Barodontalgia

Relationships among barodontalgia prevalence, altitude, stress, dental care frequency, and barodontalgia awareness: a survey of Turkish pilots

Background

Gas expansion in body cavities due to pressure changes at high altitudes can cause barodontalgia. This condition may compromise flight safety.

Aim

To investigate relationships among barodontalgia awareness, dental visit frequency, and barodontalgia prevalence in civilian and military pilots operating at high altitudes.

Materials and Methods

Civilian pilots from Turkish Airlines and military pilots from the Turkish Air Force, flying between November 2022 and January 2023, participated in this study. A 20-question survey was administered to 750 pilots, covering topics such as barodontalgia awareness, dental visit frequency, breaks after dental treatments, in-flight pain, and pain type and severity. The voluntary surveys were distributed by email.

Results

Of the 750 pilots, 526 completed the survey; 61% were aware of barodontalgia, and 81% of pilots who had experienced it reported pain at altitudes <2000 feet. The study revealed higher barodontalgia awareness among pilots who had experienced it, with the highest prevalence among jet pilots. Pilots with barodontalgia also showed a higher frequency of dental visits (p < 0.001). Additionally, this group reported more frequent interruption of flight due to dental treatment (IFDT), more problems experienced in flights after treatment (PFAT), and higher instances of bruxism or teeth clenching during flight, suggesting stress and anxiety (p < 0.05).

Conclusions

Barodontalgia, a type of pain linked to stress, significantly impacts pilot performance, and can threaten flight safety, even at lower altitudes. Thus, there is a need to educate pilots about stress management, barodontalgia awareness, and the importance of regular dental check-ups.

Retrospective Longitudinal Study on Changes in Atmospheric Pressure as a Predisposing Factor for Odontogenic Abscess Formation

In our retrospective longitudinal study based on the data from 292 patients, we wanted to investigate whether there was an association between weather conditions and the occurrence of odontogenic abscesses (OA) requiring hospitalization. In the adult group (249 patients), the incidence of severe OA was highest in winter (32.9%) during January (11.6%), with the most common localizations being the perimandibular (35.7%) and submandibular (23.3%) regions. We found that changes in mean daily atmospheric pressure five days before hospitalization showed a positive association with the occurrence of OA, especially pressure variations greater than 12 hPa. Atmospheric pressure changes two and five days before hospitalization were also found to be moderate predictors of complications during treatment. Antibiogram analysis revealed resistance of streptococci to clindamycin in 26.3%. In the pediatric group, OA were also most frequent in winter (30.2%), and the perimandibular region (37.2%) and the canine fossa (20.9%) were the most frequent abscess localizations, while an association with meteorological parameters was not demonstrated. Clinical experience teaches us that weather change influences the occurrence of severe OA requiring hospitalization, which we confirmed in this research. To our knowledge, our study is the first to provide a threshold and precise time frame for atmospheric pressure changes.

Dental tourism and the risk of barotrauma and barodontalgia

Background and aim Dental tourism, which reflects the provision of health care services abroad, also includes a travelling component. Air travel after dental intervention may cause barotrauma and barodontalgia. This paper aimed to provide guiding principles regarding the minimal time interval between dental procedures and air travel to prevent these adverse effects.Methods A literature search was performed to reveal information with regards to complications related to flights following dental treatments. There is little research in this area and most of it has been conducted on the military aircrew population, which has different characteristics of flight and personnel than civilian commercial flights.Results The recommended time of flying is one week after most dental intervention and six weeks after a sinus lift procedure. The minimal time required between a procedure and flight is 24 hours after restorative treatment, 24-48 hours after simple extraction, 72 hours after nonsurgical endodontic procedure, surgical extraction, and implant placement, and at least two weeks after sinus lift procedure.Conclusions The provided guidelines may serve as a starting point for the clinician's decision-making. The tailoring of an individual treatment plan to the patient should take into consideration the patient's condition, dental procedure, complications and flight characteristics. Further research based on commercial flights is needed to formulate more accurate guidelines for the civilian population.

A retrospective study of oral pathoses in Israeli military divers and non-divers: 2011-2020

BACKGROUND/AIM

Self-contained underwater breathing apparatus (SCUBA) diving has grown tremendously as a recreational sport over the past decade. The pain divers experience due to barometric changes is referred to as barodontalgia, and it is known to cause various oral pathoses. Furthermore, divers suffer more frequently from temporomandibular disorders than non-divers. The aim of the study was to characterize oral pathoses between military divers and military non-divers.

