Here's a list compiled over the years of commonly asked questions. The list was created by DAN MDs and represent specific, evidence-based recommendations our member should take into consideration.
During post-surgical osseointegration (the fusion of the implant into the bone), it is necessary to avoid anything that could apply pressure to the skin over the implant and cover screw or the healing abutment.
Diving too soon after surgery with its resultant pressure, no matter how slight, could damage the site. For example, if the regulator’s bite tabs are over the implant site, transmitted biting forces can result in implant failure. There are other considerations as well. Diving should be suspended for as long as it takes to avoid other complications associated with oral surgery:
- revascularization (resumption of blood flow);
- stabilization of the implant;
- oral and sinus cavity pressure changes;
- ability of the patient to hold a regulator in the mouth; and
- use of medications for pain or infection.
Bone grafting procedures and sinus surgery are more complex and will require a longer waiting period. The larger the graft site, the longer the wait. Some doctors will recommend avoiding any activity that causes micro-movement for at least six months. It can actually take up to one year for complete bone healing at an implant site. While diving sooner than one year may not cause a problem, your surgeon should determine the appropriate time period. Even if your surgeon doesn’t dive, follow his or her advice.
As your implant is a molar, then the problem with the regulator bite does not apply but the other concerns remain.
Diving does not mean any particular problem for both procedures. Therefore, as soon as your maxillofacial surgeon authorizes you to perform normal activities of daily life, you will also be able to dive again.
Root canal therapy is generally necessary after a tooth nerve has been damaged from a direct blow to the dental area or the result of decay, abscess, or infection.
Most root canals are done in patients who are over 50 years of age and who have had one of these events occur after a lifetime of using their teeth.
In the thousands of certified divers over age 50, root canals are rarely reported. In all likelihood, the problem was just coincidental and would most likely have occured even if you had not participated in scuba diving.
There is a small risk of infection immediately after a root canal, but once you are released by your dentist, you should have no problem when diving.
Commonly, IBD usually occurs to divers aged 20 to 40 years and who experience the following:
- Intermittent disease with long periods of normal bowel functioning; and
- Complications including anemia, electrolyte disturbances, dehydration, poor absorption of fluids, liver disease and generalized fatigue.
Drug treatment often involves corticosteroids, which can impair one’s ability to fight infections.
Fitness and diving
Someone with symptomatic IBD should not dive until treatment has caused remission and they do not need medication. A person experiencing no significant complication of IBD or its treatment and has adequate cardiovascular fitness could consider diving.
Next the damage to the lung must be assessed.
Scarring and/or adhesions may prevent proper gas exchange, making diving unsafe. DAN is not in a position to determine an individual’s fitness for diving; a physician must make that decision. The best way to begin the process of assessing your fitness to dive is to get a high-resolution spiral CT scan to determine if there is damage to the lung tissue. If there isn’t, and exercise tolerance is normal, diving can be considered.
Pulmonary hypertension and other associated medical conditions may restrict your exercise tolerance.
Certain medications can have side effects that might limit your ability to dive safely, so you should discuss all medications you take and your complete medical history with your doctor.
If your doctor approves your return to diving, request this approval in writing so you can provide documentation to dive operators, who will likely require a written statement before allowing you to dive.
at upper airways and bronchial level is completely recovered and thus you may discontinue the medication therapy.
This is because of two reasons:
- If it occurred without any injury (so the name “spontaneous”), it can happen again at any time. In fact, there are some statistics showing that half of those persons who had spontaneous pneumothorax in the past, will have it again in future.
- If pneumothorax occurs while diving, any decrease of pressure, for example during surfacing, will increase volume of air in the pleural cavity leading to a tension pneumothorax, when internal pressure will compress the lung and the heart.
This is a real life-threatening disorder, especially when occurring underwater, just after surfacing or even on the diving boat. All in all, the risk is too high for potentially fatal consequences, so you should understand that you should avoid diving. And this restriction expands also for any hyperbaric exposures, like for example hyperbaric chambers, even for training purposes.
FITNESS AND DIVING ISSUES
Research has shown that accidents in general are more common among women during PMS. If women suffer from premenstrual syndrome, it may be wise to dive conservatively during this time. There is no scientific evidence, however, that they are more susceptible to decompression illness or dive injuries/accidents.
Also, individuals with evidence of depression or antisocial tendencies should be evaluated for their fitness to participate in diving: they may pose a risk to themselves or a dive buddy.
As a rule, if no side effects or a documented greater individual risk of thrombotic events are present (but this would also affect the prescription of the contraceptive), also the use of oral contraceptives does not have any contraindications connected to diving.
This said, the practice of choosing more conservative dive profiles is strongly advised (dives without decompression stops, no more than two dives a day, maximum depth within 30 meters, bottom time within 70-75% of the maximum limit, possible use of Nitrox with dive times calculated for air).
