Have you ever experienced an unpleasant pain sensation on your teeth during a flight? Barodontalgia is dental pain due to a change in barometric pressure and includes the pain felt in the teeth, but referred from somewhere else. The pain often comes on suddenly, though the intensity is unpredictable. When severe it can lead to total incapacitation, and for pilots, barodontalgia can be especially serious, leading to distraction from flying.
Studies have found the onset of pain occurs typically between altitudes of 5000 feet and 15,000 feet. In civil aircraft with the cabin altitude limited to 8000 feet, the incidence of barodontalgia is low. Nevertheless, with the variable standard of oral health in airline passengers, and with the large number of travelers mainly elderly, barodontalgia is a real problem.
The 3 main causes of barodontalgia are
1. Pulpitis
This is the most common cause and occurs on ascent to cabin altitudes to over 5000 feet. The pain may be severe and is usually relieved by descent. The teeth may often have been filled recently, with intact and sound restorations done over the deep cavity that is near the pulp.
2. Periapical and periodontal pathology due to necrotic pulps, abscesses or cysts
The pain from a necrotic (non-vital) pulp occurs mainly during descent and is dull and throbbing in nature. Expansion of air bubbles in the necrotic pulp or periapical/periodontal abscess and cysts is thought to cause pressure effects on adjacent nerve endings, generating pain.
3. Maxillary sinusitis
Passengers with maxillary sinusitis often experience pain during flight which is a referred pain that affects the upper teeth at the back.The mucosa of the sinus swells on ascent and closes the ostium. On descent, pressures across the ostium do not equalize, leading to stimulation of the pain receptors in the sinus mucosa. The pain is usually sudden in onset, dull and poorly localized and usually affects more than one tooth. Symptoms occur mostly on decent and postural changes, together with coughing and bending, exacerbate the pain.
In conclusion , most in-flight dental problems are largely preventable with good oral health. The frequent airline passengers and aircrew should undergo annual dental examinations and radiographs (bite-wings) taken to detect presence of interdental caries. Do avoid flying on the same day of a tooth extraction or a restorative procedure requiring local anaesthetic will prevent majority, if not all, of in-flight dental problems.