MATERIAL AND METHODS

Data from the dental files of healthy Israel Defense Forces (IDF) soldiers aged 18-40 years were collected retrospectively for the years 2011-2020. The data for subjects exposed to diving were compared to commando and special forces soldiers.

RESULTS

The study population was composed of 6398 soldiers, which included 1036 divers and 5362 non-divers. All participants were male, with a median age of 22 years (mean = 22.1 years). Overall, higher rates of faulty dental restorations were seen among divers than non-divers (9.3% vs. 6.7% p = .006). Temporomandibular disorders were more prevalent among divers, specifically Disc Displacement Without Reduction (DDWOR) (0.4% vs. 0.1% p = .003). While dental fractures showed no significant difference between divers and non-divers (3.8% vs. 3.5% p = 0.8), other oral injuries were nine times more prevalent among divers versus non-divers.

CONCLUSION

Military divers are, overall, at a higher risk of oral pathoses than non-divers. This may be related to the characteristics and intensity of their military service.

Dental and Orofacial Barotraumas among Saudi Military Naval Divers in King Abdul Aziz Naval Base Armed Forces in Jubail, Saudi Arabia: A Cross-sectional Study

Background:

The aim of this study was to assess dental as well as orofacial pain under atmospheric pressure in military divers.

Materials and Methods:

Cross-sectional study was conducted in King Abdulaziz Naval Base Armed Forces (KANB) in Jubail, Saudi Arabia involving 216 Saudi military divers. Questionnaire was formulated to assess the prevalence and factors associated with dental as well as orofacial pain among divers.

Results:

Of total 216 participants, 35.6% participants dive 10-50times/year; whereas 52.8% dive in more than 20 m depth and 67.2% dive in the atmospheric pressure of >1.5bar. Majority (81.9%) used compressed air when diving. Sudden pain during or after diving was experienced by 67.1% in head or facial area, 69.2% in nose and paranasal sinuses, and 52.3% have experienced dental injury. Statistically significant associations were found between pain during diving with a frequency of diving, diving depth, and atmospheric pressure with P < 0.001, 0.001, and 0.011, respectively.

Conclusion:

Through this study, we concluded that dental and orofacial pain were experienced by more than half of the military divers at least once during their dive. Factors like increased frequency of diving, deep divers, and increased atmospheric pressure increases the extent of pain. Findings of this study suggested that more studies focusing on diving centers should be performed to realize the complete range of the issue.

Relationship between oral symptoms during diving work and preventative dental visits in Japanese male occupational divers

This cross-sectional study examined the relationship between dental symptoms experienced by occupational divers during diving and their participation in preventative dental visits. The questionnaire for this study was sent by post to 160 establishments and 215 members of the Japan Diving Association and participants were asked to complete a self-reported questionnaire. Data from 242 occupational divers (male, aged 20-79 yr) were analyzed. Multiple logistic regression analysis and correspondence analysis were performed to determine the relationship between dental symptoms experienced during diving and participation in preventative dental visits. We found that divers who experienced tooth pain while diving had not undergone preventative dental visits within the previous year (odds ratio: 2.76, 95% confidence interval: 1.12-6.80). This was also confirmed by correspondence analysis These findings suggested that not undergoing preventative dental visits was related to tooth pain during diving.

Incidence of the Acute Symptom of Chronic Periodontal Disease in Patients Undergoing Supportive Periodontal Therapy: A 5-Year Study Evaluating Climate Variables

Although patients under supportive periodontal therapy (SPT) have a stable periodontal condition, the acute symptom of chronic periodontal disease occasionally occurs without a clear reason. Therefore, in the present study, to obtain a better understanding of this relationship in patients undergoing SPT, we hypothesized that the acute symptom of chronic periodontal disease might be affected by climate factors. We conducted a questionnaire study and carried out oral examinations on patients undergoing SPT who had been diagnosed as having the acute symptom of chronic periodontal disease. We collected climate data from the local climate office in Okayama city, Japan. We predicted parameters that affect the acute symptom of chronic periodontal disease with unidentified cause and divided patients into high and low groups in terms of climate predictors. Then we defined the cut-off values of parameters showing significant differences in the incidence of the acute symptom of chronic periodontal disease. The incidence of the acute symptom of chronic periodontal disease with unidentified cause was significantly different when the cases were classified according to the maximum hourly decrease in barometric pressure (1.5 and 1.9 hPa) (p = 0.04 and p = 0.03, respectively). This suggests that climate variables could be predictors of the acute symptom of chronic periodontal disease. Therefore, gaining a better understanding of these factors could help periodontal patients undergoing SPT prepare to avoid the acute symptom of chronic periodontal disease.

