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Prevalence of Barodontalgia Among Pilots and Divers in Saudi Arabia and Kuwait Wadha Al-Hajri,* BDS Ebtissam Al-Madi,** BDS, Msc

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Prevalence of Barodontalgia Among Pilots and Divers in Saudi Arabia and Kuwait Wadha Al-Hajri,* BDS Ebtissam Al-Madi,** BDS, Msc 134 SAUDI DENTAL JOURNALSAUDI DENTAL JOURNAL SAUDI DENTAL JOURNAL Prevalence of Barodontalgia among pilots and divers in Saudi Arabia and Kuwait Wadha Al-Hajri,* BDS Ebtissam Al-Madi,** BDS, MSc Barodontalgia is defined as tooth pain occurring with changes in pressure environment. It commonly affects pilots and divers, as they are frequently subjected to barometric pressure changes during their work. AIM: To measure the prevalence of barodontalgia among pilots flying non-commercial war planes and divers practicing in air bases, naval bases and diving schools in Saudi Arabia and Kuwait. MATERIAL AND METHODS: Three-hundred and fifty questionnaires consisting of demographic data and questions about the occurrence of tooth pain during flying or diving were distributed among pilots and divers. RESULTS: There was a response rate of 72.8% in Saudi Arabia and 80% in Kuwait. Almost thirty-four percent of the sample experienced barodontalgia at one point in time during their practice. More pilots had an occurrence of pain while flying (49.6%) than did divers while diving (17.3%). Pilots had higher incidence of pain while ascending (30.4%) than descending (19.3%), while divers had higher incidence of pain while diving (13.9%) than resurfacing to sea level (3.6%). The highest percentage of tooth pain occurred in pilots while flying at an altitude that ranged from 11,000 - 20,000 ft (3300 - 6000 m) and with divers while diving with a depth that ranged from 60 - 80 ft (18 – 24 m). Recurrence of tooth pain after treatment occurred in 16.4% of pilots and 25.0% of divers during their practice. CONCLUSIONS: Barodontalgia is common in Saudi Arabia and Kuwait with a prevalence rate as high as 33.6%. Pilots reported high occurrence than divers. It was common on ascent while flying and descent while diving. Recurrence of pain after treatment was not frequent. INTRODUCTION decrease in barometric pressure.4,5 Barodontalgia is essentially dental pain Subjects exposed to a sudden reduction provoked by atmospheric pressure or increase of ambient pressure sometimes 1 changes which usually disappear when complain of toothaches. This problem the affected person reaches normal was first reported in pilots and was called pressure zone again.6 aerodontalgia.2 More recently, dental pain 3 During the 1940s, large numbers of has also been reported during diving and military pilots were subjected to major the more general term barodontalgia was barometric changes in unpressurized introduced to include both conditions, air craft. In some cases the variations whether produced by an increase or in atmospheric pressure experienced Received 3 October 2005; Revised 21 May 2006 in flight caused severe dental pain. Accepted 12 June 2006 Incapacitation due to this pain was a *Intern serious problem and stimulated research College of Dentistry, King Saud University 7 P.O.Box 495, Dhahran Airport 31932, KSA into barodontalgia. [email protected] The incidence of barodontalgia in **Assistant Professor aircrew has been reported to vary from Department of Restorative Dental Sciences 0.26% to 8%.1,2,6,8,9 The US Army air College of Dentistry, King Saud University [email protected] force reported a 1.63% prevalence of Saudi Dental Journal, Volume 18, No. 3, September - December 2006 AL-HAJRI and AL-MADI 135 barodontalgia among 12,000 subjects history and examination should be undergoing decompression tests performed. A hypobaric chamber is an after World War II,10 while Harvey, in ideal environment that may be used for 1947, identified only 0.8% incidence reproducing the conditions of barometric of toothaches in a sample of 5,711 pressure and hypoxia that flight personnel persons taking decompression tests.9 have to withstand at different altitudes, Barodontalgia has been known to occur and their effects.14 If dental examination across a broad range of altitudes during fails to identify the problem then an flying, having been reported at altitudes examination by a physician would be as low as 5000 feet and as high as 35000 appropriate to examine the sinuses or feet but is more common between 9000 even to evaluate the potential that the and 27000 feet.6 Barodontalgia is more pain was referred from the heart.13 common on ascent,6 and it was shown Treatment of barodontalgia is similar that the onset of pain occurred at to therapy rendered for pain of dental altitudes ranging from 5,000 to 15,000 origin at ground level. Prevention of ft.4 Barodontalgia is not limited to any barodontalgia is based on maintenance particular age group.6 of higher standards in preventive and The causes of barodontalgia have been restorative dentistry.6 investigated for many years. In general, No information