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. 2025 Oct 27;25(1):1678.
doi: 10.1186/s12903-025-07068-x.

Occupational health in aviation: a cross-sectional study of barodontalgia among Malaysian air force pilots

Sulhi Abidin  1 , Sofia Azreena Mohd Nazri  1 , Nurhidayu Mazlan  1 , Muhd Sharifuddin Mat Daud  2 , Mohammed Haizar Haron  3 , Munawarah Silam Abu Muslim  3 , Galvin Sim Siang Lin  4
Affiliations

Occupational health in aviation: a cross-sectional study of barodontalgia among Malaysian air force pilots

Sulhi Abidin et al. BMC Oral Health. .

Abstract

Background: Barodontalgia, or pressure-induced dental pain, poses a significant occupational risk to pilots, potentially impairing flight performance and safety. The present study aimed to determine the prevalence of barodontalgia among Malaysian military pilots, identify the associated risk factors, and examine its relationship with flight performance.

Methods: A cross-sectional study employing a census approach was conducted among active Malaysian military pilots between 2021 and 2022 using a modified questionnaire. The questionnaire underwent content validation by five experts and was pre-tested on 10 pilots. Data collection was performed through an online survey. Statistical analyses included descriptive and inferential statistics (Chi-square, t-tests, ANOVA, logistic regression, and ANCOVA), with results considered significant at p < 0.05.

Results: The questionnaire demonstrated excellent content validity. Among the 190 pilots surveyed (63% response rate), 12.1% experienced barodontalgia, most commonly at altitudes of 6,000-10,000 feet, with worsening symptoms at 0-5,000 and 11,000-15,000 feet. Transport pilots reported the highest prevalence (43.5%), and the most common symptoms were headaches (43.5%) and loss of concentration (34.8%). Age was negatively associated with barodontalgia (β=-0.1505, p = 0.023), with younger pilots more likely to be affected. Meanwhile, years of service, aircraft type, smoking, dental awareness, and brushing frequency showed no statistically significant associations (p > 0.05). Gender was a significant predictor when controlling for service years (p = 0.048) but not when controlling for age (p = 0.067).

Conclusion: Barodontalgia is an occupational concern for Malaysian military pilots, particularly among younger pilots. Preventive dental care, targeted treatment, and regular check-ups are essential to mitigate risks and maintain operational readiness.

Keywords: Altitude sickness; Dental care; Military personnel; Occupational health; Pilots.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the International Islamic University Malaysia (IIUM) Research and Ethics Committee with registration number IREC 2020 − 112. Permission to distribute the questionnaire was also obtained from the Chief of the Royal Malaysian Air Force Office with Reference Number MTU.PTU100-2/4-(81). Informed consent was obtained from all participants included in the study. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki. All subjects’ rights were protected, and all data were kept confidential. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Barodontalgia during flight across different age groups of Malaysian military pilots (n=190)
Fig. 2
Fig. 2
Altitude at which barodontalgia begins during flight among Malaysian military pilots (n=190)
Fig. 3
Fig. 3
Consequences of barodontalgia during flight among Malaysian military pilots (n=190)
See this image and copyright information in PMC

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