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Kastubios KISMANTO
Lt.-Colonel/Air Force drg. Kastubios KISMANTO Sp.BM, born in Yoyakarta, Indonesia,
18 September 1966, graduated as Dentist with specialization in Oral Surgery.
Currently, he is Secretary Institute at the Dental and Oral Health institute of the
Air Force Health Department in Jakarta, Indonesia.
RESUME
Quelques cas darodontalgies : complications dentaires dues aux changements de pression atmosphrique.
Nous prsentons trois cas darodontalgies chez des membres de larme de lair indonsienne et leur traitement.
Larodontalgie a t dcrite pour la premire fois pendant la deuxime guerre mondiale lorsque des quipages eurent souffert
de douleurs dentaires au cours de leurs missions. On identifia le phnomne de douleur dentaire au cours du vol comme li
des diffrences de pression atmosphrique. Dans la mesure o latmosphre entourant la terre a une masse et un poids, elle
gnre une pression appele pression atmosphrique. Lorsque lon se trouve haute altitude cette pression diminue. La loi de
Boyle Law tablit que le volume dun gaz est inversement proportionnel sa pression et chaque individu doit saccommoder de
ces diffrences. Larodontalgie est la douleur dentaire cause lorsque le volume dair emprisonn dans lespace clos dune dent
est incapable de se dilater ou de se contracter pour saligner sur la pression atmosphrique ambiante. Larodontalgie survient
plus frquemment sur des dents en mauvaise sant, atteintes dinfections de caries ou de fractures. Un traitement convenable
des maladies dentaires est la meilleure stratgie de prvention.
INTRODUCTION
These air pressure changes can cause medical complications. H.F. Adler referred to this as dysbarism which he
divided into two types:
1. Trapped gas
2. Evolved gas
Correspondence:
Lieutenant Colonel drg. KISMANTO. Sp.BM
Dental and Oral Health institute
Air Force Health Department
Lembaga Kesehatan Gigi & Mulut TNI AU
JL. Puntodewo, No. 1, Komp. Dirgantara II
Halim Perdanakusumah, Makasar,
Jakarta Utara, 13610, Indonesia
kastubios@yahoo.com
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tooth which results in a localized infection encompassing the tissue around the roots of a tooth. That localized infection can create an air space that is influenced
by changes in air pressure.
In many places in the world, public awareness of dental
health is still relatively low; therefore, they do not seek
treatment for existing dental problems6. The physiological changes of air travel alters the oral environment
resulting in asymptomatic dental problems becoming
symptomatic with pain.
AERODONTALGIA
Aerodontalgia is a painful feeling in the teeth resulting
from atmospheric pressure changes such as that experienced at high-altitudes. The more general diagnosis
of barondontalgia applies to any condition that is a
result of air pressure differences which would include
air crew and sea divers. (insert reference)
Aerodontalgia incidence was 0.7 - 9.5%8. This pain was
first identified during military conflicts where military
aviation was utilized. This finding resulted in research
regarding barodontalgia. It was discovered that predisposing factors such as dental caries, defective restorations, and fractured teeth often initiated a pulpal response of pain with the changes in air pressure.
3. G. Force
Both G positive or G negative may affect pre-existing
dental conditions. When G positive, blood fluid collects
to the end of body part, so that the top of body part,
including teeth will experience a deficiency of blood
circulation. Inversely if G negative, blood collecting to
the top of body part may include teeth. Deficient blood
circulation caused by G force may trigger pre-existing
dental conditions resulting in pain7.
4. Air emboli
If an air emboli occurs around the apical area of a tooth
which encompasses the pulpal or nerve tissue, this pressure change may cause tooth pain as air planes ascends
or descends. This typically occurs when a plane ascends,
because of the exploitation effect more spontaneous
than emphasis effect1.
CASE SERIES
The following three cases reports describe cases of
aerodontalgia experienced by Suswatud and
Suskesbangans students after their experiences in a
hyperbaric chamber. A hyperbaric chamber is a room
that is pressurized three times higher than normal air
pressure and delivers pure oxygen. It used to simulate
air travel and treat a variety of conditions including
serious infections and decompression sickness. In these
cases, two of the students experience pain in their
teeth resulting from atmospheric pressure changes,
while a third student has his pre-existing tooth pain
relieved with altitude (pressure) change.
Case I
29 year-old male experiences toothache in lower left
posterior tooth when reaching an altitude of 5000 ft.
