RESEARCH, EDUCATION & MEDICINE
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I N C I D E N T I N S I G H T
62
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WINTER 2014
B Y B R I T T A N Y T R O U T
Unexpected Air Pockets
THE DIVER
The diver, a 40-year-old male with more than 1,500
lifetime dives, had no known medical conditions
and reported a healthy lifestyle. In the months
before this incident, he had multiple root canals
and other major dental work done. He made several
decompression dives on a rebreather using a scooter
without any problems in the week preceding the
incident.
THE INCIDENT
On his last dive of a weeklong series, the diver felt
a momentary dull pressure and pain in his lower
teeth during his descent; he dismissed it since the
pain seemed to vanish as he continued with the dive
to a maximum depth of 154 feet. When he started
to ascend after spending 30 minutes at 135 feet, he
experienced sharp and severe pain in the same teeth.
After ascending an additional 6 or 7 feet, the diver
became aware that several dental fillings had come
loose. As he continued his ascent, two fillings fell apart
and came out of his teeth. He halted the ascent for a
few minutes to compose himself and assess how to
reach the surface safely before proceeding.
To avoid further complications and prevent the
dental-filling debris from damaging the bailout valve
of his rebreather, he switched to his backup open-
circuit unit and spit out the filling fragments. He
then returned to the closed-circuit loop to conserve
breathing gas. His dive buddy was attentive and
assisted him with his scooter and reel throughout
the ascent. The diver stayed at 95 feet for 10 minutes
to deal with the excruciating pain he felt throughout
his lower teeth before proceeding with a safe ascent to
the surface.
THE DIAGNOSIS
Several days after the incident the diver went to his
dentist, who suggested that biting too hard on the
regulator mouthpiece had generated pain similar to
that caused by bruxing, the grinding or clenching of
the teeth. Diagnostic X-rays showed the amalgam
(metal) fillings in five of the diver’s teeth were
either damaged or missing entirely. Defective fillings
may have allowed air to enter between the filling
and the tooth and become trapped. During ascent
the trapped air expanded and created pressure
against the internal structures of the tooth, which
triggered the tooth pain and caused two of the
fillings to fall out.
The dentist replaced the damaged fillings, but
the diver continued to experience tooth pain when
diving. He sought a second opinion from another
dentist, who identified through further X-rays that
there were problems with the fillings of four teeth and
recommended replacement. The diver had the fillings
replaced and returned to diving without experiencing
tooth pain. This was a case of barodontalgia (tooth
pain caused by change in ambient pressure), also
known as dental barotrauma.
STEPHEN FRINK
