Dental Health for Scuba Divers: Preventing Barodontalgia and Tooth Squeeze

Barodontalgia is defined as oral pain evoked by changes in barometric pressure [1]. Known colloquially as “tooth squeeze,” it typically occurs because of Boyle’s Law, which states that the volume of a gas is inversely proportional to the ambient pressure.

As a diver descends, the increasing pressure causes gas volumes to decrease. Conversely, during ascent, gas expands. If air is trapped within a rigid structure—like a tooth with a cavity, a failing root canal, or an old filling—it cannot equalize. This results in a pressure differential that “squeezes” or “pushes” against the nerves and blood vessels inside the tooth [2].

Barodontalgia is rarely a primary condition; rather, it is a symptom of an underlying, often subclinical, dental issue [5]. The most frequent culprits include:

• Leaking Restorations: Old silver (amalgam) or composite fillings that have developed microscopic gaps allow air to seep in but not exit quickly enough during ascent.

• Dental Caries (Cavities): Untreated decay creates “dead space” where air can become trapped.

• Incomplete Root Canals: If a tooth has been started but not finished, or if there is a lingering infection at the apex of the root, the trapped gas can cause excruciating pain upon ascent.

• Dental Barotrauma: This is the physical damage resulting from the pressure, which can include shattered teeth or fillings that are literally “blown out” of the mouth [3].

• Periodontal Pockets: Deep pockets in the gums can trap air, leading to localized swelling and pain [1].

Recent systematic reviews published in Frontiers in Public Health indicate that barodontalgia is a significant concern for the diving community. Data shows prevalence rates ranging from 10.8% to 56.1% depending on the population, with military divers often reporting the highest frequency due to deeper and more frequent dives [1].

While much of our Dental Health 101: Essential Tips to Protect Your Smile guide focuses on everyday hygiene, divers must go a step further and ensure their dental work is “pressure-tested” by a professional.

Beyond the internal pressure of the tooth, the external mechanics of diving can cause orofacial pain. A poorly fitting regulator mouthpiece can lead to:

• TMJ Dysfunction: Constant clenching to keep a heavy or stiff mouthpiece in place can cause jaw fatigue and “Diver’s Mouthpiece Syndrome.”

• Gum Irritation: Excessive pressure on the soft tissues can lead to localized inflammation, similar to the issues discussed in our guide on Dental Care for Musicians.

For frequent divers, investing in a custom-molded mouthpiece is highly recommended to distribute biting forces evenly and reduce jaw strain.

Prevention is significantly more effective and less expensive than dealing with an emergency tooth fracture in a remote dive location.

1. Annual Dental Clearance: Inform your dentist that you are a scuba diver. They should specifically look for “secondary caries” (decay under old fillings) and check the integrity of all margins.
2. Wait After Procedures: The Divers Alert Network (DAN) recommends waiting at least 24 hours after simple procedures (fillings) and 7 days after more invasive surgeries (extractions or implants) before diving to ensure stable healing and no trapped air [3].
3. Address Pain Early: If you feel a “twinge” while chewing or sensitivity to cold, do not ignore it. Under water, that minor sensitivity can escalate into a “Level 10” emergency pain [4].
4. Sinus Health: Sometimes “tooth pain” in the upper molars is actually a sinus squeeze. Ensure your sinuses are clear and you can equalize easily before descending.

Key Points Covered:

• Definition: Barodontalgia is pressure-related tooth pain caused by gas expansion or contraction within the tooth or surrounding tissues.

• Physics: Boyle’s Law explains why trapped air spaces in teeth become dangerous during ascent and descent.

• Prevalence: Up to 56% of divers may experience orofacial pain, with military populations at highest risk.

• Causes: The most common causes are decaying fillings, untreated cavities, and recent dental work that hasn’t fully healed.

Action Plan for Divers:

1. Schedule a Pre-Trip Checkup: Visit your dentist at least 4 weeks before a major dive trip to allow time for any necessary repairs to heal.
2. Verify Restorations: Ask your dentist to specifically examine older amalgams for cracks or margin failure.
3. Custom Mouthpiece: If you experience jaw pain, replace your standard regulator mouthpiece with a heat-moldable custom version.
4. Emergency Protocol: If you feel tooth pain during a dive, notify your buddy, abort the dive safely (avoiding rapid ascent), and seek dental care before your next immersion.

Maintaining oral health is not just about a bright smile; for divers, it is a critical safety measure. By ensuring your teeth are free of trapped air and decay, you can focus on the dive rather than the “squeeze.”