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Dental work and Vertigo

Timothy C. Hain, MD Most recent update: July 19, 2010

There is a modest literature concerning dental work and vertigo. For students -- a good topic for research ? Nevertheless, as a result, the content of this page is based on a combination of consideration of mechanisms and clinical material from the author's dizziness practice in Chicago Illinois.

General categories of disorders where dizziness might be associated with or provoked by dentistry include:

Clinical observations and commentary on dizziness associated with dentistry

brandt daroffdix-hallpike

BPPV: is by far the most common cause of dizziness reported to be associated with dentistry ( Brauer, 2009). There are so many papers published that we do not list them all (see references). For the most part, reports are associated with blows to the jaw -- such as use of the "osteotome". It would also seem very logical that vibration associated with dental area drilling might cause BPPV.

Another source, much more rarely reported, is when positional vertigo triggered in the person who is supine or head turned on the side during the dental encounter. The illustrations above shows positions that typically trigger vertigo. Positions where the body is supine and head turned to either side are equally provocative. This situation nearly always is due to a very common ear condition -- benign paroxysmal positional vertigo (BPPV), which fortunately is generally easily treated.

Cardiac conditions -- do not seem to be a common cause of dizziness during dentistry. We suspect that this is due to a tendency for participants to accept as normal a rapid heart beat. We have never encountered anyone who has indicated that dizziness was accompanied by angina pain or an event that could be interpreted as being due to low blood pressure, in the course of dentistry. So to summarize, this seems very unlikely.

Migraine - similarly, migraine associated dizziness does not seem to greatly interfere with dentistry.

Hyperventilation -- Clinically this is not a substantial problem. We think that this is due to the fact that HVT induced dizziness is usually transient, minor and fairly easily ignored.

Psychiatric condtions - - dentistry can be painful and anxiety provoking. It is not surprising that dizziness can be a consequence. We know of no papers published on this assocation.

TMJ and TMD (temporomandibular joint or temporomandibular dysfunction) :

According to literature published by the dental community (e.g. Tuz, Onder, et al. 2003; Lam et al. 2001), ear (otologic) complaints are common in persons with TMJ/TMD. Typical reports (including ear pain) have prevalence much greater than 50%.

It is our position that TMJ or TMD and vertigo are both common medical conditions, but there is almost never a causual relation. TMJ disorders are essentially a type of arthritis. While the joint is close to the ear, it does not have any direct connection to the inner ear. Accordingly, the hypothesis that TMJ "causes" vertigo is very implausible. As another example, although the heart is just underneath the ribcage, it would be implausible to attribute heart-attacks to arthritis of the ribs. Neverthless, there are numerous examples of individuals with the opposite opinion -- suggesting, for example, that Meniere's disease might respond to treatment of the TMJ( Bjorne and Ajersberg, 2003).. In our opinion, these papers are simply mistaken.

Salvetti et al. (2006) pointed out that that the methodological problems with studies of this nature are common. There are several logical places for mistakes in papers published by the dental community in regard to TMJ/TMD are mistaking dizziness provoked by their procedures (i.e. positioning) as being caused by the disease that they are treating, and certainly attributing pain associated with TMJ/TMD to an inner ear source. We are especially dubious about small, uncontrolled studies.

There are also reports of hearing disturbances in TMJ/TMD. This is interesting, but we would like to see confirmation using a more objective methodology than subjective audiograms.

Some simply report that vertigo or tinnitus improves after treatment for TMJ, e.g. (Wright, 2007). This is a less aggressive claim. It does seem possible to us that reduction of discomfort in one part of the body might provide more cognitive resources to deal with discomfort in another part of the body.

Diagnosis of Dizziness associated with Dentistry

As is the usual situation with dizziness, the first step to sort out the condition.

A careful history is the beginning. While it has not been our experience that many patients will report dizziness associated with dentistry, they will nevertheless commonly report dizziness associated with particular head positions or exercise.

Office(bedside) testing is the next step. One should also attempt to reproduce positioning of the head (Dix-Hallpike testing), as well as have the patient strain and hyperventilate, while monitoring eye movements with a video frenzel goggle system. Persons who have psychological disturbances (i.e. anxiety or malingering), should have no substantial exam findings, or might refuse office testing -- usually claiming that the vertigo is so severe that a diagnostic evaluation is impossible. This is highly unlikely as with appropriate medication, any patient can be examined successfully.

Laboratory testing is not always needed -- if a person has BPPV, one can simply proceed on to treatment. However, in situations where the diagnosis is not so clear, the tests above should be considered.

Audiometry seems very reasonable. According to Pekkan, G., S. Aksoy, et al. (2010). TMD patients with otological complaints have hearing impairment at low frequencies and also perhaps, at high frequencies. As audiometry is a subjective test, and because this conclusion is illogical (see discussion above) we would like to see the results of an objective test such as OAE.

Treatment of dizziness associated with dentistry

As there are several causes of dizziness associated with dentistry, it follows that there are also many approaches to treatment. In most cases, and especially with positional vertigo, one can correct the underlying inner ear dysfunction and allow the person to go about life normally. Occasionally of course, individuals will instead find ways to modify the way that they go about their activity. In this case, it is still very helpful to know what triggers the vertigo, how long it lasts, and what can be done to mitigate it's effects.

Medication can be useful, especially vestibular sedatives. Particular useful medications are listed below:

References:

 

Copyright October 6, 2013 , Timothy C. Hain, M.D. All rights reserved. Last saved on October 6, 2013