In January 2014, 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. One of the divers on the trip, Brian, had a terrible toothache that began on the flight from the U.S. 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]. He is doing well now after having root canal therapy and a new crown upon return home.
You have 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. 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 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 three ear bones 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 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 common for people who have an infection of an upper back tooth to feel pain in the sinus or vice-versa.
• 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/her dentist. The pain usually eases on return to sea level. 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 in 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. Tooth squeeze is another good reason to have regular dental care. George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ malkemusdds.com. Visit Dr. Malkemus’ Web site at http://www.malkemusdds.com