3. Periapical abscess
The periapical abscess is an infection of the pulp of the
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Case III
35 year-old male with a history of tooth pain in maxillary right third molar experiences opposite effects of
previous cases of aerodontalgia with the pressure
changes in the hyperbaric chamber relieving his dental
pain. Pain disappears while ascending to altitude of
8000 ft - 25000 ft and while descending to normal altitude. At the time of coming up with first position that
tooth pain start to arise. Patient reports dental history
of having pain in maxillary right posterior tooth two
days prior to hyperbaric oxygen chamber training
which was treated with analgesics. Pain persisted until
the pressure changes of the hyperbaric chamber alleviated the tooth pain. No other dental complications
noted
3rd Case: Dental x-ray image radiolucency distal teeth 18.
tooth decay is not known, resulted in the air space.
Pain feeling disappear when patient at the altitude.
Pressure changes can caused drainage in tooth cavities.
Case II
29 year old female complains of pain in maxillary left
molar within altitude range of 8000 to 25000 ft, After
altitude was normalized, tooth pain was alleviated.
Extensive dental history with several extractions and
restorations in tooth number 12, 21, 22, 26, 36 and 35.
Tooth restoration in 26 was restored by non-dentist. No
history of dental abscess, tooth fractures or temporalmandibular pain.
2nd Case: Dental x-ray image radiolucency distal teeth 26.
tooth decay is not known, resulted in the air space.
Gas swelling that happened will suppressed apically
because lack of drainage so that the pain will occur.
IMPLEMENTATION
With case I and II, the tooth pain caused by pressure
changes was treated by replacing the defective dental restorations. Before completing restorations, hermetically
root canal treatment is important. Complete obturation or
filling of root canal space is needed to prevent any open
spaces that could be affected by air pressure changes. For
case III, tooth #1 was diagnosed with gross caries and nonrestorable so the treatment choice was extraction.
For these cases, the diagnosis is aerodontalgia or barodontalgia which is dental pain experienced in teeth
resulting from pressure differences in entrapped gas
within the tooth.
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DISCUSSION
Based on experiences since World War II and prior
research, aerodontalgia which is tooth pain caused by
difference in air pressure is not a separate pathology but
is a condition that occurs when a pre-existing dental
pathology exists.
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include crown-tooth fracture, tooth erosion, acute abscess periapical, odontogenic infections and barophysic
phenomena, also imperfect tooth restoration3.
Main etiologies of aerodontalgia are also related to
non-hermetic endodontic treatment and subsequent
pulpitis which is caused by bacterial contamination
secondary to a defective tooth restoration. One of the
most painful responses that often occurs while in-flight
or in a decompression chamber is due to defective amalgam restorations which are undercondensed or incompletely filled within the preparation. In cases of aerodontalgia, replacement of defective restoration will
often alleviate symptoms of tooth pain immediately.
Large tooth restorations in close proximity to the pulp
can induce tissues changes so that symptoms may occur
weeks after its insertion and may mimic aerodontalgia
during flight. In these situations, no treatment should
be completed because the hypersensitive pulp or reversible pulpitis due to the large restoration will often normalize. If the symptoms continue after a few weeks
and the tooth is diagnosed with an irreversible pulpitis,
then root canal treatment should be completed.
Carious or decayed teeth where the pulp has been compromised will often by symptomatic with altitude
changes. In those cases, the etiologies of the pain can be
divided into two categories. First category is pain caused
by vital pulp reaction of decayed tooth as a result from
atmospheric pressure. Second category is pain caused by
non-vital pulp reaction or pulpal necrosis as a result of
atmospheric pressure changes.
Dental treatment will be unique for each clinical case
with root canal therapy preferred versus extraction.
Rarely etiology of pain while in-flight is periapical abscess around root of teeth which related with infection,
so that occur small gases. Those gases trapped and will
expand with more increase height and its cause painful
feeling in the teeth. That pain usually ceases at ground
level. Although at ground level those teeth seems like a
normal teeth and patient compliance is not exist, but the
abscess should be examination with dental X-ray. There
was one case happened while pressure changes with
decompression chamber, which periapical abscess broken out at high altitude and make infectious spreading
so that the patient should be hospitalized.
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CONCLUSION
REFERENCES
SUMMARY
We present three cases of aerodontalgia in Indonesian airforce
personnel and their treatment. Aerodontalgia was first described in World War II when air crew experienced tooth related
pain during military missions. They identified the phenomena
of tooth related pain during flight that is caused by differences
in air pressure. Air encircling earth has mass and weight, so
that will generate a pressure which is called air pressure. As you
proceed to higher altitudes, the outside pressure decreases.
Boyle Law states that gas volume is inversely proportional with
its pressure, hence as the air pressure increases or decreases,
the individual needs to physically accommodate these differences. Aerodontalgia is tooth related pain that is caused
when the air pressure in the enclosed space of a tooth is unable to expand or contract to adjust to the outside air pressure.
Aerodontalgia more frequently occurs when dental health is
compromised due to a complications such as infection, caries,
or tooth fracture. The correct treatment of dental disease is the
best strategy in avoiding Aerodontalgia.
dalam
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