Head and dental injuries or other dental problems in alpine sports

In the hectic daily life, spending our leisure time outdoor in the mountains becomes more and more popular. Although information describing dental injuries in various sports is available, data specifically on dental trauma and other dental problems in alpine sports are lacking. Data of 1,128 alpinists were generated by using a standardized questionnaire. The questions focused on the frequency of head and dental injuries and other dental problems. The participating alpinists have been recruited through the network of alpine clubs and an outdoor equipment supplier. Injuries were most frequently caused by a fall while doing alpine sports (14.7%, = 154). Of the participants, 8.2% (n = 93) suffered from a facial injury: 16% (n = 15) of these had a dental trauma. Other dental problems such as barodontalgia were more common than dental traumas. A sensation of pressure or pain was noticed in 13% (n = 135) of the participants at least once. Of all the participants who suffered pain, 54.1% reported one or several previous restorations. Pain medication was beneficial in 92.1%. Dental traumas are rare while doing alpine sports but not negligible because of its requirement of lifelong therapy and incurs substantial treatment costs. An intraoral pain of a usually asymptomatic tissue occurred, in this sample of participants, nearly as often as in pilots and divers. Pain killer is an efficient tool for the alpinists to reduce the pain until they reach a lower altitude.

Prevalence of dental problems in recreational SCUBA divers: a pilot survey

Objective To determine the prevalence of dental symptoms in recreational scuba divers and describe the distribution of these symptoms on the basis of diver demographics, diving qualifications and dive conditions during the episode of dental pain.Design A survey was designed and distributed through online social media platforms dedicated to scuba diving. A convenience sample of 100 recreational divers was obtained by this method.Main outcome measures The outcome measures of interest were: diver demographics, diving characteristics (level of certification, number of dives completed), occurrence of dental problems during a dive, and details of the episode.Results Forty-one percent of the respondents experienced dental symptoms during a dive. Barodontalgia was the most frequently experienced dental symptom during a dive.Conclusion Within the limits of the small sample size and online method of recruitment, the findings of this study suggest that a high proportion of recreational divers may experience dental symptoms during a dive. It would be meaningful to ensure that dental decay and damaged restorations are addressed before a dive and that the mouthpiece design be evaluated in case of complaints of temporomandibular discomfort during a dive.

Relationship between Acute Phase of Chronic Periodontitis and Meteorological Factors in the Maintenance Phase of Periodontal Treatment: A Pilot Study

The acute phase of chronic periodontitis may occur even in patients during supportive periodontal therapy. However, the details are not fully understood. Since the natural environment, including meteorology affects human health, we hypothesized that weather conditions may affect occurrence of acute phase of chronic periodontitis. The aim of this study was to investigate the relationship between weather conditions and acute phase of chronic periodontitis in patients under supportive periodontal therapy. Patients who were diagnosed with acute phase of chronic periodontitis under supportive periodontal therapy during 2011–2013 were selected for this study. We performed oral examinations and collected questionnaires and meteorological data. Of 369 patients who experienced acute phase of chronic periodontitis, 153 had acute phase of chronic periodontitis without direct-triggered episodes. When using the autoregressive integrated moving average model of time-series analysis, the independent covariant of maximum hourly range of barometric pressure, maximum hourly range of temperature, and maximum daily wind speed were significantly associated with occurrence of acute phase of chronic periodontitis (p < 0.05), and 3.1% of the variations in these occurrence over the study period were explained by these factors. Meteorological variables may predict occurrence of acute phase of chronic periodontitis.

