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Patient Education
General: Effects of hypoxia are experienced only while exposed to a hypoxic environment. No residual
effects should present. Patient will likely be affected in similar manner by exposure to similar altitudes.
Prevention: Early recognition of the symptoms of hypoxia allows early intervention and avoids performance
decrement. Use pre-mission altitude chamber testing to determine individual team member’s response to
the hypobaric environment.
Follow-up Actions
Return evaluation: If any sequelae present, must consider neurologic DCS. Evaluation by neurologist is
indicated at earliest opportunity.
Consultation Criteria: Consultation with Aerospace Medicine specialist, Diving Medicine specialist, Flight
Surgeon, or Aeromedical PA is helpful but not necessary in uncomplicated cases.
NOTES: Hypoxia is a particular danger for HALO and HAHO missions. There is tremendous opportunity for
impairment of judgement and thinking, which can quickly lead to death or serious injury. Hypoxia may also
manifest less acutely in association with living and working at high altitude. An acute hypoxic event without
complications or sequelae is not grounds for restriction of special duty status.
Aerospace Medicine: Barodontalgia
LTC Brian Campbell, MC, USAIntroduction: Dental decay can produce small pockets of gas in or around teeth. When the ambient pressure
changes, the pressure differential in the trapped pocket of gas cannot be equalized and severe pain results.
This rare condition almost always occurs on ascent. Since barodontalgia may develop during diving or flight
operations, see also Dive Medicine chapter.
Risk Factors: Dental pathology (e.g., active caries, pulpitis, periapical abscess), recently placed amalgam
restorations or crowns.
Subjective: Symptoms
Acute onset of sharp, stabbing pain in a single tooth on ascent. This pain can be quite severe and will
increase in severity with continued ascent. Symptoms abate with return to sea level.
Focused History: When did symptoms start? (acute onset associated with change in altitude [i.e. pressure]
is typical) Did you have a fever or other signs of illness prior to this flight? (may suggest barodontalgia or
other alternate diagnosis) Have you had any dental problems or dental treatments recently? (typical exposure
history; body slowly absorbs free gas, so older treatment less problematic)
Objective: Signs
Using Basic Tools: Obvious dental lesions help make the diagnosis. Percussion of the involved tooth should
exacerbate symptoms.
Assessment: History makes the diagnosis, especially in a patient with risk factors.
Differential Diagnosis
Barosinusitis - may be indicated with maxillary tooth symptoms-look for signs and symptoms of maxillary
sinus involvement
Acute pulpitis or periapical abscess of the tooth - unrelated to pressure changes
Acute infectious sinusitis - may be indicated if systemic symptoms or purulent nasal discharge is present-see
ENT chapter
Plan:
Treatment
Primary: Increase ambient pressure by descent to sea level if possible.
Alternative: Analgesics as required. Consider fracture of tooth or removal/replacement of restoration if