Incidence and Features of Barodontalgia Among Military Divers.

OBJECTIVE: Divers are vulnerable to barodontalgia (atmospheric pressure change related dental pain), which may jeopardize diving safety and mission completion. Our aim was to investigate the experience of barodontalgia among western military divers. METHODS: French Armed Forces diving personnel were asked to answer a structured questionnaire including questions regarding their oral health, diving and career features, and barodontalgia while diving. For analysis, the participants were divided into commando/clearance divers (Group A) and ship divers (Group B). RESULTS: All the requested 1389 divers agreed to participate in the study (100%) and 1317 divers (94.8%) who fully completed the questionnaire were included in the analysis. Of these 1317 individuals, 96 (7.3%) suffered from at least 1 episode of barodontalgia while diving, with a total of 119 episodes of barodontalgia. Barodontalgia was more frequent in the upper (62.2%) than the lower dentition (37.8%) (OR = 2.7; 95% CI, 1.6-4.5) and appeared more common during descent (77.3%) than ascent (22.7%) (OR = 11.6; 95% CI, 6.3-31.3). Barodontalgia experience was higher in divers who have an examination less than once per year (14.5%) in comparison to divers who usually have a dental examination once a year or more (6.3%) (OR = 2.5; 95% CI, 1.5-4.2). DISCUSSION: Barodontalgia mostly appeared in the maxilla and during descent; therefore, a great role for barosinusitis in the etiology of oral pain while diving may be suggested. The infrequent experience of barodontalgia in divers who routinely visit the dentist once a year or more suggests that the risk of barodontalgia might decrease with the maintenance of a good oral status.

Dental Barotrauma in French Military Divers: Results of the POP Study.

OBJECTIVE: The aim of the POP (odontological problems among divers) study was to assess dental barotrauma among French military divers exposed to an underwater environment. METHODS: A questionnaire on dental barotrauma was completed by the divers who presented at the SMHEP (Centre for Hyperbaric Medicine and Diving Expertise) for their quadrennial medical exam from March 2011 to July 2014. RESULTS: There were 1317 questionnaires completed, representing 60.6% of all French military divers. A total of 5.3% of divers had a dental barotrauma (70/1317), mainly fracture and/or loss of dental restoration. Dental barotrauma disrupted diving in 34.3% of cases. A total of 76.4% of divers were informed by a military physician of the importance of maintaining good oral health and 88.5% of divers consult their dentist at least once a year. Of the participants, 82.5% made their dentist aware they are divers, but only 4.9% of the dental practitioners advised their patient not to dive after some types of dental treatments and 12.8% indicated that, as divers, they need adapted dental treatments. CONCLUSIONS: Dental barotrauma was experienced by 1 in 19 military divers. Nevertheless, a contradiction exists between the frequency of dental barotraumas and the rigorous medical and dental follow-up of military divers. We note that there is inadequate dental management of divers when dental issues are identified. To avoid this unsatisfactory situation, "diving dentistry" should be taught to military and civilian dentists and physicians to make them aware of the potential dental complications and preventive measures associated with operating in a subaquatic environment.

Medical evacuation of French forces for dental emergencies: Operation Serval.

OBJECTIVES: The objectives of this study were to (1) quantify the number of intratheater dental Medical evacuations (MEDEVACs) required for French Soldiers in Mali during Operation Serval and (2) determine a Soldier's time away from their unit because of MEDEVAC, dental treatment, and return to unit. METHODS: Data concerning MEDEVACs occurring during Operation Serval were recorded by the Patient Evacuation Coordination Center. MEDEVACs resulting from oral/facial/dental conditions were evaluated for the period from February 15, 2013 to May 15, 2013. RESULTS: Fifty-four (15.7%) of the 338 MEDEVACs recorded were required to treat dental emergencies. Dental emergencies accounted for 54 (23.9%) of nonbattle injury MEDEVACs. Soldiers evacuated for dental problems were unavailable to their units an average of 10.5 days. CONCLUSIONS: French military personnel often require MEDEVAC to treat dental problems occurring in the theater of operation. Dental casualties requiring MEDEVAC are absent from their units for almost 2 weeks, which could drastically decrease their operational capacity and ability to complete their mission. Predeployment dental readiness and the presence of a dental surgeon in close proximity to deployed forces may reduce the number of MEDEVACs required and reduce the time away from the unit.

Non-barotraumatic tooth fracture during scuba diving.

BACKGROUND: When dental pain or tooth fracture occurs during diving, variations in atmospheric pressure are usually considered as etiology. CASE REPORT: We present a case of a military diver referred for dental pain which appeared during diving. Diagnoses suggested by the diving medical specialist were barodontalgia and dental barotrauma. The dental exam, however, highlighted a tooth fracture due to the in-diving use of an inappropriate mouth regulator which yielded excessive occlusal pressure on a tooth with pre-existing extensive dental restoration. DISCUSSION: This case highlights the importance of the use of an adapted mouthpiece by divers, and the need for awareness of physicians and dentists who treat divers of the implications of scuba diving on dental and oral medicine.

The rate of dental emergencies in French Armed forces deployed to Afghanistan.

OBJECTIVES: The objectives of this study were as follows: (1) to quantify the dental emergency (DE) rate observed in French soldiers serving in Afghanistan and (2) to determine the percentage of DEs that could have been prevented had predeployment treatment been provided. METHODS: All DEs presenting at the French medical-surgical hospital in Kabul, Afghanistan, were documented during the period of December 12, 2009 to February 6, 2010. Dental Officers documented (1) the etiology of each DE and (2) whether the DE could have been prevented with predeployment treatment. RESULTS: An estimated rate of 293 DE per 1,000 personnel per year was observed, 78% of the 210 DEs were considered preventable, and 65% of patients required medical evacuation from their units. CONCLUSION: Previous studies have observed high DE rates for French Army personnel. The intensity, danger, and geography of the mission in Afghanistan exacerbate the negative operational impact of dental pathologies.

Operational impact of tongue piercing on French military pilots during overseas deployments: a case report.

Piercing in general and particularly tongue piercing is gaining popularity in the Western world. The French army and so the French air force are concerned by this phenomenon. A case report of a pilot suffering from dental pain with operational consequences due to a dental fracture during Operation Trident (Kosovo) is presented. The dental examination highlighted the fact that the dental fracture was directly due to the presence of a tongue piercing. Tongue piercing and wearing tongue jewelry have numerous adverse effects, especially frequent dental complications. If these complications do not result in death, they can generate sufficient pain to disturb the vigilance and concentration of pilots and can have a major impact on flight security. For these reasons, tongue piercing is in total contradiction to a professional army and particularly to military pilots and aircrews.

Fracture of a sound tooth in a pilot under hypobaric conditions.

Dental fractures induced by changes in atmospheric pressure, called odontocrexis, are described in aviation dentistry articles. According to previous reports, these pathologies are induced exclusively in teeth with defective dental restorations. Nevertheless, in this case report we describe a tooth fracture occurring on an apparently sound tooth in a fighter pilot during a flight. All usual etiologies of this odontocrexis can generally be eliminated. This atypical fracture shows that all pathophysiology and contributing factors of odontocrexis are still widely unknown.