What does this mean?
A sound tooth has no free air inside it. Under decay, in the gap beneath a filling that is leaking at its edge, inside a crack or in a root canal that was not filled all the way, a small pocket of air can become trapped. As the aircraft climbs the outside pressure drops and the air in that pocket expands; on descent, or as you go deeper on a dive, the opposite happens and the air is squeezed. This shift in volume presses on an inflamed tooth nerve. This picture is called barodontalgia.
What sets this pain apart from similar ones is its trigger: not hot, cold or biting, but only a change in pressure. The second telling detail is the point in the flight at which it arrives. Pain that starts during the climb is more often described in teeth whose nerve has died or is dying; pain that starts on descent points instead to a tooth nerve that is still alive but inflamed. This distinction does not make the diagnosis on its own, but it tells your dentist where to look.
How many teeth hurt also points the way. If a single tooth hurts, the source is most likely that tooth. If several of the upper back teeth on the same side hurt at once, and you also feel pressure in your cheek and a blocked nose, the source may be the sinus rather than a tooth. The pain clearing completely once the flight is over does not mean there was nothing wrong; it may have gone quiet simply because the pressure has evened out.
Behind pain that shows up with pressure there is usually a problem that went unnoticed on the ground. The headings below are not ranked by likelihood; they show the sources your dentist tries to tell apart with an examination and X-rays.
Likely causes
What helps at home?
- Note down at which point in the flight the pain started, which tooth it was in and how long it lasted after landing; these three details guide the examination before any X-ray does.
- If you have a tooth that has hurt recently, has a broken filling or has treatment left unfinished, have it looked at before you fly or dive; a tooth that is quiet on the ground may not stay quiet under pressure.
- Do not crush aspirin or a similar tablet onto the painful tooth; this leaves a chemical burn on the gum and does not take the pain away.
- If the pain starts during the flight, do not clench your jaw and do not chew anything on that side; clenching makes the pain worse in a tooth that is already under pressure.
- If the pain does not settle after landing and builds over the next few hours
- If there is swelling in the gum around the painful tooth or in your face
- If fever, feeling generally unwell or difficulty opening your mouth has joined in
- If a piece of the tooth or the filling broke off during the flight or the dive
- If pain in the upper teeth comes with pressure under your eye and a foul-smelling discharge from one side of your nose
Frequently asked questions
- Do I need to see a dentist before I fly?
- If you have no symptoms, a flight on its own is not a reason for a check-up. But if you have a tooth that has hurt recently, is sensitive to hot and cold, has a broken filling or has treatment left unfinished, having it looked at before you fly makes sense. A change in pressure does not create new damage; it makes what is already there noticeable. If you are going diving and have had an extraction or surgery recently, tell your dentist the date, as the decision depends on the state of the tooth and the area.
- The pain went away after landing, should I still have it looked at?
- It would be sensible to have it looked at. Pain stopping once the pressure has evened out is expected, and it does not mean the source has put itself right. The same tooth may hurt again on your next flight. An examination and an X-ray often show decay that cannot be seen by eye, a filling that is leaking at its edge, or a part of a root canal that was left empty.
- Could this pain be coming from my sinuses?
- It could. The roots of the upper back teeth sit close to the floor of the sinus, and a change of pressure in the sinus can be felt as pain in those teeth. The difference usually shows up like this: with sinus pain it is not one tooth but several upper teeth on the same side that hurt at once, and a blocked nose comes with it. Pain coming from a tooth gathers in a single tooth. Telling them apart for certain is done by an examination and, where needed, imaging.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.