There are plenty of reasons to have a regular check up with your dentist. Practically all adults (99.7%, according to an American Academy of Cosmetic Dentistry survey) believe that a healthy-looking smile is socially important, and nearly three-quarters of Americans think that an unattractive smile could hurt their chances for career success. But scuba diving enthusiasts may have one more reason to add to the list: All of that underwater pressure could be putting a strain on their teeth, mouths, and jaw.

A new pilot study from the University of Buffalo School of Dental Medicine suggests that scuba divers might be at increased risk for dental problems during and after dives. The study’s lead author, Vinisha Ranna, is both a dental student and a certified stress and rescue scuba diver. She first contemplated the study after her own experiences with diving, where she would frequently experience a condition known as barodontalgia, or a squeezing sensation on the teeth, while underwater.

Barodontalgia is due to the pressure conditions and the equipment involved in scuba diving — including a mouthpiece clenched between the teeth. Ranna set out to discover whether other divers experienced similar challenges.

“The potential for damage is high during scuba diving,” said Ranna. “The dry air and awkward position of the jaw while clenching down on the regulator is an interesting mix. An unhealthy tooth underwater would be much more obvious than on the surface. One hundred feet underwater is the last place you want to be with a fractured tooth.”

As a pilot study, Ranna sent out a survey to 100 healthy adult scuba diving enthusiasts. Some 41% reported dental problems that seemed related to diving, 42% of which were also barodontalgia. Another 24% reported mouth pain, 22% reported jaw pain, and a few even said that their crowns often became loose during dives.

The symptoms were most pronounced for scuba instructors, likely because they spend more time in the water than recreational divers. Based on the results of the pilot study, which were published last month in the British Dental Journal, Ranna plans to extend the survey to some 1,000 additional divers to gain a more comprehensive picture of dental health for humans who take to the waters.

“Divers are required to meet a standard of medical fitness before certification, but there are no dental health prerequisites,” Ranna said, noting that the results might indicate that a pre-diving dental check up might not be a bad idea, either.

“Considering the air supply regulator is held in the mouth, any disorder in the oral cavity can potentially increase the diver’s risk of injury,” Ranna said. “A dentist can look and see if diving is affecting a patient’s oral health.”