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 Table of Contents  
Year : 2015  |  Volume : 2  |  Issue : 3  |  Page : 138-140

Aviation dentistry: Past to present

Department of Pediatric Dentist, Pathak Dental Care, Karnal, Haryana, India

Date of Web Publication19-Nov-2015

Correspondence Address:
Sidhant Pathak
Department of Pediatric Dentist, Pathak Dental Care, Karnal, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2348-2915.167877

Rights and Permissions

Airline industry has gained popularity in recent years and not much known about the dental problems associated with the high altitude. It is most common in frequent flyers, crew members, pilots etc. Due to the closed chamber pressure gets accumulated in these organs causing pain, discomfort, and organ dysfunction. The presence of dental abscesses, periodontitis, deep carious lesions and deep unlined restorations in oral cavity can stimulate severe pain due to the extreme altitude changes. With proper diagnosis, the various complications can be avoided. Thus, dentist needs to be well versed with these facts and should provide a comprehensive treatment.

Keywords: Aviation dentistry, barodontalgia, barotrauma

How to cite this article:
Pathak S. Aviation dentistry: Past to present. J Dent Res Rev 2015;2:138-40

How to cite this URL:
Pathak S. Aviation dentistry: Past to present. J Dent Res Rev [serial online] 2015 [cited 2023 Jan 30];2:138-40. Available from: https://www.jdrr.org/text.asp?2015/2/3/138/167877

  Introduction Top

Dental care is an integral part of aircrew's operative fitness which could be jeopardized by a reduction in air density and air pressure at higher altitudes.[1]

For the comfort of crew and passengers, aircraft pressure is maintained at high altitude by means of aircycle machines and outflow valves in spite of low atmospheric pressure outside.[2]

Aviation dentistry is chiefly concerned with the oral and dental health status of the aviators with special emphasis on the prevention of disorders related to change in atmospheric pressure.[3]

In the human body, various organs viz. facial sinuses, lungs, stomach, and middle ear contain gases which tend to expand at low atmospheric pressure. Due to closed chamber pressure gets accumulated in these organs causing pain, discomfort, and organ dysfunction.[4]

The presence of dental abscesses, periodontitis, deep\ carious lesions and deep unlined restorations in the oral cavity can stimulate severe pain due to extreme altitude changes.[5]

  Head and Face Barotrauma Top

Barotrauma refers to the physical damage or trauma to the body tissues caused by a difference in pressure between a gas space inside the body and the surrounding fluid.[6] It occurs commonly in scuba divers, air travellers, hyperbaric oxygen therapy, or after the the explosion due to the shock waves.[7] It involves various conditions such as external otitic barotrauma, barotitis media, barosinusitis, barotrauma related headaches, dental barotrauma, and barodontalgia.[6] During descend from high altitudes, partial vacuum develops which is manifested by a retracted tympanic membrane leading to barotitis and barosinusitis.[8] Barotrauma refers to an acute inflammation of the sinus and middle ear cavities whereas barosinusitis is an inflammation of the paranasal air sinuses. The vacuum created due to air pressure difference causes mucosal edema, submucosal hematoma leading to dizziness, headache, and anoxia.[9]

Pain and numbness can also be sequelae due to the pressure exerted on branches of the fifth cranial nerve.[6]

  Barodontalgia Top

Dental pain occurring due to the changes in barometric pressure is called barodontalgia. It is a symptom and not a pathologic condition itself. Most often, it is an exacerbation of preexisting subclinical oral disease.[10] It occurs due to the entrapment of gases in the closed chamber due to which it is unable to adjust to the internal pressure. Pain is generally sharp or squeezing in nature.[3] Pain occurring on ascend is related to vital pulp tissue and that occurring on descend is related to pulp necrosis or facial barotrauma. Pain occurring on both ascend and descend is related to the periapical disease.[10]

The explanation for the pathogenesis of barodontalgia was given by Strohaver in 1972 where he advocated the differentiation into direct and indirect types. In the direct barodontalgia, the reduced atmospheric pressure leads to direct effect on a tooth on the affected tooth, whereas, in the indirect type, pain occurs due to the stimulation of the superior alveolar nerves at the time of maxillary barosinusitis. In the direct type, the pain is moderate to severe, which develops during take-off and is well localized and the patient can identify the involved tooth. In the indirect type, pain is dull, poorly defined involving the posterior teeth and develops during landing.[11]

