Have you been on a plane recently? Whether it was to fly home for the holidays or attend a national ASDA meeting, air travel is common among dental students. Aviation dentistry is an emerging science that primarily deals with the oral and dental health status of fliers with emphasis on prevention of disorders related to changes in atmospheric pressure.
At high altitudes, the atmospheric pressure is too low for humans, but, the aircraft pressure is maintained so that it is comfortable for the crew and travelers with the help of aircycle machines and outflow valves. Nevertheless, these pressure changes may affect fliers occasionally. One may face any of the following problems:
- Barodontalgia: It is a dental pain associated with atmospheric pressure changes which is usually an exacerbation of pre-existing subclinical oral disease. Pain is generally sharp or squeezing in nature. Pain occurring on ascend is related to pulpitis and that occurring on descend is related to pulpal necrosis. Pain occurring on both ascend and descend is related to periapical disease. Barodontalgia can be caused due to reduced atmospheric pressure or an indirect effect, wherein dental pain is caused due to the stimulation of nerve endings. The direct type usually occurs during take-off and is characterized by moderate to severe well-localized pain, while the indirect type occurs during landing and a dull, poorly localized pain is experienced.
- Odontocrexis: Also called barometric tooth explosion, it occurs in teeth with leaky restorations, dislodged crowns or recurrent caries when exposed to changes in atmospheric pressure. It is caused due to the accidental explosion of gas trapped under faulty restorations, crowns or in cavities.
- Barotitis: Extreme pain in the ear may be experienced when the aircraft is landing due to the pressure change that creates a vacuum in the middle ear and pulls the eardrum inward.
- Barosinusitis: At high altitudes, negative pressure is created between the external environment and paranasal air sinuses which cause inflammation of the sinuses, mainly the frontal sinus. This too can cause indirect barodontalgia.
- Barotrauma: Physical damage to organs in the body due to rapid or extreme pressure changes is called barotrauma. Expansion or contraction of gases present in organs in accordance to external environment causes pain, numbness and eventually damages the tissues. Pulmonary barotrauma is most deadly.
- Peri-orbital headache: Vacuum created inside the frontal sinus may damage the ethmoid cell mucosa which may trigger the ethmoid nerves, thereby causing peri-orbital or orbital headache.
The best way to combat these problems is to prevent their occurrence, which can be done in any of the following ways:
- To avoid barotrauma or barosinusitis, it’s better to postpone flights when suffering from common cold. Using a decongestant may also help.
- To relieve pressure during landing and take-off and to prevent dry mouth, chewing gum or sucking on candy can be beneficial.
- Usage of filtered ear-plugs can help to slowly equalize air pressure against one’s ear drum.
- Deep breathing at the time of ascent can be useful to prevent pulmonary barotrauma.
- Leaky restorations and caries should be treated before air travel.
- Cementing restorations with resin cement has proven helpful in retaining crowns as opposed to glass ionomer cement at high altitudes.
- Oral cavity needs to be thoroughly checked post extraction of maxillary teeth to rule out oro-antral communication that can cause sinusitis when exposed to pressure changes.
- As per literature, direct pulp capping should be avoided. Instead, direct canal intervention is advised in frequent fliers to prevent subacute pulpitis or silent pulpal necrosis and their potential barometric pressure related consequences.
So, next time your patient plans to fly, inform him about the potential problems associated with it and carry out the necessary precautionary measures to avoid inconvenient air travel.
~Archana Menon, predental