Oral health risks associated with recreational and professional scuba diving – a pilot study

Abstract

The pressure experienced during diving can cause a variety of pressureinduced injuries to the head, face and oral regions. The most common oral complications are odontocrexis (dislodgement of dental restorations), barometric-related dental pain caused by air bubbles and increased pressure at the restoration–tooth interface or by flaring of periapical infections, temporomandibular joint disorders caused by heavy or poorly designed mouthpieces, and cross-contamination of pathogens caused by improper disinfection of shared equipment. This study aims to identify the most common effects of frequent pressure variation on the oral health of divers from Ras Al Khaimah (RAK) Police and assess the in vitro survival of composite and amalgam restorations. A questionnaire eliciting demographic, occupational and barotrauma-related information was completed by members of RAK Police and the data analysed. High-quality composite and amalgam restoration was performed on extracted teeth before exposure to 0.5–0.6MPa at 37°C, simulating deep-diving conditions, and repeated seven times for a duration of 10 minutes. Survival of the restorations was monitored. Questionnaire data revealed that deep divers experience periodontal damage, enamel fissures and odontocrexis of metal and composite restorations, which could be associated with diving depth and frequency. These observations were supported by the in vitro assessment. Odontocrexis was observed earlier and more severely in amalgam restorations than in composite restorations. Increased pressure during diving can therefore affect the integrity of both amalgam and composite restorations, but composite restorations can withstand increased pressure for a longer duration than amalgam restorations before eventually showing damage, as observed both in vitro and in vivo. Divers with more experience and who dive deeper are affected to a greater extent by barotrauma than those with less experience or who do not dive as deep.