Issue 9 Diving Dentist from the Archives of the Tanked Up Magazine

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20 April 2024

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	ISSUE 9 ARCHIVE - DIVING DENTIST Celehte Fortuin Picture this: There we were, five days into our holiday and well into the 'liveaboard groove'–chilled out, a.k.a. comatose divers, with the rhythm of waking, diving, eating, snoozing, diving, eating, snoozing, reading, diving, eating, sleeping repeating itself merrily. Defences are lowered, the sun shines brightly, new friends are made, old friends try to kill me... That's right people. I knew I wasn't paranoid! My so-called friend and dive buddy, always slightly to my left (or right, or below or above me in the water, or walking upside down on the keel of the boat) suddenly disappears off my radar at about minute 40 of our last dive of the day. One minute he's there, the next he has me pinned, tank between his knees, going for my mask, my tank valve, my regulator, everything he could whilst (I am imagining) laughing maniacally (I promise it had NOTHING to do with his last dental visit – although I can't prove this either). Pure stealth he was. What my dear friend did not count on was our guide – Kung Fu master and 007 understudy – who, whilst watching this craziness from a distance and flooding his mask laughing, decided to join in, much to my buddy's detriment. He was flicked off me like an inconsequential speck of dust. Swallowed a lot of salt water? Yes. Flooded mask laughing? Absolutely! Seeing my buddy on his back on the sea floor? Priceless. For everything else there's MasterCard. Better luck next time Andy!
	Back in the real world it seems like the diving season has taken a few teeth hostage and rendered a few of us polishing our shiny bits instead of getting our gear wet. Spare a thought for diver below! Q: I recently had a cyst removed from below my front teeth and will now need root canal treatment on two or three teeth in the area. Following the op I had an infection which cleared after a week or so on antibiotics. I still have a slight 'seepage' (mmm, lovely) from the area which I am told is pretty much fluid connected with the void where the cyst was and entirely normal. This is noticeably reducing day by day and the area is healing well. Now, can I safely dive while the cyst 'void' heals or re-forms bone or will this process be adversely affected by pressure changes during diving? What risks are associated with root canal treatment and diving that I should be aware of? The consultant was not able to give an informed decision but has said that, for example, contact sports should be avoided for a while.
DD: Wow, OK. I think my brain just exploded. Short answer? No diving till healing is complete. Long one... Root canal Treatment has been well researched and documented and the current guidelines state no diving whilst treatment is incomplete. This procedure, during which the tooth nerve and its blood supply is removed and the canals cleaned, shaped and sealed with a rubbery material (Gutta Percha), often requires two stages, during which the tooth is medicated and temporarily filled. The very nature of the procedure means that small air bubbles are often included inside the tooth and/or temporary restoration or gases form due to bacterial action. Due to the limited research (and by limited I mean none!) in the area of jaw cysts, it has led me to use my special powers of deduction, conjecture and 'mad scientist common sense' based on basic diving principles and dive safety. Yes, any air space in your body is going to be affected by changing pressure, whether a bone in your jaw or your lungs. Your cyst directly affects two or three of your front teeth, requiring considerable amount of dental and surgical work to be performed over time. So we're talking bone voids and weakened teeth. Here comes the common sense. Breathing compressed gas leads to the formation and penetration of micro bubbles into all body tissues, including bone and teeth. These can subsequently get trapped in the spaces of teeth and bone. Upon ascent the expanding bubbles exert pressure on the surrounding bone and its blood supply causing osteonecrosis in certain bone structures. Should this become involved in a healing cystic area it COULD slow the healing or have other unfavourable effects. But we simply can't say for sure due to lack of research. What we do know is the possibility of odontocrexis (tooth explosion) in incomplete root treated teeth due to barometric pressure changes on air within these teeth! What would be helpful is X-ray evidence of the area before and after the cyst was found, so as to ascertain the size of the cyst, how it developed and its relationship with the roots of your little toothy pegs. Or even better, let's get a full-on, 3D-imaging, functional MRI scan combined with the latest CT technology of the area while in a recompression chamber, wearing striped yellow pyjamas, singing 'Somewhere over the rainbow', all whilst signing away any rights to be used as a living test subject in highly controversial research that the Medical Research Council will never condone. HOWEVER, this way we could empirically evaluate the situation and extrapolate what could conceivably happen to the area while diving. How proud would you feel helping out fellow divers?
My advice? Hang up the fins for a little while, save up and buy lots of shiny dive thingies, go back for regular follow-ups to your dentist and carefully introduce yourself to diving (I would start by snorkelling in the bath tub). And if it hurts, abort the dive and reassess! Alternatively, you can take your dentist (me) on holiday (liveaboard) to ensure close monitoring whilst diving... see pics. Safe diving and happy flossing! Photography by Pia Gottschalch from Blue Planet Liveaboards. Celehte can normally be found singing her way through the day at her Fulham practise. Any questions or queries can be sent here or you can call Fulham Dental Care on 020 7610 9400.
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