Barodontalgia, commonly known astooth squeeze, is apain in atooth caused by a change inambient pressure. The pain usually ceases at return to the original pressure.[1][2][3]Dental barotrauma is a condition in which such changes in ambient pressure causedamage to thedentition.
The most common subjects areunderwater divers because in deep dives pressures can increase by severalatmospheres,[4] and militarypilots because of rapid changes.[5][6][7][8]In pilots, barodontalgia may be severe enough to cause premature cessation of flights.[9]
Most of the available data regarding barodontalgia is derived fromhigh-altitude chamber simulations rather than actual flights. Barodontalgia prevalence was between 0.7% and 2% in the 1940s, and 0.3% in the 1960s.[7]
Similarly, cases of barodontalgia were reported in 0.3% of high altitude-chamber simulations in theLuftwaffe.[10]
The rate of barodontalgia was about 1 case per 100 flight-years in theIsraeliAir Force.[11] DuringWorld War II, about one-tenth ofAmerican aircrews had one or more episodes of barodontalgia.[9] In a recent study, 8.2% of 331 Israeli Air Force aircrews, reported at least one episode of barodontalgia.[11]
In addition, a large epidemiologic study suggested that changes in barometric pressure were the reason for the initiation and/or exacerbation of various oral pains observed in dental emergency departments.[12]
Barodontalgia is asymptom ofdental disease, for exampleinflammatorycyst in themandible.[13]Indeed, most of the common oral pathologies have been reported as possible sources of barodontalgia:dental caries, defectivetooth restoration,pulpitis,pulp necrosis,apical periodontitis,periodontal pockets,impacted teeth, andmucous retention cysts. One exception is barodontalgia manifested as referred pain frombarosinusitis or barotitis-media. The latter two conditions are generated from pressure changes rather than pressure-related flare-up of pre-existing conditions.[14] Ameta-analysis of studies conducted between 2001 and 2010[15] revealed a rate of 5 episodes/1,000 flight-years.Maxillary andmandibulardentitions were affected equally in flight, but in diving, maxillary dentition was affected more than the mandibular dentition, which can indicate a greater role formaxillary sinus pathology in diving barodontalgia.[15] Surprisingly, despitecabin pressurization, the current in-flight barodontalgia incidence is similar to the incidence in the first half of the 20th century. Also, despite the greater fluctuation in divers' pressures, the weighted incidence of barodontalgia among aircrews is similar to the weighted incidence among divers. Furthermore, contrary to common belief, and in contrast to diving conditions, the role of facial barotrauma in the cause of in-flight barodontalgia is only minor (about one-tenth of cases).[15]
TheFédération dentaire internationale describes 4 classes of barodontalgia.[1] The classes are based on signs and symptoms. They also provide specific recommendations for therapeutic intervention.[1]
Sometimes, pressure changes damage teeth (rather than just causing pain). When the external pressure rises or falls and the trapped air within the void cannot expand or contract to balance the external pressure, the pressure difference on the rigid structure of the tooth can occasionally induce stresses sufficient to fracture the tooth or dislodge a filling.[16] Typically this is seen inunderwater divers[4] oraviators[17] who experience pressure changes in the course of their activity. Identifying the pain during a pressure change is adiagnostic indicator for theclinician.Treatment involves removing the void space by carefully replacing the offending restoration, repeating theendodontic treatment orremoving the tooth.[18]
^Brubakk, Alf O; Neuman, Tom S (2003).Bennett and Elliott's physiology and medicine of diving (5th Rev ed.). United States: Saunders Ltd. p. 800.ISBN978-0-7020-2571-6.
^abDehart, RL; Davis, JR (2002).Fundamentals Of Aerospace Medicine: Translating Research Into Clinical Applications (3rd Rev ed.). United States: Lippincott Williams And Wilkins. p. 720.ISBN978-0-7817-2898-0.
^Goethe, WH; Bäter, H; Laban, C (October 1989). "Barodontalgia and barotrauma in the human teeth: findings in navy divers, frogmen, and submariners of the Federal Republic of Germany".Military Medicine.154 (10):491–5.doi:10.1093/milmed/154.10.491.PMID2515472.
^abZadik, Yehuda; Chapnik, L; Goldstein, L (June 2007). "In-flight barodontalgia: analysis of 29 cases in military aircrew".Aviation, Space, and Environmental Medicine.78 (6):593–6.PMID17571660.
^Kloss-Brandstätter, Anita; Hächl, Oliver; Leitgeb, Philip C.; Buchner, Andreas; Coassin, Stefan; Rasse, Michael; Kronenberg, Florian; Kloss, Frank R. (September 2011). "Epidemiologic evidence of barometric pressure changes inducing increased reporting of oral pain".European Journal of Pain (London, England).15 (8):880–884.doi:10.1016/j.ejpain.2011.01.013.ISSN1532-2149.PMID21334931.S2CID221681201.
^Zadik, Yehuda (August 2006). "Barodontalgia due to odontogenic inflammation in the jawbone".Aviation, Space, and Environmental Medicine.77 (8):864–6.PMID16909883.
^Zadik Y (Jul–Aug 2009)."Dental barotrauma".The International Journal of Prosthodontics.22 (4):354–7.PMID19639071.Archived from the original on 2020-05-09. Retrieved2017-01-28.
