Monday, November 16, 2009

Diver's mouth syndrome.(strive: the student view)(Disease/Disorder overview).

Holiday 2008 USA, LLC

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You are about to embark on an adventure, descending into the deep blue sea to explore what lies below. Do you know the ramifications for your oral health?

Over the past decade, the sport of scuba diving has become more popular then ever. (1) This increasing popularity has brought to light some concerns and risk factors of which divers and their health care providers should be aware. Conditions that divers may encounter are headache, toothache, sinus infections, inner ear infections and temporomandibular joint (TMJ) dysfunction syndrome. Related to all of these is the condition known as diver's mouth syndrome.

Diver's mouth syndrome results from barodontalgia due to Boyle's Law: as pressure increases, volume decreases and vice versa. Because teeth cannot decrease and increase in volume as atmospheric pressure changes, pulpal pain occurs. The teeth most affected are the posterior and maxillary teeth.

Diver's mouth syndrome has been increasing in incidence amongst divers, due to the increased popularity of the sport. (1) Divers are known to take several 30- to 40-minute dives in one day, subjecting themselves to certain conditions that contribute to diver's mouth syndrome. One such condition that is not widely recognized as such is temporomandibular dysfunction (TMD). (1) The factors that contribute to TMD include cold water and a commercial scuba-diving mouthpiece of substantial weight. (2)

Exposure to cold water for long periods of time makes it virtually impossible for the diver to hold the mouthpiece properly. The cold impairs the lips' ability to grip the mouthpiece, which is of significant weight and bulk, and the anterior teeth are forced to take on the responsibility of retaining the mouthpiece. This causes the mandible to protrude, and the biting forces exercised on the anterior occlusion can bring about pain and dysfunction. (1) Divers also have a tendency to bite harder on one side, intensifying the condition and creating soreness in the muscles of mastication and temporomandibular articulation. (1)

Symptoms caused by TMD that are directly related to diver's mouth syndrome include but are not limited to pain in the TMJ and ears, crepitus, trismus, headache and facial pain, masticatory pain, stuffy sensation in the ears, Eustachian tube dysfunction and vertigo. (2,3)

After identifying patients with diver's mouth syndrome, the oral health care provider must implement a treatment plan according to individualized needs. The treatment plan might include the following.

Orthopedic Stabilization: Devices called orthopedic bite splints, stabilize the TMJ to make any necessary changes in the jaw's posture and/or correct underlying problems. (3)

Physical Mediation: Exercise can help increase range of motion in the jaw.

Pain Control: Management of trigger points can help reduce pain in joints, ligaments and muscles. Taking an anti-inflammatory drug four times daily may help reduce inflammation within the joint.

Diet Modification: Avoidance of hard foods and a focus on a soft diet, not chewing gum, and cutting foods into smaller pieces can help eliminate unnecessary stress on the TMJ. Attempt to avoid aspartame, alcohol, chocolate, caffeine, nicotine, sugar and excessive dairy products, as these increase muscle irritability.

It is also recommended by Brandt to fabricate a customized mouthpiece for the avid diver. These can either be made from thermoforming material or can be purchased through a scuba equipment manufacturer.

TMD usually takes six to eights months to treat, with follow up visits annually, bi-annually or as needed according to the severity of the dysfunction.

There are 8.5 million certified scuba divers in the United States alone, and 68 percent suffer from TMD. (1) We believe that in order to provide optimal oral care for our patients, dental hygienists as well as dentists should be aware of conditions involved in diver's mouth syndrome associated with TMJ dysfunction. If these conditions are not recognized, our patients will go untreated and continue to suffer. Health care professionals should continue research efforts to ensure that patients receive optimal care.


(1.) Brandt MT. Oral and maxillofacial aspects of diving Medicine. Military Medicine 2004; 169 (2): 137-41.

(2.) Aldrige RD, Fenlon MR. Prevalence of temporomandibular dysfunction in a group of scuba divers. Br J Sports Med 2004; 38:69-73.

(3.) Stein L. Dental problems from scuba regulator bites. Scubadoc's Diving Medicine Online, 2000. Available at Accessed Feb. 4, 2007.

Additional Resources

Grant SM, Johnson F. Diver's mouth syndrome: a report of two cases and construction of custom made regulator mouthpiece. Dent Update 1998; 25(6): 254-6.

Stein L. Dentistry and diving. Scubadoc's Diving Medicine Online, 2005. Available at Accessed Feb. 3, 2007.

Wilkins EM. Clinical practice of the dental hygienist, 9th ed. Boston: Lippincott Williams and Wilkins; 2005: 279-81.

By Pre Venneri, RDH, and Dominique Masseria, RDH

Pre Venneri, RDH, recently graduated from the dental hygiene program at New York University and is an active ADHA member. She has been practicing dental hygiene for the past five months and finds it very gratifying. She plans to obtain a bachelor's degree in dental hygiene in the future.

Dominique Masseria, RDH, graduated from the dental hygiene program at New York University in May 2008. She is currently working towards a bachelor's degree in dental hygiene at New York University. She has been practicing dental hygiene for the past four months and loves her career. She is currently an active ADHA member.

Source Citation
Venneri, Pre, and Dominique Masseria. "Diver's mouth syndrome." Access 22.10 (2008): 4. Academic OneFile. Web. 16 Nov. 2009. .

Gale Document Number:A191646465

Disclaimer:This information is not a tool for self-diagnosis or a substitute for professional care.

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