Diver's mouth syndrome: a field study

Influence of wearing a scuba diving mouthpiece on the stomatognathic system - considerations for mouthpiece design

Although diver's mouth syndrome (DMS) has long been recognized by scuba divers, little attention has been paid to the influence of wearing a scuba diving mouthpiece on the stomatognathic system. In this review, DMS-related stomatognathic events (DMS-SE) while wearing a mouthpiece, the relationship between components of the mouthpiece and those events, and design considerations to reduce the risk of those events are discussed based on evidence from 32 articles concerning scuba diving mouthpieces. Forward movement of the mandible, loss of molar occlusal support, and continuous jaw clenching while wearing a mouthpiece are considered to be pathogenic for DMS-SE. Several experimental studies have suggested a relationship between incidence of those events and the design of mouthpiece components such as the connector, labial flange, platform, and occlusal rug, and the possibility of reducing risk of those events through design customization of these components. Improvement of the shape of commercially available mouthpieces and creation of custom-made mouthpieces may thus contribute to the prevention and treatment of DMS-SE and the provision of a comfortable diving environment.

Predictors for the development of temporomandibular disorders in scuba divers

The aim was to determine predictors for the development of complaints of temporomandibular disorders (TMD) in a large sample of Dutch scuba divers who were free of any TMD complaints before they started diving actively. Five-hundred and thirty-six scuba divers (mean ± SD age = 40.4 ± 11.9 years; 34.1% women) completed a specifically developed questionnaire, either online or on paper. Stepwise forward logistic regression analysis was performed to predict the presence of TMD pain, with several potential risk factors as predictors. Four hundred and eighty-five of the 536 respondents were free of any TMD pain before they started diving actively. In this sample, TMD pain was present in 214 persons (44.1%). Four predictors contributed significantly to the presence of TMD pain, viz., clenching (OR = 2.466), warm water (OR = 1.685), biting on the mouthpiece (OR = 1.598), and the quality rating of the mouthpiece (OR = 0.887, that is, a higher rating means a smaller odds of having TMD pain). TMD pain is a common complaint among scuba divers who were free of such complaints before they started diving actively. Clenching, biting on the mouthpiece, and a low rating of the mouthpiece are predictors for the presence of TMD pain in scuba divers, while diving in cold water serves as a protective factor for TMD pain.

Dental evaluation of scuba diving mouthpieces using a subject assessment index and radiological analysis of jaw position

OBJECTIVE

To compare two experimental scuba mouthpieces with a commercially available design.

METHODS

A laboratory study using six men to assess effort, muscle pain, muscle fatigue, facial discomfort, tooth discomfort, and loss of lip sensation using a visual analogue scale. Cephalometric radiographs and analysis of jaw position with each mouth piece were also used.

RESULTS

Fully customised mouthpieces caused the least discomfort, muscle pain, fatigue, and effort. They also resulted in the least mandibular displacement from the resting position. Radiographic analysis of jaw position showed that the fully customised design resulted in the least displacement from normal jaw position.

CONCLUSIONS

A fully customised design gives the greatest comfort, least effort, and least mandibular displacement. This design is recommended, particularly for divers who experience temporomandibular dysfunction associated with diving.