regarding barodontalgia barodontalgia is a condition intimately in the Gulf region have been reported to related to pre-existing dental pathology.6 date. The aim of the present study was to Several factors have been speculated to measure the prevelance of barodontalgia make teeth susceptible to barodontalgia among pilots and divers in selected bases such as inability of gases within the tooth and centers in Saudi Arabia and Kuwait. to expand to adjust internal pressure when exposed to external pressures by MATERIAL AND METHODS diving or flying,11 circulatory disturbances in an abnormal pulp,7 nearness of caries The study population consisted of to the pulpal tissue,4 dilation of pulpal pilots and divers working in selected vessels during decreases in pressure, and centers in Saudi Arabia and Kuwait. The pulpal hyperemia.4 Precipitating factors group of pilots targeted were those flying that contribute to barodontalgia include non-commercial war planes, practicing inadequately filled root canals, chronic in King AbdulAziz Air Base (KAAB) in pulpitis resulting from insufficient Dhahran, King Khaled Air Base (KKAB) base materials, untreated caries, and in Khamis Mishaet, Saudi Arabia and periapical abscesses in which gas had Hammad Al-Jabir Air Base in Kuwait. The been generated.4 Referred pain from divers targeted in this study were those unerupted or partially erupted third practicing in King Abdulaziz Naval Base molars, new and recurrent caries or (KANB) in Jubail and the Al-Sharq Diving restorations, intra-treatment endodontic School in Al-Khobar, Saudi Arabia and symptoms, dental and periodontal cysts, the Kuwait Diving School in Kuwait. abscesses or “cracked tooth” and from A questionnaire was developed in aerotitis media may complicate the English and Arabic and distributed diagnosis of barodontalgia.12 among all pilots and divers present during The diagnosis of barodontalgia should the research period between November be considered if a patient complains of 2004 to April 2005. The survey contained dental pain during diving or flying.13 inquiries about age, type of practice (pilot A complete and thorough dental or diver or both) and years of experience. Saudi Dental Journal, Volume 18, No. 3, September - December 2006 136 PREVALENCE OF BARODONTALGIA AMONG PILOTS AND DIVERS Questions about the occurrence of Table 1. Distribution pilots and divers tooth pain during flight or diving were Number of pilots and Place of employment Percent % presented as well as inquiries regarding divers included whether the pain was during ascending or in study descending (pilots), diving or resurfacing K.A.A.B * & K.K.A.B** 101 38.4% to sea level (divers), the altitude or depth K.A.N.B*** 13 5.0% at which the pain occurred, whether they Diving School in Al-Khobar 68 26.0% had visited a dentist to treat the pain or Hammad Al-Jabir Air Base 34 13.0% not, what the dentist diagnosed the pain in Kuwait as, what kind of treatment was rendered Diving School in Kuwait 46 17.6% at the dental office, and if they had any Total 262 100% recurrence of the pain after treatment. *King Abdulaziz Air Base in Dhahran, Eastern Province, The questionnaire was designed in Saudi Arabia **King Khaled Air Base in Khamis Moshaet, Southern Arabic and a pre-test questionnaire was Province, Saudi Arabia done on 20 subjects. A translation of the ***King Abdulaziz Naval Base in Jubail, Eastern Province, questionnaire was devised to be presented Saudi Arabia to non-arabic speaking divers. A total of 350 questionnaires each This study showed that 33.6 % of the were distributed, with 50 questionnaires sample had incidence of barodontalgia to KAAB, KKAB, KANB, and Hammad at least at one point in time during their Al-Jabir Air Base and the Kuwait Diving activities. Significantly more pilots had School in Kuwait, and 100 questionnaires an occurrence of pain while flying (49.6%) to Al-Sharq Diving School in Al-Khobar. than did divers while diving (17.3%) The collected data were analyzed using (P<0.0001). For individuals that were the Statistical Package for Social Science both pilots and dived (10) as a hobby, the (SPSS) program version 10. Descriptive prevalence rose to 40.0 %. statistics were performed and Chi- Most of the participants (21.4%) square test was used to determine the indicated that they had experienced relationship of pain among pilots and pain while flying and diving several years divers. previously, while 7.3% indicated that they had pain one year previously and only 5% RESULTS indicated they felt pain while flying and diving several months previously. Two hundred and sixty-two subjects Pilots had a higher incidence of pain responded from both Saudi Arabia and while ascending (31.2%) than descending Kuwait. The response rate was 72.8% (19.2%), while divers had a higher (182) in Saudi Arabia and 80% (80) in incidence of pain while diving (13.4%) Kuwait. The distribution of pilots and than when resurfacing to sea level divers is shown in Table 1. The age of the (3.9%).
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