In the first few months, we recommend to stay within the limits of “no-deco dives”, i.e. dives which don’t have mandatory decompression stops – after all, the bodily changes induced by these 9 months of pregnancy should not be underestimated.
Only one disadvantage may occur when your wife dives during the months she is still breastfeeding: the pressure exerted by the dive suit on the chest and on the breasts could (in some cases) reduce milk production (it is a known technique for woman who want to stop breastfeeding, to wear tight clothes or bandages around the chest).
But as your wife will not wear the dive suit all day, this risk isn’t very high.
Although nitrogen accumulates in all of the tissues and fluids of the mother’s body, washout of inert gas occurs quickly after a safe dive.
Insignificant amounts of nitrogen may be present in the mother’s breast milk, but it is inert and poses no risk to the infant. However, because of the possible risk of bacterial growth on the skin under a suit, careful cleansing of the breast after diving and before feeding may help prevent systemic illness.
Since the evaluation is extremely delicate and complex, I advise you to talk to a specialist in diving medicine, who should visit the girl and can then give you a direct assessment.
His/her opinion will then need to be compared and cross-checked with that of the neuropsichiatrist who follows the girl.
- Accumulation of carbon dioxide in the blood caused by wrong breathing techniques. These headaches are very severe and last quite a long time.
- Unfavorable diving position with overextension of the cervical spine. Often hardening of the neck muscles can be found.
- Biting the mouthpiece of the regulator too hard can lead to overstressing the chewing and postural neck muscles and can therefore also lead to severe headaches, which should, however, resolve swiftly after the dive.
Some cases present accompanying seizures, learning disability and speech defects. Diving fitness depends entirely on the extent of disability in the individual case.
Candidates with mild problems may qualify; candidates with more severe disabilities may qualify through one of the scuba programmes for disabled people.
The absence of seizures and the ability to master water skills are particularly important.
For participation in scuba, case-by-case selection is needed.
As with epilepsy, any loss of consciousness underwater is likely to have a bad outcome. When diving using nitrox or mixed gas as a breathing gas, increased partial pressures of oxygen can increase the likelihood of seizures. Increased carbon dioxide may also increase seizure risk. The best advice is to get a precise diagnosis of the cause of these altered states of consciousness: effective treatment is often available. You cannot make a reasonable fitness-to-dive decision until this is sorted out. It may take some time and a visit to a neurologist or other specialist is necessary.
Fitness & Diving
- There is no evidence that diving in itself has an effect on the disease. About 20 years ago an unsuccessful effort was made to treat MS with hyperbaric oxygen. Patients neither suffered nor benefited from this treatment.
- Persons with MS are advised not to exercise to the point of exhaustion and to avoid becoming chilled or overheated. Diving candidates with MS should respect that advice.
- In each individual case, consider whether the candidate can handle the physical load and master the water skills. Diving candidates should talk to their DMO and neurologist about diving.
In this specific case the third condition is not satisfied, therefore I suggest you to recommend your student to be assessed by a specialist in diving and hyperbaric medicine in order to evaluate his fitness to dive in relation with his medical history
Even though the fast-acting nature of decongestants can be appealing, there are several reasons why steroids may provide a safer option.
The swelling and inflammation of the cells lining the Eustachian tubes, middle ear space and sinuses may lead to occlusion and barotrauma. The mucous membranes lining these structures are vascularised and decongestants provide a short-term solution to congestion by constricting the blood vessels in the mucous membranes, which decreases swelling.
When the decongestants wear off, however, the blood vessels are no longer constricted. The after effect is that the blood vessels will swell and may become more engorged with blood that before, which is known as the rebound-effect.
Unlike decongestants, steroids do not act as vasoconstrictors, so there is no rebound. Another disadvantage of decongestants is that they are only intended for short-term use and may lose effectiveness with habitual use.
The steroid, fluticasone propionate, and similar medications, on the other hand, are intended to be used over substantially longer periods of time than decongestants. So prevention of a middle-ear barotrauma is best achieved by avoiding nasal decongestants and by training the diver in correct middle-ear equalization techniques during descent.
After this, again, an ENT doctor has to decide whether diving can be resumed.
The altered anatomy of the ear after complete healing absolutely necessitates the precise examination by a specialist who tests the endurance and equalization capacity in such cases.
While these variables make it difficult to quantify tiredness as a symptom of decompression sickness (DCS), unusual fatigue has long been documented in association with other symptoms of DCS.
The mechanism behind fatigue as a symptom of DCS remains elusive, although it is possibly a response to a cascade of physiological events taking place in various tissues.
It could be through direct stimulation of nervous tissues or indirectly through the stimulation of other tissues. It is possible that the attention currently being directed toward identifying biochemical markers of DCS will help resolve the questions.
In the meantime, it is reasonable to say that DCS represents a complex, multifocal response to a decompression injury. Unusual or “undue fatigue” (that in excess of normal fatigue for a given individual and diving exposure) is a recognized symptom.
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