Barodontalgia

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Format
Introduction

Definition
Etiology Classification Diagnosis Management Conclusion
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Introduction

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Barodontalgia refers to the dental pain experienced during air travel or deep sea diving.

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 It

was reported first during second world war and was termed then as airodontalgia. is an attempt to have a birds eye view of the condition

This

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 Results

from environmental pressure changes. Previously described as airodontalgia Incidence is more when the cockpit is not pressurised Very frequent among deep sea divers, marine biologist,scuba divers
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 Baropressure pain affects air crew ,and passengers and also under water divers mainly due to the difference in the pressure gradients

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Boyles Law
States that at a given temperature, the volume of a gas is inversely proportional to the ambient pressure, may be used to explain barodontalgia.

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Etiology

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 As

atmospheric pressure decreases during ascent, trapped gases may expand and enter dentin tubules, which can stimulate nociceptors in the pulp or cause the movement of pulp chamber contents - through the apex of the tooth, thereby causing pain.
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same law applies if a person climbs to high altitudes (in flight); in this case, outside pressure decreases, permitting the volume of gases to increase. As a person descends deeper and deeper below the water surface, pressure exerted on the diver by the water increases and reduces the volume of gases in enclosed spaces such as teeth and sinuses.
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problem arises when the enclosed spaces containing gases cannot expand or contract to adjust the internal pressure to correspond to the outside pressure.

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Possible conditions
Acute

or chronic peri-apical infection

Caries
Deep

restorations dental cysts Sinusitis History of recent surgery

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 Incidence Maxillary

is more in posterior teeth

teeth is more affected than mandibular teeth More incidence reported in restored teeth

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Effect of barodontalgia
Full

porcelain crowns can also shatter from relatively shallow dives of 65 feet. It is reported that trapped air is a very efficient crown remover in teeth where the cement bond is failing.

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Classification

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 The

Fdration dentaire internationale (FDI) has classified barodontalgia into 4 groups according to its signs and symptoms; acute pulpitis, chronic pulpitis, necrosis of the pulp periapical abscess or a cyst.
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Rauchs classification

According to the chief complaint.

Class

I- If the patient has pulpitis, he will have pain on ascent- sharp momentary pain in acute pulpitis Class II- dull throbing pain in case of chronic pulpitis
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 Class

III -If the pulp is necrotic, a dull throbing pain on descent (compression) and asymptomatic on ascent (decompression) In case of periradicular abscess or cyst, severe persistant pain (class iv) occurs with both ascent and descent.

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Barodontalgia and Scuba diving

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Physical properties of the gas mixture used during deep sea diving may contribute to barodontalgia. In scuba tanks, oxygens natural diluent gas- nitrogen, is replaced by helium, resulting in a gas of lower viscosity. This gas can enter tissues, including teeth, and can sometimes become trapped in closed spaces, such as the pulp chamber and root canal.
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There are 2 mechanisms by which gases can be trapped in spaces:.

If there is a space between a tooth and its restoration, gas may be forced into it during an increase in pressure; dissolved gas may diffuse from tissues into spaces as pressure decreases.

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Odontocrexis

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 Refers

to the physical disruption of tooth during diving,descent or ascent. This is due to trapped gas-which will expand and the resulting stress cause tooth fracture

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 Teeth

that have been opened for endodontic treatment and temporarily sealed have been known to explode from air trapping and expansion on surfacing. This is found to be more common in deep divers using a heliox mixture.

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Barodontalgia and Microleakage

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 Lyons

and coworkers compared types of cements and their role in barodontalgia. The results showed that micro leakage was greater in cast crowns that were luted with zinc phosphate , followed by Glass ionomer cement and the least was observed with Resin cements
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 It

is thought that the porosities that occur during the mixing of zinc phosphate and glass ionomer cement could be responsible for micro leakage. These porosities may contract or expand along with pressure changes

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 They

further suggest that micro leakage may not have occurred in the resin cement group because the dentinal tubules were obstructed by resin tags and flexibility of the cement.

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Barodontalgia Vs Barosinusitis

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 Barosinusitis

is distinguishable from barodontalgia, as the former will always occur on descent, whereas the latter always begins on ascent.

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Management

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 The

placement of a zinc oxide eugenol (ZOE) base was found to prevent barodontalgia when reversible pulpitis was the underlying cause. This is attributed to the wellknown sedative affects of ZOE.

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 Another

study suggested that when treating people who are subjected to large pressure changes, it is best to avoid procedures such as pulpectomy and capping of an exposed pulp. Rather, endodontic treatment is indicated.

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conclusion
To

sum up the present day dental clinicians should be in a position to diagnosis and treat situations which ,require interventions especially for those who very regularly take to flight and those who are in to the deep see diving,sports .

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Thank you
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