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AD 2016 Q4

Alert Diver is the dive industry’s leading publication. Featuring DAN’s core content of dive safety, research, education and medical information, each issue is a must-read reference, archived and shared by passionate scuba enthusiasts. In addition, Alert Diver showcases fascinating dive destinations and marine environmental topics through images from the world’s greatest underwater photographers and stories from the most experienced and eloquent dive journalists in the business.

RESEARCH, EDUCATION &

RESEARCH, EDUCATION & MEDICINE FROM THE MEDICAL LINE Diving with Dental Implants DAN MEDICS AND RESEARCHERS ANSWER YOUR QUESTIONS ABOUT DIVE MEDICINE. Q: I’m going to see an oral surgeon next week for dental implants; will I ever be able to dive again? A: A dental implant is a titanium post or frame that’s surgically placed in the jawbone. An implant replaces a natural tooth root and provides a base for mounting replacement teeth or a bridge. There are multiple steps in the process of dental implantation, and each step has its own restrictions on diving. The steps can be completed simultaneously as a same-day implant or extended over time. Your dentist or oral surgeon is your best resource, but the following information may be helpful. In general, diving is not recommended until all healing is complete, the implant has had adequate integration time and the appropriate dental restoration is in place. The initial step is extraction of a damaged tooth. At the time of the extraction, several things may happen. A bone matrix (bone graft) may be placed in the socket to provide a suitable site for the future implant. Placement of grafting material depends on the site in the jaw and the density and thickness of the surrounding bone. Alternatively, the tooth could be extracted and the socket allowed to heal naturally. Or the implant might be placed at the time of the extraction. The placement of the implant is the most critical step. Your implant specialist will drill a precise hole into the bone and screw in a threaded titanium post. Following this procedure, you will need to avoid diving for an extended period to allow osseointegration of the implant. Fusion of the titanium implant and the surrounding bone is crucial to success. Anything that interferes with this osseointegration, including micromovement of the implant, infection, etc., can cause the implant to fail. There is no specific research on dental implants and diving, and dentists’ opinions about time out of the water vary. Some will suggest a minimum of three ISTOCKPHOTO.COM 56 | FALL 2016

months, while others advise six to 12 months before resuming diving (or other activities that put stress on the teeth). Please follow your dentist’s recommendations about healing time. While some dentists may not know diving, they should have a recommendation about how long to avoid dental stress. The final steps are relatively simple and will not appreciably affect diving. The inserted titanium implant is topped with a small post. The dentist will access the post and place the final appliance. This may be a crown, an anchoring point for a bridge or a similar reconstruction. If the osseointegration has already occurred, diving can generally be resumed after a few weeks to allow the gums to heal. Once the final device or crown is in place, the implant can be treated like any other tooth. Keep it brushed and flossed, and it should serve you well. Consider a trial run in a pool to see how the bite wings of your regulator’s mouthpiece fit the final reconstruction. — Frances Smith, MS, DMT, EMT-P Q: and are there any implications for diving? I have a student who has a neurostimulator for back pain. What exactly is a neurostimulator, A: Neurostimulators are surgically implanted devices that have some similarity to cardiac pacemakers. Used for chronic pain as well as other conditions ranging from gastrointestinal problems to Parkinson’s disease, they are implanted under the skin and have leads (wires) that run from the device to the areas in need of stimulation. Neurostimulators used for chronic back pain are often placed in the abdomen or upper part of the buttocks, and the leads are placed in the epidural space near the spinal cord. As with other implanted electrical devices, there are some issues divers should consider relative to both the device itself and the underlying medical condition. COURTESY ST. JUDE MEDICAL, INC. • Includes all meals, beverages and transfers • Free Nitrox • Tech diving available • Nine spacious suites ALERTDIVER.COM | 57