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 In a laboratory experiment, the study team showed that under high
pressure, some dental restorations are more prone to leak than at
sea level. That could cause pain during or after a dive, as well as
other consequences like making the restored tooth vulnerable to
infection, the researchers write in the British Dental Journal.
“Sinus or ear barotrauma are more well known, but dentists are
increasingly seeing patients with dental pain after an underwater
dive,” said lead author Dr. Caroline Mocquot of Paris University
Diderot in France.
“All patients must know about this phenomenon and notify their
dentist if they are divers,” she told Reuters Health by email.
Mocquot and colleagues created simulated teeth made from real third
molars bonded to composite material and shaped into uniform discs.
Ten of the discs incorporated polyester to simulate porosity and 10
did not. These samples were then exposed to a special dye inside
bariatric chambers to see how much microscopic leakage occurred
between the composite and tooth material.
The discs were submerged six times for 30 minutes each to a pressure
of six bars, or the equivalent of about 150 feet underwater.
Researchers found that the porous samples showed 45 percent dye
penetration under pressure while the non-porous discs showed 38
percent. That compares to about 30 percent dye penetration, with or
without porosity, when samples are exposed in everyday settings
without added pressure.
“The next steps would be to test different composite resins and
bonding agents in simulated hyperbaric environments,” said Dr.
Sangeeta Gajendra of the University of Rochester Medical Center in
New York, who wasn’t involved in the study.
In her own recent study of recreational divers, Gajendra found that
41 percent experience dental pain during a dive. “More than half of
the teeth affected were molars and had damaged restorations,” she
told Reuters Health by email. “Ultimately, we need to have
techniques that prevent microleakage and reduce porosities.”
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A limitation of the French study is that it uses only 20 samples,
and it simulates diving at depths greater than 150 feet, which
recreational divers can’t reach, said Vinisha Ranna of the
University of Buffalo in New York.
Certified divers, particularly military divers and speleologists,
are able to dive at that depth, noted Ranna, who wasn’t involved
with the study. “It would be misleading to base clinical
recommendations on a study that has been conducted in a simulated
environment on a small sample,” she told Reuters Health by email.
Mocquot’s team recommends specific techniques and materials that
dentists can use to minimize the likelihood of leakage in
restorations - and suggests that divers discuss the options with
their dentists when getting work done.
More studies need to be done, however, to understand what’s really
happening during a dive and how to prevent the pain, Ranna noted.
“There are no established criteria that optimize dental treatment in
divers,” she said. “To make recommendations and guidelines, more
rigorous studies are needed.”
Dentists and patients should discuss hobbies such as diving when
considering procedures with dental extractions, anesthesia and
endodontic treatment in particular, the study authors write.
“It is really important for divers to have good oral health, as they
will be less likely to have dental pain during a dive,” Gajendra
said. “It is imperative for divers to visit their dentists regularly
and talk about their diving activities.”
SOURCE: http://go.nature.com/2yxtsGk British Dental Journal, online
September 8, 2017.
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