Tooth squeeze in Philippines proves painful
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By George Malkemus  February 21, 2014 12:00 am

In January, my wife Mary Alice and I experienced a scuba diving adventure in the Philippines. 

In 1974, I became a scuba dive instructor, and in 1981 I certified Mary Alice on our honeymoon in Hawaii.

We have been avid divers ever since. The Philippines diving was wonderful, including snorkeling with whale sharks, diving with schools of beautiful, colorful fish, seeing mesmerizing, swaying soft corals, and discovering weird creatures, like the flamboyant cuttlefish and pygmy seahorse. 

The Philippines has the most varieties of fish in the world, more than 2,500 species vs. only 250 in Hawaii. The Steinhart Aquarium in San Francisco has a Philippine underwater exhibit, including the beautiful Mandarin fish. Amazingly, we saw even more colorful, dense collections of fish around the coral heads on our many dives.

On one scuba dive at 50 feet, suddenly it became dark. Looking up, there was a whorl of sardines, 100-feet oval, so dense that I could not see through. The thick whorl continually changed shape in a hypnotic illusion, while predator jacks and barracuda swam distractedly about the mass.

One of the divers on the trip, Brian, had a terrible toothache that began on the flight from the United States. Prior to the trip during a dental check up, his dentist had found a small hole up under an old crown and a possible crack in his lower left molar. 

Brian did not find time to have the tooth fixed before he left. The tooth continued to hurt off and on with diving.

Pressure changes were causing the toothache. Brian was experiencing tooth squeeze, medically called aerodontalgia (air in the teeth). The only thing that I could recommend until he returned to the U.S. was pain medication, Ibuprofen and Tylenol. He continued to dive and endure the pain.

However, I did not feel too bad for Brian, because he was from Seattle and was a Seahawks fan. While in the Philippines, together we listened to the 49ers’ last-second loss to Seattle, plus I lost a bet to him. He was celebrating joyfully, even with a toothache. Back in Seattle, I imagine he is doing well now after having root canal therapy, a new crown and a Super Bowl win. 



You’ve probably noticed how your ears ‘pop’ when quickly changing altitude in an airplane or even a car. The ear popping is the process of equalizing the pressure change between the outer ear and the middle ear air space. If you are unable to equalize the pressure change, a painful earache occurs. This is commonly called squeeze.

The physical damage to body tissues caused by a difference in pressure between an air space inside the body and the changing outside pressure is called squeeze, because it feels like the tissue is being painfully crushed. Damage occurs in the tissues around the body's air spaces because gases are compressible and the tissues are not. The most common tissues that feel the effects of squeeze are the ears and sinuses, but the gut, lungs, eyes, and teeth can also be affected. Air can be trapped in these air spaces and the pressure needs to be equalized when changing pressures.

Squeeze typically occurs to airspaces within a body when that body moves to or from a higher-pressure environment. The most common occurrences are seen when Scuba diving or flying. 


Ear squeeze

The ear is composed of the outer ear canal, the eardrum, the middle ear air space with the three ear bones (hammer, anvil and stirrup) and the inner ear. When the pressure increases on the outside of the eardrum during descending when scuba diving or flying, the eardrum is compressed inward, unless the pressure is equalized on the inside of the eardrum in the middle ear space. 

Swallowing, yawning, chewing gum, moving the lower jaw from side-to-side and/or pinching the nostrils closed and blowing can help equalize the pressure in the ears. If unable to equalize the ears, they can become very painful and in extreme cases, usually during scuba diving, the eardrum can rupture. This can lead to bleeding, hearing loss and ear infection. Usually, the eardrum will heal naturally over time with the use of antibiotics. Occasionally, surgery is necessary. 


Sinus squeeze

The sinuses are air-containing spaces in the bones of the face and skull. There are four pairs of sinuses lined with a continuous membrane through which they are interconnected to the nose. These air spaces are designed to help warm and filter the air and lighten the weight of the head. Sinuses should naturally equalize pressure change by letting airflow in and out. 

But sinus squeeze can occur. With congestion during a cold or allergies, the sinuses can be blocked, causing a painful headache to occur during an altitude change with flying or diving. Decongestants can help open the sinuses and relieve the pain.

The roots of the upper back teeth lie in the maxillary sinus and share the same pain perceiving nerves. It is therefore not uncommon for people who have an infection of an upper back tooth to feel pain in the sinus or vice-versa: for people who have a sinus infection to feel pain in their teeth. This is call referred pain. So sinus squeeze can cause a toothache.


Tooth squeeze

A change in atmospheric pressure can cause a painful toothache called tooth squeeze. Tooth squeeze results from a small air pocket under a filling or crown or air leakage in a cracked or decayed tooth. With a change in pressure, the air space in the tooth is ‘squeezed.’ Extreme pain is the result. The most common victims are scuba divers and military pilots.

With divers, every 33 feet of depth increases another atmosphere of pressure, so the pressure change is dramatic. If severe tooth pain is noticed on descent, the diver should surface and see his or her dentist. The pain usually eases on return to sea level.

Because of rapid changes in altitude, military pilots often have tooth squeeze. With military pilots, tooth squeeze can be extremely painful to the point that a premature cessation of the flight is necessary. Once the pilot returns to the ground, usually the pain lessens. The pilot should then seek dental treatment. 

Though still a problem for military pilots, tooth squeeze is less common than in the past because of improved dental treatment. During War World II, about one-tenth of American aircrews had one or more episodes of tooth squeeze. With better dental care today, tooth squeeze is less frequent, but still as painful.

Although less common, tooth squeeze can occur with anyone who is flying or even driving to a different altitude. Last winter, I saw a 25-year-old man who had a cracked upper molar as a result of a ski accident at Park City, Utah. He slammed his teeth together during a bad fall. The tooth hurt him slightly after the accident but became excruciating when flying home from the mountains to lower altitude and increased pressure. The tooth had a deep crack in which air had seeped and then expanded and compressed during flight. 

His pain was relieved and the tooth saved with root canal therapy and crown placement.

Ouch! Tooth squeeze is another good reason to have regular dental care. 

Through many years of diving, flying and dentistry, I have seen first hand the pain of Aerodontalgia. I am glad I have never experienced tooth squeeze myself.

Enjoy life and keep smiling.


George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ Visit Dr. Malkemus’ Web site at

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