 1ATA. Snorkelling is still allowed though! Safe diving and remember, only floss the ones you want to keep!