Are Scuba Divers Really at Significant Increased Risk for Dental Symptoms?

I have been an avid scuba diver for nearly 20 years, with about 200 dives under my belt, and I have many friends and patients who dive. Therefore, a recent article published in “Dentistry Today” – and circulated by several other websites – caught my eye: “Scuba Divers Experience Dental Symptoms Underwater.” 

The article referenced a study by the University of Buffalo School of Dental Medicine. 

 I would like to share my own thoughts on the study, as I found both conclusions with which I agreed but also others I questioned. 

In the study, entitled “Prevalence of Dental Problems in Recreational SCUBA Divers: A Pilot Survey,” it was found that “41% of divers experience dental symptoms while they’re in the water due to the constant jaw clenching and atmospheric pressure fluctuations.” While atmospheric pressure changes cannot be avoided, jaw clenching should not be constant while diving, at least not for experienced relaxed divers. I get it that some divers clench, but this should decrease with experience. My point is we cannot and should not assume all divers clench constantly when diving, which seems to be implied in the study.

According to the article, Vinisha Ranna, BDS, the lead author of the study and a student at the school, said recreational divers, then, should consider consulting with their dentist before diving if they recently received dental care. I would argue that all divers should see their dentists on a regular basis. In my opinion, if they are seeing a proactive dentist following the principles we teach at Spear Education, those who have received recent care should be “good to go” rather than “consider consulting with their dentist before diving if they recently received dental care.” My reasoning here is based on the fact that if they have been seen, treated and educated appropriately, and are partnering with their dentist in their care – again, as we teach here at Spear Education – the diver/patient will know if they have a dental need that should be tended to prior to diving. The people who should worry the most are those who are not getting routine care. In fact, in my nearly 20 years of diving, almost every time a dental issue has come up with a diver, said diver either knew they had a pre-existing problem or they had not been in to a dentist in a very long time. 

Later in the article, Ranna, who also is a certified stress and rescue scuba diver who has completed 60 dives, said, “Divers are required to meet a standard of medical fitness before certification, but there are no dental health prerequisites.” I agree 100 percent that divers should indeed assure they meet both the proper medical and dental health to dive safely. The fact of the matter is many divers are diving with serious medical issues already. Thus, we have long way to go in order to get more people to pay attention to the medical risks, let alone the dental risks.

“Divers are required to meet a standard of medical fitness before certification, but there are no dental health prerequisites.”

Ranna's survey, which she created and distributed online to 100 certified recreational divers, showed that of the 41 percent who reported dental symptoms:

• 42 percent experienced barodontalgia
• 24 percent described pain from holding the air regulator in their mouths too tightly
• 22 percent reported jaw pain
• 5 percent noted that their crowns were loosened during their dive
• 1 person reported a broken filling

I found these statistics to be very interesting. While I agree that diving puts one at increased risk for baridontalgia, I would suspect that to get to 42 percent incidence, many of the divers had to either know they had preexisting issues or they were ignoring their dental health and had not been in for care in quite some time.

When it comes to TMD symptoms from holding the regulator in their mouth, I would say by far this is the most common thing I see. The 22-percent and 24-percent findings seem reasonable, especially if the divers studied were stressed, as I mentioned earlier. Stressed divers would hold their regulator very tightly due to fear for it falling out of their mouth.

When it comes to loosening crowns and broken fillings these almost certainly have to have been from either freak accidents. It could also be from serious pre-existing conditions that they were not aware of due to having not been to the dentist – or they just plain chose to ignore it.

When it comes to diving causing loose crowns or broken fillings, I would guess the mostly likely way for this to happen would be a slip on the deck or during botched water entry. As any experienced diver knows, done properly there just is not anything that should happen during recreational diving that should result in enough force for this to happen – unless there is a pre-existing issue like I mentioned above.

Ranna said she hopes to see oral health incorporated into the overall assessments for certification, and I agree. However, while it is a great idea to incorporate oral health into assessments for certification, at the end of the day the individual diver has to take responsibility for their ongoing health. All too often even experienced divers feel they are immune to accidents since they are on vacation. They let their guard down thinking, “I’m on vacation and bad things don’t happen on vacation!”

A follow-up study is already being conducted, this time with more than 1,000 participants. Without a doubt, the follow-up study will be very interesting. I hope the researchers will assess with more clarity the specific increased risk that can be attributed to divers who have been maintaining their oral health. I think it is safe to say that, as with just about every sport, there may be some minor increased risk for dental problems; however, my own experience with dental problems encountered by divers tends to stem from issues that were being ignored by the diver. These issues were bound to give them problems at some point, even if they were not diving.

What are your thoughts on this research? Please feel free to discuss in the comments below.

(Click this link to read more dentistry articles by Dr. John Carson.)

John R. Carson, D.D.S., P.C., Spear Visiting Faculty and Contributing Author - www.johncarsondds.com