“Tooth squeeze,” or barodontalgia, is dental pain caused by changes in atmospheric pressure, most commonly affecting individuals who rapidly change altitude or depth, such as scuba divers, pilots, and high-altitude travelers. This condition is not a disease itself but a symptom, indicating an underlying dental weakness or pathology that makes the tooth sensitive to pressure variations.
The Mechanism of Barodontalgia
The physical basis for barodontalgia is described by Boyle’s Law, which explains the inverse relationship between the pressure and volume of a gas at a constant temperature. When a person ascends, such as during a flight, the surrounding atmospheric pressure decreases, causing any gas trapped within a compromised tooth structure to expand. Conversely, when descending, the increasing pressure causes trapped gas to contract.
This expansion or contraction of gas within a rigid tooth structure creates a pressure differential that cannot be equalized. The trapped air pocket might be found under a faulty dental filling, within an untreated cavity, or in the space of an infected root canal. The resulting pressure is exerted directly onto the sensitive dental pulp, leading to the sensation of pain. The pain usually initiates when the ambient pressure exceeds a threshold equivalent to approximately 3,000 feet of elevation change.
Determining the Duration of Pain
For a typical barodontalgia episode, the pain is acute and ceases almost immediately once the external pressure returns to the approximate level at which the pain began or upon returning to ground or surface level. This short duration indicates a direct pressure-volume effect on a pre-existing dental void. For instance, the pain experienced during a flight ascent may subside as the plane reaches cruising altitude and the pressure stabilizes, or it may vanish completely upon landing.
However, the pain can persist for hours, days, or even weeks, which signifies a more serious underlying issue. Persistent, lingering pain after the pressure change event is a warning sign that the pressure differential has aggravated or initiated a severe dental pathology, such as irreversible pulp inflammation or a periapical infection. If the pain continues for more than a few minutes after the pressure is equalized, or if it lasts for three days or longer, immediate dental evaluation is necessary. This extended duration suggests the pressure event served as a trigger, turning a silent dental problem into an active infection or severe inflammation that requires professional intervention.
Underlying Dental Conditions That Trigger Tooth Squeeze
Barodontalgia is almost always a symptom of a pre-existing dental condition that creates a gas-trapping void within the tooth. The most common trigger is untreated dental decay, where a cavity creates an open space for air to become trapped. Similarly, faulty, incomplete, or poorly sealed dental restorations, such as old fillings or crowns, can develop microscopic gaps that allow air to enter and become pressurized.
Inflammation within the tooth’s nerve tissue, known as pulpitis, is also a frequent cause. Sharp, transient pain upon ascent often suggests reversible pulpitis, while severe, persistent pain on both ascent and descent points to a periapical lesion (an infection at the root tip). Recent dental work, including new fillings or extractions, can also temporarily predispose a tooth to barodontalgia due to residual inflammation or trapped air from the procedure itself. Referred pain from a sinus infection, called barosinusitis, can also manifest as tooth pain in the upper jaw.
Prevention and Management Strategies
Preventing barodontalgia requires maintaining optimal oral health and proactively addressing existing dental problems. Individuals who frequently engage in activities involving pressure changes, like diving or flying, should receive a thorough dental examination before their activities. A dentist can identify and treat decay, replace faulty or leaky restorations, and check for signs of infection.
It is recommended to avoid flying or diving for at least 24 hours after any dental procedure involving a local anesthetic, and to wait at least one week following oral surgery. If acute tooth squeeze pain occurs during a pressure change, a person should attempt to return to the pressure level where the pain began, or return to the surface or ground level. Immediate symptoms may be managed with over-the-counter pain relievers like ibuprofen or acetaminophen, but a subsequent dental appointment is necessary to address the root cause.