You may have never heard of barodontalgia. Commonly known as tooth squeeze, barodontalgia is pain in the teeth that is caused by a change in barometric or atmospheric pressure, and it is a common concern for deep sea divers and military pilots, both of whom may face extreme, sudden atmospheric pressure changes when diving or flying. In some cases, barodontalgia can be so extreme that pilots must cut flights short to relieve the intensity of the pressure, which can adversely affect military operations. While barodontalgia may manifest in commercial flights, it is usually related specifically to altitude changes that are rapid and extreme, such as those faced by divers and military flight crews. Barodontalgia was first observed in flight crews during World War II; because of its association with these flight crews, it was initially termed “aerodontalgia.” After World War II, when it was detected in deep sea divers, the condition was renamed barodontalgia.
Barodontalgia is most often a symptom of underlying dental diseases; dramatic changes in atmospheric pressure can affect the tooth’s pulp, which is the soft tissue inside the teeth that contains blood vessels and nerve endings, and exacerbate existing issues. Most of the more common oral pathologies have been connected to flare-ups of barodontalgia. These common pathologies that may contribute to barodontalgia include dental cavities; incomplete or defective restorations, such as dental fillings; infected, inflamed, or necrotic pulp tissue; periodontitis; impacted teeth; and oral cysts. Occasionally, barodontalgia may result from sinus issues, but the majority of the time, it manifests as a symptom of these larger dental pathologies. Because of the possibly debilitating effects of barodontalgia, dentists recommend that people who will be subjected to dramatic pressure changes receive a thorough examination of the mouth and teeth. If there are cavities present, these should be treated; if there are restorations present, these should be examined to ensure that there are no defects or remaining lesions in the teeth. Any inflammation should be treated, possibly through root canal therapy, and the teeth should undergo vitality testing to ensure that there is no necrotic or inflamed pulp present. It is advisable to avoid pressure changes until any necessary restorative procedures are completed.
Barodontalgia manifests differently in diving and in flights, with different parts of the mouth bearing the brunt of the pressure, though there is no statistical difference in the number of occurrences.. Despite advances in cabin pressurization in airplanes, in-flight barodontalgia remains a problem for military pilots, with about 10% of military pilots experiencing the issue.
Barodontalgia is divided into 4 classes, which are defined based on their signs and symptoms. Each class has its own recommendations for therapeutic intervention, and each involves the health of the tooth’s pulp. Research has shown that among people with irreversibly infected or inflamed dental pulp, barodontalgia manifests in sharp pain upon ascent. With reversible pulpitis, barodontalgia manifests as dull pain upon ascent. In cases of necrotic pulp, if the inside of the tooth has died entirely, barodontalgia presents as dull pain upon descent. Periapical pathology, in which there is disease or infection in or around the tip of the tooth’s root and possibly into the jawbone, leads to barodontalgia manifesting as severe pain upon ascent or descent.
If changes in barometric pressure cause sustained or permanent damage to the teeth, this damage is known as dental barotrauma, though in many cases, barodontalgia doesn’t cause any lingering issues and will subside when atmospheric pressure returns to normal. If gases inside the teeth cannot stabilize and balance with the external pressure, the tooth or existing restoration may fracture, and dental fillings may dislodge. Barotrauma may also affect other parts of the body, including the ears and sinuses, and may lead to severe conditions like the bends, which can be fatal.