Have you ever stood up too fast and caused yourself to be dizzy? As a child, do you remember the feeling of spinning fast on a merry-go-round and suddenly stopping, but the world around you continued to spin?
Now, imagine you are standing still, not moving, and the room starts spinning around you. Although your body is still, you feel you’re losing your balance. Suddenly you feel nauseated because you can’t get the room to stop spinning. Finally, think of how it would feel if this sensation lasts for several hours.
This is how many people feel with various forms of vertigo.
I recently had a patient for a moderately long dental appointment, probably about 2.5 hours. When we were finished, the patient said they felt well, thanked us for our service, and left in a stable and ambulatory state. The next day the patient’s spouse called our office and reported the patient was experiencing dizziness if they tried to get up and walk. Furthermore, the dizziness was inducing some significant nausea. These symptoms slowly got better throughout the day, and by noon the following day the patient was fine.
This patient had experienced a significant vertigo episode shortly following her dental appointment. They had never experienced vertigo problems like this before. This begs the question: can dental work cause vertigo? This post will explore the relationship of vertigo and dental visits.
What is Vertigo?
As described above, vertigo is a sensation of dizziness or lack of balance. Patients often report they feel the room is spinning, even though they are standing still. Obviously this can be quite a disconcerting experience!
There are several different types of vertigo, but the one appearing to be most associated with dental work is benign paroxysmal positional vertigo (BPPV). It is the most common type of vertigo observed in the general population.
Most causes of BPPV are unknown, but some inner ear disorders and trauma to the head have been known to cause it. Several risk factors have been identified which include bed rest, osteoporosis, migraines, and some vascular factors.
It is believed BPPV is induced by small calcifications in the ear that dislodge and collect in the vestibular canals. The vestibular canals are the part of the inner ear that affect your sensation of balance from your head position relative to gravity.
Many times, patients with BPPV will experience symptoms on and off for a few days, sometimes even weeks. The symptoms may disappear for weeks or months, then return again.
A Look at the Literature
There have been a number of case reports that document the onset of vertigo symptoms following dental visits. Until 2016, no major population-based studies had been published. This study by Tzu-Pu Chang, et al. explores onset of BPPV in the general population in Taiwan. It pays particular focus to those who had recent dental work.
The study found a correlation between recent dental work and onset of BPPV symptoms. It took note of patients with BPPV onset within 1 month following dental work and those with BPPV onset within 3 months. They documented a statistically significant difference between those receiving recent dental work and the control groups.
The study also explored the types of dental procedures performed to explore their relationship to BPPV onset. However these were reported as very broad fields. For instance, one of the procedures reported was “prosthodontics”. Prosthodontics is an extremely broad field of dentistry that is further divided into “fixed” and “removable” sub-fields. Techniques and procedures for fixed prosthodontics are totally different than those of removable prosthodontics.
I didn’t put much stock into this section. The procedures explored were far to broad and non-specific. Instead, I would like to have seen a focus on appointment length and chair position rather than the very broad types of dentistry performed.
Can Dental Work Cause Vertigo?
Based on the available evidence, it is difficult to conclude that dental work is a direct cause of BPPV.
Onset of BPPV symptoms seemed to correlate with recent dental visits in the Taiwan study. However, it is still not clear if these patients already had BPPV and dental work merely induced the first onset of symptoms.
I would say it is a possibility that should not be ignored. Furthermore we still do not know why dental work would cause onset of BPPV symptoms. I have a few educated guesses on the matter.
First, patients often need to turn their heads left and right during dental procedures to provide the caregiver access to different parts of the mouth. It is known that turning of the head in this manner can bring about BPPV symptoms.
Another possibility is the length of time the patient is supine (laying on their back) in the chair. Many patients sleep with multiple pillows at home and do not sleep in a totally supine position. The length of time spent supine while turning the head left and right could also be an inducing factor for BPPV symptoms.
Finally, another possibility could be related to the micro-vibrations experienced with the dental handpiece (or “drill”). These micro-vibrations could cause calcifications already deposited in the vestibular canals to circulate. This would send confusing signals to the brain related to balance and head position.
The bottom line I draw from all of this is: It’s difficult to conclude that dental work directly causes BPPV, however the correlation between the two cannot be ignored.
Treatment for Benign Paroxysmal Positional Vertigo
There are several different ways to treat BPPV. Several in-office remedies exist that can be performed to alleviate symptoms, or in some cases cure BPPV altogether. There are also reported home remedies and surgical interventions. This article goes into some detail about the treatments available.
Our recommendation is to discuss treatment options with your physician. A joint effort by your dentist and PCP can get you to the doctor with the right knowledge and skill set to help. As is often the case with many conditions, treating BPPV is a team effort!
Tell Your Dentist!
If you have a history of vertigo of any kind, it is extremely important to notify your dentist and their staff team. Each patient should be received and treated differently based on their health needs. We strive to create an environment where patients’ individual needs are met so they do not have to be nervous about dental treatment!
There are several things your dentist can do to mitigate the risk of BPPV symptom onset.
I usually recommend shorter visits for patients with a history of vertigo. We have several patients who come for their routine cleaning appointments and have no problems. However, those same patients often feel much dizzier after a longer appointment such as a crown prep. I try to keep their appointments around an hour in length, and ideally no more than 90 minutes.
Chair position is also important! Vertigo patients will often notify us to not lean the chair too far back. I make it a routine practice to let patients dictate how far back they are willing to lean in the chair. I want to maximize my ease of access to the mouth in order to work most efficiently, while keeping the patient in a comfortable position.
Finally, we will attempt to minimize turning the patient’s head during procedures. Certain parts of the mouth are easier to access when the patient is facing toward or away from the dentist. This keeps the dentist from having to excessively bend his/her back, neck, and shoulders to perform treatment. While all dentists have their ideal chair position for treatment, it does not work for every patient. I would much rather bend a little awkwardly for one short appointment rather than induce a vertigo episode in my patient that could last for a day or more!
Our chart program has a feature where we can set pop-up alerts for individual patients. If you tell us you have a history of vertigo, we will set an alert that will pop up on our screen any time we access your chart. This way, we have constant reminders of your treatment modifications to keep you comfortable!
I’ve had 2 patients so far in my career that had their very first vertigo episode either in the dental chair or in the 24 hours following an appointment. In both cases, the patients kept me informed of their condition. We were able to work together to manage the vertigo and keep the patients’ mouths healthy!
I want to give special thanks to one of these patients who inspired this post. This person kept me informed of their condition and helped find a lot of the background information and research used to write this post. Due to privacy laws, I can’t credit this person here by name. But, you know who you are, and I want to say thanks!
Based on the available literature, there is clearly some correlation between dental procedures and onset of vertigo symptoms. However it is still unclear whether dental treatment directly causes the underlying conditions for BPPV.
Dentists and patients alike should be aware of this link. Patients should be thorough and communicative with their dentist in regards to their health history. Likewise, dentists should be prepared to observe treatment modifications on behalf of their patients’ comfort.
Have you ever had vertigo symptoms seemingly linked to a dental visit? What triggers your vertigo, and what helps prevent vertigo episodes? Let us know in the comments.