A Broken Tooth Four Hours Before a Flight to New York

Quick answer: Flying with an unsealed broken tooth is a genuinely bad idea. Cabin pressure changes make an inflamed nerve or a trapped pocket of air hurt sharply at altitude. Get the tooth sealed before you board, even if the definitive treatment has to wait until you are back.

The call

7:40am. Daniel, 41, from Ramat Shilo, on a 2pm flight from Ben Gurion. He had broken a lower molar on a hard roll at breakfast and was, understandably, more worried about eleven hours in a metal tube than about the tooth itself.

We told him to come straight over. This is the kind of appointment where the goal is not perfection, it is getting him on the plane safely with a tooth that will hold for three weeks.

What we found

The lower right second molar had lost a large portion of its distal wall, exposing a wide field of dentine and part of the pulp chamber floor — though not the nerve itself. Cold produced a sharp response that faded within a few seconds. Nothing was tender to tapping, and the x-ray showed no infection.

That is the profile of a tooth that will probably behave, but not one you want to gamble on at 35,000 feet.

The mechanism people ask about is real. Cabin pressure at cruising altitude is roughly equivalent to being at 2,000 metres. Gas trapped in a cavity, under a loose filling or in an inflamed pulp expands as pressure drops. Dentists call it barodontalgia. It is not common, but a freshly broken tooth with an irritated nerve is precisely the situation that produces it.

What we did

Ninety minutes, start to finish. We removed the decay and the unsupported enamel, placed a well-sealed bonded restoration built to the full contour of the tooth, and adjusted the bite carefully so he was not loading it.

We did not start a root canal and we did not prepare it for a crown. Starting a root canal and sending someone abroad with a temporary dressing is a poor idea — if it flares up, they are looking for an emergency dentist in a foreign city and paying accordingly.

He left with a written summary of what had been done, the tooth number, and a copy of the x-ray on his phone, so that any dentist anywhere could pick it up if needed. That takes two minutes and has saved several of our patients a great deal of money abroad.

The outcome

He flew comfortably and had no pain during the trip. Three weeks later we reassessed the tooth. The nerve had settled, so it needed a crown rather than a root canal, which we completed over two visits.

What to do if this happens to you

1. Phone before you head to the airport, not from the departure lounge.
2. Say your flight time immediately. It determines what is realistic.
3. Ask for a sealed, full-contour restoration, not a soft temporary dressing that will wash out.
4. Ask for your x-ray and a written note to take with you.
5. Pack ibuprofen and paracetamol in your hand luggage, and a temporary filling kit from the pharmacy.
6. Do not fly with active swelling or a fever. That needs treating before you travel, full stop.

Travelling soon with a dental problem? Ramat Beit Shemesh Urgent Dental Care keeps same-day slots for urgent pre-travel treatment. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.