Imagine you’re floating in the void, 384,000 kilometers from Earth. You’re Neil Armstrong or Buzz Aldrin on Apollo 11, and the whole world is watching you, but suddenly, you feel a sharp, excruciating pain in your mouth. 
1) Risks for astronauts in space
1A) Can a toothache kill you?
It’s a tooth that starts throbbing violently, preventing you from concentrating on landing. What do you do? You can’t call an ambulance, you can’t go to a dentist, and you can’t go to the ER for treatment. But the worst part is that you can’t just “tough it out,” because in space, A toothache can kill you. 
1B) Invisible dangers in space
Today we’re leaving Earth to explore Space Dentistry, a fascinating story full of invisible dangers, teeth exploding from the pressure, and toothpaste astronauts have to swallow. Get ready, because what you’re about to hear surpasses any science fiction film.
When we think about the dangers of space, we imagine the lack of oxygen, radiation or the cold, but during the space race, NASA had a much more earthly fear: the teeth of its astronauts.
1C) What is barodontalgia or aerodontalgia?
To help you understand, I’m going to explain a physical phenomenon called Barodontalgia or aerodontalgia. It is a pain caused by sudden changes in pressure because, when a gas is trapped, it expands or contracts according to the external pressure.
1Ca) Can astronauts suffer from barodontalgia?
Imagine that an astronaut has a small hidden cavityor an old, poorly done filling with a tiny air bubble trapped underneath.
As the rocket lifts off and leaves the atmosphere, the pressure drops drastically, and the air trapped inside the tooth tries to expand with brutal force. What happens at that moment? It presses directly against the nerve, causing such extreme pain that it can be debilitating, almost maddening, and can incapacitate a pilot or astronaut in seconds.
1Cb) Can pilots suffer from barodontalgia?
In fact, during World War II there were already cases of pilots who lost control of their planes, blinded by this pain while ascending.
2) NASA and its strict dental protocols
That’s why NASA dentists became the strictest guardians of the Apollo program, and to that end they created a prevention program that required astronauts, before boarding the spacecraft, to achieve the “Class I” category, perfect oral health.
They were so strict that if there was the slightest doubt about a tooth, it was dealt with however necessary.They would even replace old fillings with high-quality amalgams or gold fillings.to ensure that not even the smallest air bubble remained trapped. Some astronauts even had healthy wisdom teeth extracted just as a precaution.
They had a very clear philosophy. In space, prevention is the only medicine, and nobody wanted to be responsible for aborting a moon landing because of a dental infection.
3) Dental hygiene in zero gravity
But once you’re up there… How did Neil Armstrong and his crew brush their teeth?Because that’s another problem. On Earth, spitting in the sink is easy, but in zero gravity it’s a disaster. If you spit liquid, it doesn’t sink; instead, it breaks into thousands of floating spheres that can get into electrical panels or cause short circuits. So spitting out the toothpaste wasn’t an option.
3A) Special toothpaste for astronauts
What did they do to solve it? For Apollo 11, NASA developed a special paste called “NASAdent” that had two key features. First, it didn’t foam. And second, and more importantly, it was edible.
Armstrong and his crewmates followed a hygiene protocol: brush their teeth with this toothpaste and, upon finishing, swallow the mixture of toothpaste and bacteria. It was the only safe way to keep their mouths clean without endangering the spacecraft.
4) What protocol should astronauts follow in case of incapacitating toothache?
But despite all this, the question remained. What if something went wrong? What if, in the middle of the journey to the Moon, an emergency arose? uncontrollable phlegmonWell, it had to be fixed somehow. For this purpose, in the Apollo 11 first aid kit, along with the bandages and motion sickness pills, there was a small emergency dental kit.
But don’t expect cutting-edge technology; NASA’s solution for extreme pain boiled down to two options: massive doses of antibiotics and painkillers, and if that didn’t work, the tooth had to be removed with forceps.
The protocol stated that if an astronaut couldn’t tolerate the pain, one of their crewmates would have to act as an “accidental dentist.” Imagine floating in zero gravity, holding onto your partner as best you can, with a basic injectable local anesthetic, and having to pull the tooth out right there with pliersWithout a doubt, it would be the most terrifying extraction in history.
5)The ordeal of Russian astronaut Yuri Romanenko
Fortunately for them, we know that in Apollo 11 it wasn’t necessary; none of its astronauts had dental problems, but others weren’t so lucky, like the Soviet cosmonaut Yuri Romanenko.
In late 1977, Romanenko commanded the historic Salyut 6 mission alongside a colleague. Their objective was to break the record for time spent in space, but halfway through the mission, Romanenko began to experience a minor toothache.
At first, Romanenko tried to hide his pain from mission control on Earth. Like any good commander, he didn’t want a toothache to jeopardize a multimillion-dollar mission or show weakness to his superiors, but the pain became so unbearable that he had to confess it to his flight partner.
5A) A toothache 27,000 km from Earth
Imagine being locked in a metal cylinder the size of a bus, orbiting the Earth at 27,000 kilometers per hour, unable to sleep because of the pain, and knowing that you can’t turn around and go home.
5B) Yuri Romanenko and his remedy for toothache
The big problem was that the Soviets hadn’t included a proper dental extraction kit, but what did Romanenko do? He just suck it up and endured absolute torture for two whole weeks. And to try and ease the pain, he resorted to a desperate remedy. He spent the day with his mouth full of hot water, holding it directly over the infected tooth, to try and soothe the throbbing nerve, even if only for a few minutes.
It was 14 days of agony in which he had to continue working, carrying out experiments and complex space maneuvers with a pain that, here on Earth, would send us straight to the Emergency Room crying.
5C) How can a toothache incapacitate an elite commander?
And of course, when they returned to Earth and the capsule landed, you can imagine that Romanenko’s number one priority wasn’t celebrating the record, but going straight to his dentist.
That two-week ordeal was a historic turning point, because it showed that such a tiny pain could completely incapacitate an elite commander and put all space agencies on alert, changing dental protocols in space forever.
6) The evolution of space dental protocols
Today, on the International Space Station, they have much more advanced kits for temporary fillings and even have remote assistance from dentists on Earth, but everything I’ve told you still applies. Space dentistry remains a priority because, as we’ve seen, reaching other worlds can depend on something as simple, yet vital, as having a healthy mouth.
So, if you’re feeling too lazy to brush your teeth or go to the dentist today, remember Neil Armstrong swallowing his toothpaste. At least you have a sink and gravity to help you spit it out.
Would you be able to pull your own tooth if you were alone on Mars?
