Dear readers,

Today I would like to continue the subject of dentistry and diving that I started in the last issue, let’s talk about root canal treatment during a diving experience.

What is a root canal treatment?

A root canal treatment is simply the removal of the nerve tissue from within the offending tooth. 

If you have an infected tooth or the dentist finds infected material inside the nerve chamber and canals, he may perform the procedure in stages--usually 2 visits. In the last few years it has become customary to try to finish a root canal in 1 visit, time permitting, if the tooth is NOT infected.

Following the 1st visit of the root canal, most of dentists will place a medicated cotton pellet and a temporary filling into the pulp chamber. In this case there is a chance of exploding in this air cavity inside the chamber especially if the diver will not take care during going down or up from the depth. So we always advise divers to be SLOW in both actions.

A cement filling or a permanent filling should only be considered temporary. If no cotton is placed and a TEMPORARY filling is used, it will leak. Leakage from the mouth into the root canal space is one of the leading causes for root canal failure. My advice is NOT to dive at least 24 hours before the treatment.

After the end of the root canal treatment, a temporary crown will be placed over a core or post and the core should cause no problem. But in the week or two after the crown preparation, while you are waiting for the permanent crown, sometimes the temporary crown comes off. Don't lose it--put it back on and get back to your dentist.

There is one exception to the diving with a temporary cap rule: IF THERE WILL BE AN AIR SPACE WITHIN THE TOOTH. In this case it is possible for the tooth to implode. So ask the dentist to place a core the time of crown preparation. No air space, no problem.

Finally, you should expect 1-2 visits to the dentist and 2 visits for the crown. If the root canal procedure is multi-visit, then wait until it is completed and has a solid core inside. Your pool classes shouldn't be a problem but any open water dive could be. Stay away from the deep end of the pool if the root canal is not complete.

The actual root canals are filled with a material called gutta percha. It is a rubbery like substance which flows under heat and pressure. It is compressed into the canals just to the narrowest part of the nerve canal(s). Filling a canal short may leave room for debris, dead tissue and bacteria to accumulate. This may lead to a future retreatment.  It is also a potential area for compressed gases from the bloodstream to accumulate, but do not be scared, nowadays most dentists have new technologies to locate the end of the canals using a perfect tool called an apex locator, it is very accurate and minimizes the chance of failure.

- DR. NAYER N. FAHMY.

BDS, ALEXANDRIA UNIVERSITY

FELLOW OF IMPLANT DENTISTRY FROM THE ICOI (USA).