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Dental Problems - Infections

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - I've have been advised to take Amoxicillin 3 times a day for a problem with a tooth. Is it safe to dive whilst on it?

A - It is indeed. Amoxicillin is a fairly bog standard antibiotic used from everything from tooth to chest infections. The only thing to watch for is an allergy, but if you haven't broken out into itchy urticarial wheals, or hives as they are otherwise known yet, then all will be OK.

Whilst on this subject, drugs and diving, I was approached by a couple of Instructors in Sharm recently, as to whether we could build some software for the e-med site that could inform those who need to know which drugs are OK with diving.

Well, we've looked at it and it's a fairly Herculaen task. Seeing as there are thousands of different medications, all with at least twenty different brand names worldwide, my IT people could be programming from now until we next win a World Cup before it is done.

But a rough rule of thumb is that antibiotics are fine, anti-epileptics are not, anti-depressives need a dive doc clearance, as do blood thinners like warfarin.

Anything that can be bought over the counter is OK as the doses are quite low, and most common of all, the blood pressure lowerers do need a consult especially if they are of the beta blocker variety. And if anyone out there is bored enough, or technically minded and can solve the software problem, I'll be first in the queue to buy it.

Q - I am going with London Scuba on a diving holiday to Egypt this coming Sunday. However I had to go to the emergency dentists yesterday due to arather bad gum infection. The infection has now been flushed through and I have been given two sets of antibiotics (1 weeks course of each). They are 500mg Amoxicillin and 400mg Metronidazole. The course will finish on the day after I arrive in Sharm. Will I still be ok to dive?

A - You will be fine. Gum infections are a bummer. But these are the only 2 antibiotics that can treat them. The former, a standard penicillin. The latter "the antibiotic you can't drink alcohol with". I took metronidazole once, drank a pint of cider and went mental. I had to apologise to Lionel Blair 20 years later. Poor luvvie was doing the summer season in Weymouth as I wandered shouting, alcohol-antibiotic reacting, down the same back street, and called him something when I saw that nice brown quiff approaching me.

Film, book, play. No, it's an insult. 2 words. First word, 2 syllables. I digress.

Give it 3 days for the metronidazole to clear from your body before the Saqqara. And also watch for any pain from the mouthpiece on your gum. That's the only problem really. There are softer, longer bites on some, so try one of those if there's some gob-chafing.

Q - I have a swelling in my jaw on the left hand side under a molar that has been root filled (about 6 years ago). I went to the dentist yesterday, had an X-ray, and the results proved to be uncertain. The dentist is trying to get me an appointment at the hospital for a second opinion. She thinks I have two areas, one of which is between the molars and the bigger area is underneath the root filled molar. She thinks they might be cysts, but is uncertain and was a bit surprised I think. She has put me on amoxicillin 250mg three times a day, as well as metronidazole 200mg three times a day.

Have you ever heard of this before, and could it be related to diving, i.e. I'm gripping my mouthpiece wrongly with my teeth, or griping too hard? I don't think I do bite too hard, but the jaw does feel tired at the end of a full days diving.

The swelling is quite dramatic and painful , and I am a little concerned. Could you please tell me if this might be diving orientated?

A - This is unlikely to be diving related. I assume they are fleshy infected cysts, rather than bony hollow cysts that sometimes occur. The antibiotics you are taking are the standard dental ones, so I assume the former. When you grip a mouthpiece you are using the molars and pre-molars, where your problem is. The amount of time in reality you have a mouthpiece in is small compared to other things you do with your mouth. Like chewing. However when you bite the rubber, so to speak, when you dive, it could worsen a pre-existing problem. But there is something you could try where no bite is involved. It's called the Manta mouthpiece and it has wings that pop out toward the cheeks which pulls the reg up against the mouth so you don't need to bite. It's fairly new on the market so ask your local dive shop to get one in for you to try.

Whilst you are waiting, finish the antibiotics and it all may end up with further root canal work. Good luck, I know how much fun that can be.

(other dive medical questions)



   


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