Issue 3 Diving Dentist from the Archives of the London Diver Magazine

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19 April 2024

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	ISSUE 3 ARCHIVE - DIVING DENTIST Celehte Fortuin Diving dentist? No, really? "Moan, groan, sigh" - the dreaded dentists have made their way into our inner circle!! Now, before most of you start secretly planning ways to "off" a dentist under water, hear me out: I come in peace, honestly! For those (un)fortunate enough to lie in my chair, I promise not to sing or tell bad jokes (lies), and for those who don't quite buy into my white flag - I still get to play with my tools, so sit back, relax and open wide…this won't hurt a bit!! So send in those questions and let's kick this off with the curious incident of the hissing tooth! Q: I am an experienced diver and have recently returned form a week's diving where we did some pretty deep dives. After about the 4th or 5th dive we geared up for a dive through The Bells. On descent, at about 10m, my upper right tooth started hurting really badly. I ascended to 5m, waited for the pain to subside (it didn't much) but decided to continue this awesome dive as I did not want to miss out! At about 15m this tooth really started talking to me, I pushed through the pain though and at about 30m the pain stopped! (Bliss). The tooth and surrounding gum had, at this point, simply gone numb and I continued the dive with a slight dull ache in the jaw. Back on land and off gassing nicely, my partner and I heard a hissing sound. After confirming that indeed it wasn't me hissing at her, we located the source, one guilty upper right molar. After this episode, I could continue my diving holiday with only slight discomfort in this tooth. It has now settled down (although the whole tooth feels rough )but I am still concerned as my next diving holiday is not too far off! John, London.
A: A very heartfelt "ouch" to you indeed. My first thought at 30m, when the pain subsided, would have been "how long will this 12l last?", it's so nice and pain free!! OK, the bad news is it sounds like you have a broken/cracked tooth or filling, if indeed not both and a trip to la dentista is inevitable! The good news: your tooth did not explode on the ascent, a very real and painful possibility! So what went wrong? Far too often, especially with older Amalgam (silver) fillings, metal fatigue sets in preventing the filling from moving harmoniously with the rest of the tooth. The problems arise when, due to this tired ol' filling, normal wear and tear, sometimes accompanied by grinding/clenching the teeth at night, small hairline cracks and gaps start appearing along the line where the filling and tooth meet. These gaps allow bacterial leakage under the filling, slowly causing decay in the tooth, weakening the dentine and enamel while undermining the filling. What would normally happen is your dentist picks this up at your routine check up, removes the old failing filling and replaces it with a spanking new one. Voila, no gaps, no air pockets and everyone's happy. Unfortunately, what more frequently happens is, the weakened tooth has one unfortunate meeting with an olive pip (or some similar offending food type, yes, I know, bread can also do it!), the enamel cracks and breaks away from the filling. The remaining filling either miraculously stays put or starts to slowly crumble. Surprisingly, this process can be totally asymptomatic, causing you no pain or sensitivity, until, of course one day we decide to go and have fun diving! So why the pain and hissing moment? Well, the clue is in the gaps and hairline cracks. Air is trapped inside tooth, either due to gas moving into the gaps or hollow areas created by decay. On the descent the bubbles/space compress, transmitting this compression through the dentine to the nerve, causing a reverse squeeze on the tooth and great discomfort to you (I know, putting it mildly here. It actually hurts like nobody's business). This is above and beyond the compressed air breathed under pressure, causing further bubble migration to the hollow area of decay and into hairline cracks. With sufficient gas inside the tooth, squeezing and compressing the nerve, eventually pain impulses are blocked leading to the anaesthetic-like effects of numbness you felt. With a nice slow ascent the bubbles have had sufficient time to migrate back out of the tooth (another reason to be a SAFE diver). Only to find yourself back on land, where after a while it hissed at you for having been put through this!! If enough bubbles had gotten trapped inside the tooth the increased pressure on ascent may have been enough to push the filling away from the rest of the tooth (gives new meaning to the Big Bang Theory). While the old fill is removed and replaced, care must be taken to examine (preferably under magnification) the tooth for further hairline cracks running into the dentine. Should these be present, a crown may be more the order of the day, the advantage being full coverage of the tooth crown (the bit of the tooth we can see), protecting the weak areas and preventing further breakdown of the tooth. In modern dentistry today, however, there is more than one way to skin a cat - they do, unfortunately, all include a visit to your dentist!
I increasingly come across more patients lucky enough to either be without silver fillings or indeed any fillings at all! Here's the bad news: Unless we all start flossing like it's going out of fashion (you knew it had to happen - when do dentists give up an opportunity to tell you about FLOSS?), the teeth can and will eventually decay, leading to holes, leading to gaps, enamel cracking, tooth breaking, gas trapping…see a pattern…hisssss? Brush twice a day, floss (as in every day), use a good fluoride toothpaste and visit the dentist regularly. Happy flossing, and safe diving! Do you have burning dentistry issues? Celehte has all the answers. Chew your way through to the Contact page and send your query to the Diving Dentist.
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