At this point, surgeons have not developed uniform recommendations related to oral surgery and scuba diving: generally, the more complicated the surgery, the longer the wait before diving. Surgical complications will add to this time, as can any underlying medical conditions, tobacco use and alcohol consumption.

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.

Root canals are generally necessary after a tooth nerve has been damaged or the result of existing decay, abscess, or infection. Most root canals are done in patients whose filling may have worn out and allowed some decay in.

First, let's state what might be obvious. If your wife's surgery had been routine, with normal healing, uncomplicated by infection or pain and she could hold a regulator without discomfort, then it would be hard to advise her to wait any longer than she has already waited -- i.e., six weeks. Normally, four to six weeks is sufficient time to allow for the risk of infection, provided there has been good healing and gum tissue has begun to fill in the empty socket. However, the nerve trauma may indicate that her case may be different. I had to consult with two of DAN's referral oral surgeons with experience in dive medicine for assistance on this issue.

Occasionally, proper healing is delayed, often in smokers or older people. In such cases, air can be forced into the subcutaneous tissues by the increased pressures in the mouth during a dive. This condition could further delay the healing process and can be uncomfortable.

Pain can impede the ability to hold the mouthpiece in place; a loosely held regulator during submersion can present a possible drowning hazard. One consultant also cautioned on returning too early to diving based on the softness of the lower jawbone (mandible) after a wisdom tooth extraction. The end of the mandible remains fragile until it's fully healed. Additionally, it is subject to fracturing when pressure is placed on the bone, such as when gripping a regulator in place.

Theoretically, if there is still some localized swelling (edema), offgassing of nitrogen from the area during decompression could be impaired. Although decompression illness in a small area of the jaw seems unlikely, we have insufficient data to be sure.

Finally, some types of pain medicine (those containing codeine, oxycodone or other narcotics) could promote nitrogen narcosis and impair performance and judgment underwater. Both consultants agreed that if you still have symptoms, diving is not a good idea.

Guidelines for diving after most dental surgery include waiting for:

1) A minimum of four to six weeks or until the tooth socket or oral tissue has sufficiently healed to minimize the risk of infection or further trauma;

2) Medication to control pain resulting from the surgery has been discontinued and there is no risk of drug interaction with nitrogen; and

That is not to say that a new diver with braces won't have some soreness or aches after scuba diving. Braces gradually realign the position of an individual's teeth over the course of many months. At any given time, most of the teeth are still mobile.The act of biting down on the bite block of a scuba regulator mouthpiece for a prolonged period of time may produce a little extra stress or tension on a young diver's teeth that are still being realigned.

This may produce a little soreness or tenderness after a couple of dives and perhaps a little jaw fatigue in a new diver. Any diver should be able to properly grasp a regulator mouthpiece for the duration of a dive or series of dives without difficulty in order to dive safely.