Provisional Crown Dislodgement during Scuba Diving: A Case of Barotrauma

Changes in ambient pressure, for example, during flying, diving, or hyperbaric oxygen therapy, can lead to barotrauma. Although it may seem that this issue was neglected in dental education and research in recent decades, familiarity with and understanding of these facts may be of importance for dental practitioners. We report the case of a patient who experienced barotrauma involving dislodgement of a provisional crown during scuba diving. Patients who are exposed to pressure changes as a part of their jobs or hobbies and their dentists should know the causes of barotrauma. In addition, the clinician must be aware of the possible influence of pressure changes on the retention of dental components.

Pathophysiology of barodontalgia: a case report and review of the literature

Changes in ambient pressure occur during flying, diving, or hyperbaric oxygen therapy and can cause different types of pathophysiological conditions and pain including toothache (barodontalgia). We report the case of a patient with severe pain in the region of his mandibular left first molar, which had been satisfactorily restored with a conservative restoration. Pain occurred during an airplane flight and persisted after landing. Radiology revealed a periapical radiolucency in the region of the distal root apex. Pain relief was achieved only after endodontic treatment. On the basis of this paper, we investigated the aetiology and management of barodontalgia. Dentists should advise patients to avoid exposure to pressure changes until all necessary surgical, conservative, and prosthetic procedures have been completed. The influence of pressure divergences should be noted at any time. Under changed environment pressures may be the changing perception of pathologies.

Barodontalgia: A Clinical Entity

Barodontalgia is the oral pain caused by the changes in the pressure caused due to altitude changes either on deep sea diving or inflight conditions. Barodontalgia is one of the important clinical entities which present with such overlapping signs and symptoms, that in normal clinical setup the pain due to barodontalgia goes unnoticed. Also the literature available in textbooks is also less informative and revealing of the nature of pain caused due to barodontalgia. Hence this article focuses on those untouched aspects of barodontalgia which are to be paid attention.

Epidemiologic evidence of barometric pressure changes inducing increased reporting of oral pain

BACKGROUND AND OBJECTIVE

The daily patient flow at dental emergency departments is subject to fluctuations. The aim of the present study was to investigate whether meteorological parameters were associated with the number of patients reporting acute pain in the oral cavity.

METHODS

We performed a retrospective review of all patients presenting with acute oro-dental pain (n=1090) at the dental outpatient clinic in Innsbruck, Austria from January to March 2005. In addition, local weather data were supplied by the Central Institute for Meteorology and Geodynamics Austria. After exponential smoothing of both series of observations, linear regression on the number of patients was performed.

RESULTS

Statistical analysis revealed that the acute pain symptoms are not related to the air pressure itself but to the deviation of air pressure. The stronger the daily deviation from the average atmospheric pressure was, the more patients presented with acute pain at the dental emergency department (p=4.2 × 10(-14)). Our findings implicate that the association of air pressure deviation with variation in patient flow at dental clinics is a consequence of barometric pressure-related oral pain.

CONCLUSIONS

These findings suggest that changes in barometric pressure were the reason for the observed initiation and/or exacerbation of the various oral pains observed in the emergency room setting. This association has been considered to be rare, with most reports suggesting this phenomenon primarily affects divers and aircraft personnel. Our data suggests otherwise, by providing clear evidence that atmospheric pressure changes commonly influences painful oral conditions.

Barodontalgia: what have we learned in the past decade?

This article reviews the current knowledge regarding barodontalgia, a barometric pressure-related oral (dental and other) pain. Contemporary classification, prevalence, and incidence, features, etiology, and diagnosis of this entity are presented regarding flight and diving conditions. Summarizing the past decade data, three-fourths of episodes were described as severe, sharp, and localized pain. Barodontalgia affects 11.9% of divers and 11.0% of military aircrews with a rate of 5 episodes/1,000 flight-years. Upper and lower dentitions were affected equally in flight, but more upper than lower dentition were affected in diving. The most prevalent etiologic pathologies for in-flight dental pain were faulty dental restorations (including dental barotrauma) and dental caries without pulp involvement (29.2%), necrotic pulp/periapical inflammation (27.8%), vital pulp pathology (13.9%), recent dental treatment (11.1%), and barosinusitis (9.7%). This review refutes 3 generally accepted conventions: According to the results, the current in-flight barodontalgia incidence is similar to the incidence in the first half of the 20th century, the weighted incidence of barodontalgia among aircrews are similar to the weighted incidence among divers, and the role of facial barotrauma in the etiology of in-flight barodontalgia is minor.