DAN Europe Medical Q&A

Ask DAN

DAN medical specialists and researchers answer your dive medicine questions

Dental extraction and diving Q: I’m 20 years old and will be having four wisdom teeth (third molars) removed soon. I understand I’ll have air pockets where my teeth were, and I assume those could cause problems while diving. How long should I stay out of the water?

A: Following an uncomplicated dental extraction, four to six weeks is normally sufficient time for the risk of infection to resolve. This assumes good healing and that gum tissue has filled in the empty sockets, eliminating any air pockets. An unhealed socket can be a route for infection as well as for air to enter subcutaneous tissues and cause further injury. Pain medication can impair your judgment underwater, so wait at least a couple of days after you finish taking it to resume diving. Following the extraction of upper wisdom teeth, the dentist should verify that there is no sinus involvement. The root tip of a molar can breach the maxillary sinus floor, resulting in a communication (abnormal connection) between the mouth and the sinus. This is not common, but if it occurs it will further delay your return to diving.

If there is sinus involvement, you should wait until the fistula (hole) is closed and healed before you resume diving. Your dentist or oral surgeon will be able to tell you how long this should take. Discomfort, tenderness or delayed healing can make it difficult to hold a regulator mouthpiece, depending on the tooth or teeth involved and the length of the mouthpiece’s flanges.

After your dentist or endodontist approves a return to diving, consider taking your scuba gear to a local pool. Swim laps underwater to confirm that breathing through your regulator does not cause any discomfort.

Antibiotics use Q: My wife and I love to travel to exotic destinations, and my previous doctor used to give me antibiotics in case I got sick in a remote location. I have a new primary care physician who is hesitant to do this. What does DAN recommend?

A: For some time now prescribing guidelines regarding antibiotic use for various conditions have favored a much more conservative approach due to increasing antibiotic resistance. Many illnesses are viral in nature, and antibiotics are of no benefit in these cases.

If you get sick while travelling, a local physician is your best resource; he or she will be aware of the common pathogens that cause problems in the area you are visiting. When travelling, your best defenses against illness are handwashing, careful sourcing of water and food, getting relevant travel immunizations and taking appropriate precautions in areas where mosquitoes and other living organisms can transmit infectious diseases to humans.

Talk to your doctor or visit a travel medicine clinic if you will be going to a region in which medical care is lacking. The doctor can advise you about any medications you should take with you and when to use them.

Stress and diving Q: A few days ago, I started a drug treatment for stress using the following medications: Wellbutrin (brupropion hydrochloride) and Xanax (alprazolam). Is my diving activity still compatible with the use of these medications?

A: It is important for you to visit a specialist in diving and hyperbaric medicine, before you keep diving while taking the drug treatment you describe. It will also be imperative to obtain, before the above-mentioned visit, a written medical consent from the psychiatrist currently providing treatment.

As a general rule, alprazolam and brupropion are drugs that are not compatible with safe diving practices, since they have different side effects such as, for example, a sedative effect on the CNS; in particular alprazolam, which would impair your attention levels, and create a synergy with the potential effects of nitrogen narcosis when diving.

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