Authors: Dr. Sudhanshu Agrawal, Dr. Dipti Singh.
Dental Clinic Shushrut Hospital Lucknow, India



ABSTRACT:
Barodontalgia is a rarely reported condition involving changes in ambient pressure resulting in tooth pain. Although considered rare, dentists may encounter oral pain evoked by a change in barometric pressure, a condition known as barodontalgia (aerodontalgia). This article describes a case of barodontalgia that was experienced by an air force pilot in Air Force Station Bakshi Ka Talab, Lucknow

INTRODUCTION:
Barodontalgia is a dental pain caused by a change in barometric pressure in an otherwise asymptomatic organ. A complaint about dental pain in barometric change may face dental practitioners with a diagnostic challenge. Although rare, dental pain during flying or while diving has been recognized as a potential cause of an aircrew member or a diver suddenly becoming incapacitated, thus jeopardizing the safety of the affected person as well as others. The accepted classification of barodontalgia at present consists of four groups relating only to pulp and periapical conditions and symptoms, where as the former classification, established in the 1940s, consisted of three groups and included pulp pathologies as well as other possible causes of barodontalgia such as barosinusitis, barotitis media, and partially erupted teeth. ^1,2

CASE REPORT:
A 25-year-old male pilot visited to our Dental Clinic for the treatment of tooth pain in the maxillary right quadrant. He reported that the pain had been present for a week but had increased significantly two days earlier during an hour-long flight. The most intense symptoms occurred as the plane took off and landed.

After landing, his symptoms diminished to the pre-flight level but did not resolve completely. On examination Root canal treatment done in 14 with amalgam restoration in 15 and metal crown in 16.


The patient reported experiencing pain when eating cold foods and discomfort when chewing, pointing to tooth No. 15 as the source of his discomfort. The patient did not exhibit swelling, sinus tract, or lymphadenopathy and no periodontal defects were noted. Comparative testing found tooth No. 15 to be moderately painful to percussion and exquisitely painful to cold, producing a throbbing pain that lasted for more than five minutes. Other teeth responded normally. Radiographically, the periodontal ligament space and lamina dura of tooth appeared uniform and intact. The patient’s previous occlusal amalgam restoration approached the distal extent of the pulp chamber. He reported that the tooth had been asymptomatic for several weeks following restorations. The pilot indicated that the moderate pain he experienced during flying at high altitude. Root canal treatment was done in 15 and patient was recalled after 1 day, the pain subscided.

DISCUSSION:
Barodontalgia is a symptom, rather than a pathologic condition itself. Barodontalgia is usually a flare-up of existing sub-clinical oral-maxillofacial disease caused by a change in barometric pressure. Most of the common oral pathologies have been reported as possible sources of barodontalgia: dental caries, defective tooth restoration, pulpitis, pulp necrosis, periapical periodontitis (jawbone cyst and granuloma), periodontal pockets, impacted teeth, and mucous retention cysts. Referred oro-dental pain derived from facial barotrauma, i.e., barosinusitis and barotitis-media, can also be considered barodontalgia. ^3,4

In the 1940s, the most common barodontalgia incidents during high altitude chamber simulations were due to pulp exposure, recently restored teeth, and periapical disease. Recently, in Kollmann’s high altitude chamber simulations series, the most common incidents were due to teeth with deep untreated dental caries without pulp exposure (36%), followed by exposed vital pulp (29%) and pulpitis or periapical periodontitis (14%). The main dental conditions affected by barodontalgia in the recent Spanish Air Force survey on in-flight barodontalgia conducted by Gonzalez- Santiago Mdel et al. were periapical periodontitis (39%) and defective restorations (23%).^5,6

Baradontalgia has been reported infrequently in the literature. One of the first reports was published in 1937, involving a painful pulpitis at 6,100 feet that was relieved with a pulpectomy.5 Ingle and Bakland reported a patient who experienced barodontalgia when crossing a 4,000 foot pass in an automobile.6 Extensive studies have been performed on military personnel in aircraft, submarine conditions, and hypobaric and hyperbaric chambers. These studies have shown barodontalgia to be a very rare condition, with reported incidence rates between 0.26% and 2.63%.^7,8

The etiologic mechanisms of barodontalgia have not been studied specifically and remain poorly explained; at present, the published literature has offered only hypotheses. In 1945, Orban and Ritchie proposed that barodontalgia was caused by the liberation and expansion of gases from blood and tissue fluids.⁹ Two years later, Harvey suggested that blood vessels dilate with reduced ambient pressure, thereby increasing intrapulpal pressure and causing pain.¹⁰

Summary:
The case reported here documents an occurrence of Class II barodontalgia on a commercial aircraft flight. Class II barodontalgia is observed in teeth with pre-existing pulpal disease. The inflammatory processes of pulpitis are thought to lower the firing threshold of nociceptors through the process of allodynia, causing a painful response to pressure change. Even though barodontalgia is rarely reported, endodontists should be aware of the different types of this unusual dental pain and its possible etiologic mechanisms. More research is needed to better define the etiologic mechanisms of this unique condition.

References:

1. Ferjentsik E. Barodontalgia: A system of classification. Mil Med 1982;147(4):299-304.
2. Glossary of endodontic terms. Chicago: American Association of Endodontists;2003:7.
3. Cottrell JJ Altitude exposures during aircraft flight. Flying higher. Chest 1988;93:(1)81-84.
4. FAA Aerospace Forecast Fiscal Years 2007–2020. Available at: http://http://www.faa.gov/data_statistics/aviation/aerospace_forecasts/2007-2020/media/Review%20of%202006.pdf. Accessed October 7, 2007.
5. Dreyfus H. Les dents des aviators. L’odontologie 1937;75:612.
6. Ingle JI. Endodontics. Hamilton, Ontario: B.C. Decker;2002:270.
7. Kollmann W. Incidence and possible causes of dental pain during simulated high altitude flights. J Endod 1993 Mar;19(3):154-159.
8. Gonzalez Santiago. Incidence of barodontalgias and their relation to oral/dental condition in personnel with responsibility in military flight. Med Oral 2004;9(2):92-105.
9. Orban B, Ritchie BT. Toothache under conditions simulating high altitude flight. J Am Dent Assoc 1945;32:145.
10. Harvey W. Dental pain while flying or during decompression tests. Br Dent J 1947;82:113-118.