Tooth Squeez and Root Canals??

[bristolxyz]

I just had 2 (yep-two!) root canals done a few weeks ago. Everything was fine until I did a dive to 110 FSW. A few months before, I experienced the need for a filling after diving to 120 FFW, what gives, can the pressue in teeth cavities cause infection to excellerate, or some sort of tooth or root trauma that leads to infection?
More details or info on this would be appreciated.

Thanks,
Bristolxyz

 

[DocVikingo]

Hi Bristolxyz,

This board has an archive with a search function, located at the top of the page. Entering "root canal" turns up this----> http://www.scubaboard.com/search.ph...id=33733&sortby=lastpost&sortorder=descending

Hope it gets you started.

DocVikingo

 

[DocRCH]

If the root canals were finished, they should be hermetically sealed and you should have no symptoms. Sometimes, a root canal is started and the canals are still open and filled with gas. In that case, you can experience barotrauma. Ideally, the space is obturated completely and you should not experience any sensation(s). Could it be that it is another tooth that is bothering you?

Robert:doctor:

 

[Laurence Stein DDS]

Dear bristolxyz

I'm going out on a limb here but here goes... The teeth that needed root canal therapy most probably had old silver fillings probably placed when you were a teenager. I checked your profile and you are no longer a teenager but you are a HECK of a lot younger than me!

Amalgams (silver fillings) actually have a published useful life of...ready for this...7-15 years! That's it. By that time the edges are chipping and corosion is probably occuring under the filling. As the filling corrodes, the filling actually expands. When this occurs, gaps can occur which can allow the entrance of bacteria and even recurrent decay. The expansion very commonly creates fractures within the tooth and those fractures may reach the nerve or allow bacteria to enter the dentin under the fillings and travel to the nerve--infecting them. DENTIN IS MADE UP OF SMALL TUBULES WHICH CONTAIN AN EXTENTION OF THE LINING OF THE PULP CHAMBER. These are the odontogenic processes. The diameter of these tubules are large enough for bacteria to pass through and certainly, their toxins, if present can pass through directly to the nerve.

The deeper the filling or cavity the wider the dentinal tubule. They are slighly conical in saggital section.

The next little tidbit may also come into play...biting on the scuba tabs or chewing on ice...anything hard may cause one of these pre-existing fractures to actually propagate deeper into the tooth so trauma to the nerve may occur.

I suspect that the reason for the need for a root canal following deeper dives is not the depth but what was in the tooth and possibly the pressure applied by your bite on the involved teeth.

To make things even more complicated, if the root canal was done in a molar tooth on the upper arch, you have about a 25-30% chance that there was an extra canal that may have been undetected by the dentist during the root canal treatment.

You may indeed have needed two root canals on two different teeth or you may have had a tooth that needed more canals treated. No one will ever know--unless your pain returns and there are no more teeth to perform root canals on.

The extra canals are so small that they may be invisible on x-rays and only an operating microscope may reveal the opening. Very often they are calcified or blocked. These extra or accessory canals may not even end at the root tip but, instead, exit along the root some distance from the tip. Some canal actually go at right angles to the main canal.

If your symptoms prior to the root canals was sensitivity to BITING PRESSURE ONLY WITH FOOD IN THE MOUTH and possibly, cold sensitivity, then you probably had a fractured tooth. If you had a sensitive bite just to applied pressure without food, sensitivity to cold and/or hot or sensitivity to tapping on the tooth, you most probably had a dead or dying nerve--cause unknown but probably related to an existing filling which had out lived its useful lifetime.

It's a good idea to have your old filling checked for wear, discoloration, breakage, etc. prior to diving. Also the deeper or more complicated the previous dental procedure, ie, a crown verses a simple filling increases the chance you will need a root canal. Many times the crown was placed because the old filling left too little tooth to fill again. Less tooth structure means a weaker tooth and more accumulated trauma over the years restoring the tooth. This all adds up to increased potential for a nerve dying and a root canal.

Sorry this is so long winded but most people never consider that a filling or a crown can wear out or redecay. But, they do.

In defense of you dentist, many times the fractures associated with old fillings are under the silver and cannot be seen. Recurrent decay can "hide" behind the silver and not be visible on x-ray. Fractures almost never show up on an x-ray and a dead nerve is only visible on an x-ray once the bone around the end of the tooth begins to break down. In other words, these problems can be hard to detect.

Do me a favor...don't dive to 200 fsw you might need brain surgery then!

Be safe,

Laurence Stein
:doctor:

 

[DocRCH]

It's really hard to diagnose over the internet! It is possible that a condition in the maxillary sinus could mimic a tooth problem. I had a little sinusitis and did a 210 fsw dive. It was uncomfortable coming up!!! I would have another evaluation by a dentist.

Robert:doctor:

 

[Laurence Stein DDS]

DocRCH

You are absolutely right it IS hard to diagnose over the internet. The patient stated, however, that following each of two deeper dives she needed endo--presumably in different teeth. The endodontic diagnosis is history now.

Your are also quite correct about the sinuses as well--but that would have added another 4 paragraphs to the already long answer I apologized for. The most common cause of barodontalgia are the maxillary sinuses. However, you rarely end up with root canal treatment on two different teeth from sinusitis.

Assuming proper diagnosis, by HER DENTIST, the endo was appropriate and the greatest chances are that the affected teeth were not "virgin".

Remember the patient's question really asked if deep diving caused cavities or infections in the teeth. For that, the answer is NO. A whole host of other conditions unrelated to diving but exacerbated by diving could trigger her problems. That was the point of the answer.

Regards,


Laurence Stein,:doctor:

 

[DocRCH]

Dr. Stein: I was thinking that in the original question that the Navy dentist was asking about the need to finish the endo before a diver was sent out. I have seen in the literature that the sucess or failure of endodontic tx is not specifically related to one or two treatment appointments. I have been doing some of the endo as a one appt. tx. If I cannot fill the canals at the first appt. (usually due to time constraints in the real world) I will obturate on the second appt. I did think that your somewhat lengthy explination was quite good. It is very difficult to adress what may seem to some as a easy question in a cyberworld equivalent to a "sound-bite"

Regards, Robert:doctor:

 

[Laurence Stein DDS]

Dear Robert,

I see what's happened here...we've crossed threads. This thread was from a diver who asked about the possiblity that deep diving caused or accelerated the infection process in teeth. She ended up needing endo on two teeth following, as I understand it, two different deeper dives.

The explanation I gave was conjecture and relied on many assumptions. It also pointed out that that it is often old deep possilbly failing fillings or their sequelae that devitalizes teeth. The act of diving per se does not cause cavities or accelerate infections leading to root canal therapy.

The OTHER thread was from a navy dentist who had performed a pulpectomy. His patient was to ship out possibly before the completion of the root canal therapy. That is where I mentioned a calcium hydroxide interim filling but warned that no guarantee that gas accumulation would not occur could be made.

The best couse of action as both you and I pointed out was completion of the root canal therapy.

I have not served in the military but if I had, I would have to recommend that until the tooth was properly completed, this diver would not be fit for the dive exercise he had been scheduled for. I would not be surprised if the naval dentist is under pressure to expedite treatment and return the patient to active status.

I have treated teeth with root canal therapy on single visits and multiple visits. I know one visit endo can succeed. However, I really feel like an idiot when a single visit endo goes south and I have to retreat. Patients don't like it much either.

We are challanged all the time to do more in less time. Sometimes saving time up front creates a situation that ends up costing both the doctor and the patient triple the time compared to a two visit endo treatment with a stop between shaping and cleaning and the final filling appointment.

Regards, and a happy holiday.
Larry Stein