Disease of pulp is the probable cause for the pain in barodontalgia but Hodges reported that dental pain can also occur in healthy teeth during the altered atmospheric pressure.[12]

Barodontalgia may also occur due to the expansion of trapped bubbles under a restoration causing activation of pain receptors. Referred pain to teeth can occur due to the stimulation of nociceptors in the maxillary sinus.[13]

  Odontocrexis Top

This condition is also known as barometric tooth explosion. Preexisting leaked restorations or recurrent caries lesions underneath restoration can cause tooth explosion when exposed to high altitude environment. Common cause of damage was the accidental expansion of gas which was trapped beneath the restorations.[14] Calder and Ramsey reported that the tooth damage was experienced due to poor quality restorations and unrestored teeth with or without caries.[15]

Dislodgement of crowns was due to the fractures in PFM restorations or due to the pressure changes in microtubules of dental cements.[16]

  Dental Treatment Top

Lack of agreement regarding the dental treatment and grounding period of aircrews for dental reasons poses a major drawback.

Prosthetic considerations

Lyons et al. advocated that crowns cemented with resin cement did not have reduced retention whereas those cemented with glass-ionomer cement or zinc phosphate cement had reduced retention with the tooth under environmental pressure changes.[17]

The most common reason for this may be porosities which are incorporated during the manipulation of zinc phosphate cement and glass-ionomer cement. These microporosities expand and contract upon the pressure changes leading to weakened cement.[18] Microleakage may also be one of the factors for low strength detected in zinc phosphate and glass-ionomer cements.[19]

Complete maxillary dentures reduce its retention at low barometric pressure at high altitude.[20] For edentulous fliers retention can be increased by osteointegrated dental implants.[6]

Restorative dentistry

Differential thermal contraction is seen in amalgam restoration at low temperature of a high altitude environment in comparison to tooth hard tissue. Harvey advocated that cold temperature is the prominent factor underlying dental fracture.[21] According to Sognnaes, grinding of teeth was a causative factor for restorative failure.[10]

Periodontal considerations

There is a high-risk of caries and periodontal diseases due to the decreased salivary flow and dryness of mouth. Dryness of the mouth can be due to the breathing of dry compressed gases in the aircraft.[22]

Endodontic considerations

Rossi contraindicated the direct pulp capping in aircrew patients and advocated endodontic treatment in suspected cases of invasion to the pulp chamber in order to prevent the sub-acute pulpitis or silent pulp necrosis and their potential barometric pressure related consequences.[23] Root canals infection if not treated may cause the leakage of the intracanal infected content to the periradicular tissues and subcutaneous emphysema.

Oral surgery

After the extraction of maxillary teeth, dental surgeons should always rule out the existence of an oroantral communication as it can lead to sinusitis when exposed to a pressure changing environment.[24]

  Prevention Top

Caries excavations and restorations should be completed before air travel. Leaky restorations should be replaced. During the restoration of a carious tooth, a thorough examination of the floor of the cavity should be done to rule out any penetration into the pulp chamber. In such cases a protective cavity liner should be applied (e.g., glass-ionomer cement). During multi-visit endodontic treatment, the temporary restoration must be placed properly. When oroantral communication is diagnosed; referral to an oral surgeon for its closure is indicated.

Cuspal coverage crowns could also be a preventive measure. Resin cements are preferred for cementation, as they give better retention. During flight, chewing gum or candy will increase the salivation and prevent dryness in the mouth.[7]

