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Barodentalgia

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Other Names

  • Barometric pressure-induced dental pain
  • Barodentalgia
  • Aerodontalgia

Background

  • This page refers to barodentalgia, a term referring to barometric pressure induced dental pain seen in divers and pilots.

History

  • First observed in air crews during World War II and was given the name “aerodontalgia” (need citation)

Epidemiology

  • Incidence of this type of tooth pain estimated to be 0.26–2.8% in aircraft personnel, air passengers, and diver[1][2][3]

Pathophysiology

  • See: Dive Medicine Main
  • General
    • Defined as a barometric pressure-induced oral pain[4]
    • Pain may be dental or nondental
    • Can occur from an increase OR decrease in pressure change (altitude or diving)
    • Relatively rare phenomenon, however the pain can be debilitating
    • Symptoms typically resolve when returning to ground level or atmospheric level.
    • Can be difficult to differentiate between barosinusitis and barodontalgia on the basis of maxillary pain

Direct

  • Dental in origin including[5]
    • Recent dental therapy (up to 30% of cases)
    • Deep dental caries and leaking restorations (4–50%)
    • Pulpitis (7–22%)
  • Location
    • Pain is located in upper dentition (up to 56%)[6]
    • Upper and lower molars are the most affected (about 30% each)[7]

Indirect

Etiology

  • General
    • Exact mechanism of pain is still not well understood[8]
    • Altitudes: Reported between 600 m and 1500 m during flights[9]
    • Depth: Reported at depth of 10 to 26 m[9]
  • Proposed contributing factors
    • Dentogenic infections
    • Sinusitis,
    • Differences in the expansion behaviour of dental enamel and pulp
    • Pressure-induced movement of fluids from exposed dentine to the pulp
  • Ascent
    • Most cases happen during ascent (in flight and diving)
    • Usually related to vital pulp conditions (i.e., pulpitis)
    • Peri-radicular pathology pain may occur during ascent or descent
  • Descent
    • Usually related to indirect barodontalgia

Risk Factors

  • Sports
    • Aviation
    • Diving

Differential Diagnosis

Differential Diagnosis Dive Medicine

Clinical Features

  • History
    • Recent history of diving or aviation
    • Patient will have mandibular or maxillary pain, or both
    • Pain is located in upper dentition (56%) and molars re commonly affected
    • Patient may have a history of recent or remote dental procedure or infection
  • Physical Exam
    • Patient may be tender along the affected mandible or maxillary teeth
    • Inspection may reveal dental fracture, pulpitis, caries, restorations, etc
  • Special Tests

Evaluation

  • Primarily a clinical diagnosis
    • No imaging is required

Classification

Classification of barodontalgia

Class Cause Symptoms
Class I Irreversible pulpitis Sharp pain on ascent
Class II Reversible pulpitis Dull pain on ascent
Class III Necrotic pulp Dull pain on descent
Class IV Periapical pathology Severe persistent pain on ascent or descent

Management

Nonoperative

  • Indications
    • Most cases
  • Return to ground level or atmospheric level
  • Dental care
    • Restoration of all carious lesions
    • Removal of all defective restorations
    • Management of inflammation
  • Analgesia

Prevention

  • See: Prevening Diving Injuries
  • In general
    • Persons should undergo a thorough dental examination before being exposed to pressure changes
    • Vitality testing of all teeth is required for the detection and treatment of asymptomatic pulp necrosis[10]

Rehab and Return to Play

Rehabilitation

  • Not applicable

Return to Play/ Work

  • Dentists should advise patients to avoid exposure to pressure changes
    • Until all necessary surgical, conservative, and prosthetic procedures have been completed

Complications and Prognosis

Prognosis

  • General
    • Self limited condition that often resolves upon return to ground level or atmospheric level
    • All dental pathology should be addressed

Complications

  • Need for dental care

See Also

References

  1. ↑ W. Kollmann, “Incidence and possible causes of dental pain during simulated high altitude flights,” Journal of Endodontics, vol. 19, no. 3, pp. 154–159, 1993.
  2. ↑ D. M. Taylor, K. S. O’Toole, and C. M. Ryan, “Experienced scuba divers in Australia and the United States suffer considerable injury and morbidity,” Wilderness and Environmental Medicine, vol. 14, no. 2, pp. 83–88, 2003.
  3. ↑ M. Del Mar Gonzalez Santiago, A. Martinez-Sahuquillo Mar- ´ quez, and P. Bullon Fern ´ andez, “Incidence of barodontalgias ´ and their relation to oral/dental condition in personnel with responsibility in military flight,” Medicina Oral, vol. 9, no. 2, pp. 92–105, 2004.
  4. ↑ Zadik Y. Barodontalgia. J Endod. 2009; 35(4):481–485.
  5. ↑ 5.0 5.1 Zadik Y. Aviation dentistry: current concepts and practice. Br Dent J. 2009; 206(1):11–16.
  6. ↑ Laval-Meunier F, Bertran PE, Arrive E, Paris JF, Monteil M, et al. Frequency of barodontalgia among military or civilian pilots and aircrew members. Aviat Space Environ Med. 2013; 84(10):1055–1060.
  7. ↑ Gonzales Santiago Mdel M, Martinez-Sahuquillo Marquez A, Bullon- Fernandez P. Incidence of barodontalgias and their relation to oral/dental condition in personnel with responsibility in military flight. Med Oral. 2004;
  8. ↑ Stoetzer M, Kuehlhorn C, Ruecker M, Ziebolz D, Gellrich NC, von See C. Pathophysiology of barodontalgia: a case report and review of the literature. Case Rep Dent. 2012; 2012:453415.
  9. ↑ 9.0 9.1 Y. Zadik, “Barodontalgia,” Journal of Endodontics, vol. 35, no. 4, pp. 481–485, 2009.
  10. ↑ K. Woodmansey, “Class II barodontalgia: review and report of a case,” General Dentistry, vol. 56, no. 7, pp. e39–e42, 2008
Created by:
John Kiel on 23 June 2022 17:33:37
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Last edited:
25 July 2022 19:56:26
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