ISSUE 24 ARCHIVE - DIVE DENTIST

Celehte Fortuin

Barodontology seems to have had a slight explosion in exposure in the past few years. More publications than we can shake a stick at and more press than we can follow up on. This is excellent news for the diving community, for researchers and developers in the dental world and clinicians alike. As we dive deeper into the ocean, pushing the boundaries and limits of our bodies, so too are we pushing the boundaries and limits of science. Through the ages, innovation has pushed the limits of science and have raised the bar in the demand for excellence.

An article published in a dental journal in 2016 has raised this awareness even more. This could be seen by the increase in tabloid newspapers doing what tabloid newspapers do best: Focussing on the Bad, the Ugly whilst promptly forgetting about the Good. Doomsday headlines of how detrimental scuba diving is to your dental health, how wearing it is on fillings and crowns and how we should all just simply "stop the fun"! Well, I have a few choice words on that matter.

As the three ardent followers of my humble article will confirm, for the past ten years I have been quietly urging you lovely depth junkies to "go see your dentist" before your next dive holiday. Nasty old fillings, decayed teeth, ill-fitting crowns and lost teeth are but a few curve balls that can be deftly batted away by your dentist. Our demand for tooth retention as opposed to tooth extraction, combined with new technologies have certainly allowed fewer divers to suffer missing teeth and ill-fitting dentures. Implant dentistry, excellence in root canal therapy and advances in dental materials that borders on alchemy now allows crowns and dental prosthesis to be more sympathetic to the oral cavity, whilst being higher wearing in pressure environments. But the main message is clear: healthy teeth equals safe and happy dives.

Question: After a nasty bicycle accident left me wired and dentally implanted to the point of setting off airport security every time I fly, I have suffered from what I can only describe as "face ache" after every dive. Admittedly, I have not been diving for a while and whilst my voodoo doctors confirm I am now dentally fit and healthy, I can't help but wonder if this is my new post-diving norm or whether I should consider another less "in-depth" activity?

Answer:

Your first mistake, in my humble opinion, is your foolhardy and reckless decision to simply abandon your scuba diving kit and opt for a sport that only has two wheels! Your folly for self-propelled two wheels (which I hope you have now left firmly in your past) has certainly not proven to be flavour of the month. Now whilst a few of my very close diver friends also have this unhealthy tendency for two- wheeled gadgets, I can just about forgive them as theirs is engine-driven. On a lighter note, I am very glad to hear you are now well enough to pursue your one and only love of scuba diving.

If you have recently undergone extensive maxillofacial surgery following facial and dental trauma things can feel a bit odd. Being heavily innervated by nerve and blood supply, the soft issues and muscles of the face can take up to two months to heal. This, combined with healing of bone after surgery of around 2-3 months can make for a lengthy recovery. The oral environment typically heals quite fast due to the rapid turnover of cells. Whilst the superficial scarring may be indicating healing, the layers underneath are what really counts. I have seen the jaws wired shut after dental trauma and surgery and the loosening up of the muscles and temporomandibular hinge joint (the open and close joint of the jaw) afterwards can be really painful.

Combine this with the strain we exert on our chewing muscles via our mouth piece to retain our regulator and you have the perfect combination for typical "diver's mouth" pain. Traditionally this achy face has its origins in the old fashioned, rather large and poorly formed mouthpieces. A good starting point to alleviate this would be to try the newer, smaller mouthpieces with shorter bite planes that do not extend as far along the biting surfaces of the teeth. Alternatively you could discuss a custom made mouthpiece with your dentist.

The next step would be to assess your occlusion, or the way your teeth meet, during resting state and in all forms of function. Any interferences in free movement could cause jarring to the joint and exert excessive strain on the musculature of the TMJ. Occlusal calibration has been shown to greatly improve facial muscle comfort, even in non-divers. Parafunctional habits such as clenching / bruxing also need to be addressed. This increased and prolonged closing of the jaw and clenching on the teeth can cause atypical facial pain, migraines, tension pain, non-pathological tooth ache and in severe grinders even tooth nerve death and fractured teeth or fillings. With scuba diving's inherent risk of pressure related dental problems, we certainly do not need any additional contributing factors.

I certainly hope this has been a helpful reference and starting point for you and your dentist to solve the mysterious "face ache" you've been suffering post- dives. Remember, my fellow depth therapy fanatics... safe diving and happy flossing!!!