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

Dive Hazards: Barotrauma, Flora, Fauna, Equipment, and Free Diving

ABSTRACT

Present-day diving comes in various forms, from utilizing sophisticated diving equipment to relying solely on one's ability to hold their breath. The diver and physician must be aware of the many common medical conditions and environmental considerations of this unique activity. While barotrauma remains the most common dive-related injury, injuries and accidents also are related to diving equipment-related accidents and exposure to marine flora and fauna. In addition, breath-hold diving, which includes free diving, snorkeling, and tasks, is an activity humans have done for thousands of years for recreation or survival. This article will update the dangers of diving and methods to prevent or treat injuries.

Primary headaches in scuba divers and the effect of temporomandibular dysfunction

OBJECTIVE

This study aimed to evaluate the frequency of episodic primary headaches (EPH) and temporomandibular dysfunction's (TMD) effect in experienced scuba divers.

METHODS

A form consisting of the Fonseca Anamnestic Index and a structured headache questionnaire was sent to individuals using social media platforms.

RESULTS

A total of 132 divers and 104 non-divers were included the study. In male divers, EPH and TMD were not different from the non-diver group (p = 0.1, p = 0.1), and TMD had an effect on increasing the possibility of migraine (OR = 2.5, p = 0.04). In female divers, the possibility of EPH and TMD were also lower (OR = 0.1, p < 0.001, OR = 0.2, p = 0.01).

CONCLUSION

Scuba diving does not pose a risk for EPH or TMD in either gender. TMD treatment in male divers is important for uncontrolled migraine attacks.

Barodontalgia and Dental Barotrauma Among Scuba Divers

INTRODUCTION: Barometric pressure variation during dives may induce barodontalgia and barotrauma. Barodontalgia refers to oral pain resulting from a change in ambient pressure. The aim of this study was to investigate the occurrence of barodontalgia and dental barotrauma among French civilian scuba divers.METHODS: A nationwide cross-sectional internet-based survey was conducted among French scuba divers over 18 yr of age registered by the French Federation of Underwater Sports (FFESSM). The online questionnaire was distributed from October to December 2020. It contained questions regarding general characteristics of participants, barodontalgia and dental barotrauma occurrences, and relationship of the diver with his/her dentist.RESULTS: There were 684 scuba divers (65.4% men; aged 48 ± 12 yr) who participated in the study. Barodontalgia was reported by 18.7%, with some respondents reporting more than one episode. Most barodontalgia affected posterior (81.2%) and upper teeth (55.2%) with dental filling (50.0%). At least one dental barotrauma was reported by 10.1% of respondents, including mainly loss or fracture of a dental filling (4.2%). The occurrence of dental barotrauma was significantly higher among men (12.3%) than women (5.9%) and increased significantly with the age, the years of diving and the diving qualification.CONCLUSION: Information should be provided to divers on the importance of routine dental checkups.Kougeon K, Yasukawa K, Baudet A. Barodontalgia and dental barotrauma among scuba divers. Aerosp Med Hum Perform. 2022; 93(5):421-425.

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.

Dive Medicine: Current Perspectives and Future Directions

As SCUBA diving continues to rapidly grow in the United States and worldwide, physicians should have a fundamental working knowledge to provide care for an injured diver. SCUBA divers are faced with many hazards at depths that are normally well compensated for at sea level. Pressure gradients, changes in the partial pressure of inhaled gases and gas solubility can have disastrous effects to the diver if not managed properly. Many safety measures in SCUBA diving are governed by the laws of physics, but some have come under scrutiny. This has prompted increased research concerning in water recompression and flying after diving. This article will give physicians an understanding of the dangers divers encounter and the current treatment recommendations. We will also explore some controversies in diving medicine.

Rhinologic and oral-maxillofacial complications from scuba diving: a systematic review with recommendations

Rhinologic and oral maxillofacial complications from scuba diving are common, representing approximately 35% of head and neck pathology related to diving. We performed a systematic and comprehensive literature review on the pathophysiology, diagnosis, and treatment of rhinologic and oral maxillofacial pathology related to diving. This included complications due to sinus barotrauma, barodontalgia, odontocrexis, temporomandibular joint dysfunction, partially dentulous patients, and considerations for patients following major head and neck surgery. Of 113 papers accessed, 32 were included in the final synthesis. We created a succinct summary on each topic that should inform clinical decision making by otolaryngologists, dive medicine specialists and primary care providers when faced with pathology of these anatomic sub-sites.

Preliminary Investigation of a Novel Mouthguard

Background:

Mouthguards (MGs) remain an important piece of personal protection for athletes for the prevention of injury. Although MGs provide tremendous benefits, the design and fabrication process does not record the position of the mandible or the occlusion, which could lead to injury. This study compared a novel MG to over-the-counter (OTC) and custom MGs on a skull model.

Methods:

The OTC MG was formed as per manufacturer's guidelines, the custom MG was laboratory fabricated, and the novel MG was fabricated through a proprietary process. Each group of the three MGs was assessed for vertical dimension change, occlusal contacts, and condylar displacement.

Results:

Average number of occlusal contacts for the OTC, custom and novel MG were 2.4, 4.0, and 10, respectively. There was a significant difference between all values (P < 0.05). Average change in vertical dimension for the OTC, custom, and novel MG were 15.3 mm, 9.3 mm, and 8.0 mm, respectively. The novel MG value was significantly different (P < 0.05). The average distance of condylar displacement for the OTC, custom and novel MG were 1.9 mm, 1.3 mm and 0.6 mm, respectively.

Conclusions:

The novel MG was significantly different (P < 0.05). The data from this preliminary investigation suggests that the novel mouthguard had maximized occlusal contacts, minimized vertical dimension change and condylar displacement as compared to OTC and custom MGs.

Effect of a hyperbaric environment (diving conditions) on adhesive restorations: an in vitro study

Objectives No recent study has addressed the effect of diving conditions (pressure increase) on adhesive restorations. We evaluated the impact of a simulated hyperbaric environment on microleakage of the dentine-composite resin interface. The ultimate aim was to propose recommendations for restorative dentistry for patients who are divers to limit barodontalgia (dental pain caused by pressure variations of the environment) and may lead to dangerous sequelae.Methods We bonded 20 dentine disks by using an adhesive system (Scothbond Universal) to ten intact composite cylinders and ten composite cylinders with porosity (Ceram X mono). For each group, the samples were divided into two subgroups, one submitted to a simulated hyperbaric environment and the other to an ambient environment. All samples were immersed in a silver nitrate solution to evaluate microleakage at the interface after analysis with a camera.Results Dye percolation for groups in the hyperbaric environment was greater than groups in ambient environment. For each subgroup, dye percolation was greater for samples with than without porosity.Conclusions High percolation percentages demonstrate that our simulated hyperbaric condition led to loss of sealing at the dentine-composite resin interface, especially with porous composites.Clinical significance Respect of the protocol and the quality of condensation for adhesive restorations are important in all clinical situations, especially for patients who are divers. A more interventionist approach must be adopted with these patients.

Just when you thought it was safe to go back in the water

Prevalence of dental problems in recreational SCUBA divers: A pilot survey.