Why teeth hurt during flights

Why does a tooth hurt on a plane?

A passenger cabin is not held at ground-level pressure. Once the aircraft reaches cruising altitude, the pressure inside matches an altitude of roughly 1800–2400 metres. As pressure falls, air trapped in a sealed space expands. If a small pocket of air sits inside a tooth or under a filling, that expanding air presses on the tissue around it, and the pressure is felt as pain. Dentists call this barodontalgia.

The ache ranges from a dull throb to a sharp jab that makes eating awkward. In most people it involves a single tooth and settles soon after landing. If it carries on once you are back at ground level, the flight has brought a real problem to the surface.

Climb or descent?

Remembering which phase the ache began in is a genuinely useful clue for the dentist. On the climb, pressure drops and trapped air expands. On the descent, pressure builds again and the air is squeezed. The same tooth can behave differently in each phase.

• Pain that begins during the climb is described more often in teeth where the nerve is still alive but inflamed.
• Pain that builds on the descent stands out in teeth with inflammation at the root or in teeth that have had root canal treatment.
• A small pocket of air left under a recent filling can ache in both phases during the first few flights.

The flight uncovers a problem, it does not create one

A change in pressure does not hurt a sound tooth. What flying does is make visible something that has been progressing quietly: decay that has gone deep, an old filling leaking at the edge, a tooth with inflammation at the root, or a pocket of air left under recent work. Teeth that give no symptoms on the ground announce themselves the moment the pressure drops.

So a tooth that hurts in the air is not a tooth harmed by the air. Even if the ache fades after landing, that tooth is worth looking at. Where the source is never found, the same tooth will ache on the next flight and keep progressing in between.

Upper back teeth and the sinuses

The roots of the upper back teeth sit very close to the sinus in the upper jaw, the air space behind the cheek. During a cold, an allergy or a sinus infection, the pressure balance in that cavity is disturbed, and flying refers the ache to the upper back teeth. One sign separates the two: sinus pain is felt in several neighbouring teeth at once rather than in one, and it grows worse when you lean forward.

What a dental check before a flight covers

When a long journey is planned, a check a few weeks beforehand heads off most surprises. Decay and fillings that leak at the edge are examined on an X-ray and renewed where needed. After a new filling or root canal treatment, a few days is usually enough for things to settle; how long to wait is decided by the dentist who did the work.

The fullness in your ears clears when you swallow; a tooth has no such movement, which is why the ache can last the whole flight.

Should a flight be postponed?

That depends on the person and on the state of the tooth, and the decision belongs to the dentist who examines you. As a rule, after a recent extraction, a drained abscess or a tooth left open, a dentist may ask for a delay of a few days. After a straightforward filling or a scale and polish, no such restriction is expected.

If the ache starts in the air, there is only so much to be done: chew on the other side, keep away from very hot and very cold drinks, and tell the cabin crew if the pain turns severe. Even when it clears after landing, the tooth still needs to be looked at.

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