  Conclusion Top

Due to tremendous increase in air travellers viz. pilots, aircrew personnel, air passengers, flight attendants and leisure pilots special precautions must be taken during endodontic, restorative, prosthodontic and oral maxillofacial surgical treatments for the aircrew patients to prevent any kind of in-flight incapabilities leading to serious issues. Aviation dentistry is an emerging science, which has been much neglected. The dental clinicians should take an initiative to raise awareness levels and sensitize the air travellers about this issue. The need of the hour is to promote the diagnostic tools and treatment guidelines to the aviation industry to ensure wellness of air travellers. Aviators and dentists should embrace all available opportunities for incorporating oral and dental health into aviators' physical standards, to promote their wellness.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Clark JB. Risk assessment and clinical aeromedical decision-making. Aviat Space Environ Med 1993;64:741-7.  Back to cited text no. 1
Kroes MJ, Watkins WA, Delp F. Aircraft Maintenance and Repair. 6th ed. New York: Tata McGraw Hill; 2010. p. 531.  Back to cited text no. 2
Lakshmi B, Sakthi DS. Aviation dentistry. J Clin Diagn Res 2014;8:288-90.  Back to cited text no. 3
Robichaud R, McNally ME. Barodontalgia as a differential diagnosis: symptoms and findings. J Can Dent Assoc 2005;71:39-42.  Back to cited text no. 4
Holowatyj RE. Barodontalgia among flyers: a review of seven cases. J Can Dent Assoc 1996;62:578-84.  Back to cited text no. 5
Zadik Y. Aviation dentistry: current concepts and practice. Br Dent J 2009;206:11-6.  Back to cited text no. 6
Zadik Y, Drucker S. Diving dentistry: a review of the dental implications of scuba diving. Aust Dent J 2011;56:265-71.  Back to cited text no. 7
Stewart TW Jr. Common otolaryngologic problems of flying. Am Fam Physician 1979;19:113-9.  Back to cited text no. 8
Anuradha P, Grover S. Aviation dentistry: The neglected field by dentists in India. J Indian Assoc Public Health Dent 2010;7:8-9.  Back to cited text no. 9
Sognnaes RF. Further studies of aviation dentistry. Acta Odontol Scand 1946;7:165-73.  Back to cited text no. 10
Strohaver RA. Aerodontalgia: Dental pain during flight. Med Serv Dig 1972;23:35-41.  Back to cited text no. 11
Hodges FR. Barodontalgia at 12,000 feet. J Am Dent Assoc 1978;97:66-8.  Back to cited text no. 12
Ongole R, Praveen BN. Textbook of Oral Medicine, Oral Diagnosis and Oral Radiology. Gurgaon, India: Elsevier; 2010. p. 141.  Back to cited text no. 13
Armstong HG, Huber RE. Effect of high altitude flying on human teeth and restorations. Dent Dig 1937;43:132-4.  Back to cited text no. 14
Calder IM, Ramsey JD. Ondontecrexis – The effects of rapid decompression on restored teeth. J Dent 1983;11:318-23.  Back to cited text no. 15
Patel DK, Burke FJ. Fractures of posterior teeth: a review and analysis of associated factors. Prim Dent Care 1995;2:6-10.  Back to cited text no. 16
Lyons KM, Rodda JC, Hood JA. The effect of environmental pressure changes during diving on the retentive strength of different luting agents for full cast crowns. J Prosthet Dent 1997;78:522-7.  Back to cited text no. 17
Jagger RG, Jackson SJ, Jagger DC. In at the deep end – An insight into scuba diving and related dental problems for the GDP. Br Dent J 1997;183:380-2.  Back to cited text no. 18
Lyons KM, Rodda JC, Hood JA. Barodontalgia: a review, and the influence of simulated diving on microleakage and on the retention of full cast crowns. Mil Med 1999;164:221-7.  Back to cited text no. 19
Musajo F, Passi P, Girardello GB, Rusca F. The influence of environmental pressure on retentiveness of prosthetic crowns: an experimental study. Quintessence Int 1992;23:367-9.  Back to cited text no. 20
Harvey W. Some aspects of dentistry in relation to aviation. Proc R Soc Med 1944;37:465-74.  Back to cited text no. 21
Fontana M, Zero DT. Assessing patients' caries risk. J Am Dent Assoc 2006;137:1231-9.  Back to cited text no. 22
Rossi DG. Health policy directive no. 411. Aviation and diving dental considerations. Melbourne: Surgeon General, Australian Defence Force; 1995.  Back to cited text no. 23
Mandke L, Garg S. Aviation dentistry: New horizon, new challenge. Int J Contemp Dent Med Rev 2015;3:1-4.  Back to cited text no. 24

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