The following article from Quiet Times was written by my friend and fellow tinnitus expert, Barry Keate. Thank you, Barry. I will reserve comment until near the end of this post.
“Dental Issues and Tinnitus
By Barry Keate
There appears to be a correlation between certain dental procedures and tinnitus. Dental work has the ability to mitigate some types of tinnitus but can also exacerbate and even cause it. Over the years I have heard numerous stories and been asked many questions about the possibility of dental work causing tinnitus. There are several mechanisms by which dental issues can cause or worsen tinnitus. Here is my best effort to untangle some of the mystery of how and why this can happen.
The high-pitched noise of dental drills is the most prominent way tinnitus can be caused or worsened. When the dentist is drilling in teeth, the sound is transmitted by bone conduction directly into the inner ear. It sounds much louder than it normally would because bone conduction has essentially no loss of intensity over short distances.
Some difficult procedures including tooth extraction and others where drilling is intense and long-term can cause noise damage to the cochlea. Wearing earplugs in this case will not be helpful; it will not prevent the damaging sound from reaching the cochlea. Anesthesia will also not be helpful as the damage will continue even though the patient is unconscious.
Dr. Jack Vernon, of the Tinnitus Center at Oregon Health Sciences University (OHSU), states that the best way to avoid hearing loss and tinnitus is to ask the dentist to drill in short spurts. Drill for five seconds then stop for ten seconds, drill for five seconds and stop for ten seconds, and so on. “The exacerbation of tinnitus by sound is a time-intensity function and by reducing the time of each drilling episode, the degree to which this kind of insult will influence the ears is also reduced.” (1)
Ultrasonic Plaque Removal
Ultrasonic cleaning tools for plaque removal can also be a cause of noise-induced hearing loss and tinnitus. These tools operate at a frequency of 12,000 to 15,000 Hz and emit bursts of high intensity sound that lasts for about ¼ to ½ second. Many people have complained of tinnitus due to these instruments.
Many technicians, if asked, will clean patients’ teeth with non-mechanical scaling implements. I have been having my teeth cleaned this way for many years as the ultrasonic devices were worrisome and also were very uncomfortable for me.
Dentists with Tinnitus
High-speed drills affect dentists much more than their patients. Dentists who work with high-speed drills for year after year in their practice are much more likely than those in other professions to acquire hearing loss and tinnitus. Estimates range from a low of 30% of dentists to a high of 100%.
One study conducted in Italy in 2012 compared hearing loss in general dental practitioners (GDPs) and general medical practitioners (GPs). Results were that 30% of GDPs had hearing impairment compared to 15% of GPs. (2)
On the other hand, Dr. Jack Vernon of OHSU reports that a dentist patient of his surveyed all the dentists in Oregon, Washington, Idaho and Northern California. He found that all who had purchased a high-speed drill, which became available in 1955, had high frequency hearing loss and tinnitus. (3)
“Most of the current high-speed hand pieces, such as high-speed drills and scalers used by dental professionals are between 90 and 100 decibels,” says Robert Folmer, PhD, a study leader on hearing loss and high-speed dental tools. “That’s the equivalent of a gas lawnmower or other power tools, which are loud enough to cause hearing loss over time.” (4)
None of the 54 dental schools nationally are known to require dental students to wear ear protection while treating patients and very few dental professionals wear earplugs.
Abscesses, Impacted Wisdom Teeth and TMJ
It is reported that tooth abscesses or impacted wisdom teeth can cause tinnitus. (5) In such cases further dental work may curethe condition. Other times the tinnitus will gradually fade over time. One way this can occur is by aggravation of existingTempero-Mandibular Joint (TMJ) dysfunction. Infection in the tooth or impacted wisdom teeth can cause inflammation that affects the TM joint.
TMJ dysfunction can be treated by dentists who specialize in the condition. They begin by fitting a mouth guard that aligns the lower jaw with the skull. When needed, more advanced, non-invasive therapies are developed to relax the muscle tissues.
There have been isolated cases of bilateral sensorineural hearing loss and tinnitus that occurs following dental surgery to remove impacted wisdom teeth. (6)
Another way that tinnitus can be caused is by the prolonged neck bending that occurs during dental surgery. This is referred to as somatic tinnitus and happens when bodily signals due to muscle strain can influence normal auditory pathways.
Unconsciously clenching the jaw or grinding the teeth is known as bruxism. This is one of the primary causes of TMJ dysfunction and often leads to tinnitus. It is a habit, which can be broken, not a reflex chewing activity. It can originally be caused by a number of conditions including allergy, trauma or high stress. Once bruxism becomes a habit, the original stimulus can be removed and the bruxism will continue.
Bruxism can also be treated with mouth guards, much like TMJ therapy. Further treatments may involve biofeedback or hypnotherapy to promote relaxation.
Mercury Amalgam Fillings
Dental amalgam fillings are commonly referred to as “silver fillings.” However, they contain approximately 50% mercury and only about 25% – 35% silver. Mercury is a neurotoxin and leads to numerous neurological problems including hearing loss and tinnitus.
There is a great debate about the safety of mercury amalgam fillings. The American Dental Association insists they are inert and safe. However, many researchers have found undeniable evidence that these fillings outgas mercury vapor and people inhale it, whereby it is absorbed into the body.
The World Health Organization proceedings of 1991 concluded the average person in the industrial world with an average number of amalgam fillings and no occupational exposure to mercury would absorb, on average, 10 micrograms of mercury per day from the fillings, with a high of 17 micrograms per day. For a 170 lb man, the maximum allowable dosage of mercury is 7.5 micrograms per day, Many scientists think even this allowable dosage is much too high.
(1) From Questions and Answers, Reprinted from Tinnitus Today, June 1998.
(2) Messano GA, Petti S. General Dental Practitioners and Hearing Impairment, J Dent. 2012 Oct;40(10):821-8.
(3) From Questions and Answers, Reprinted from Tinnitus Today, June 1999.
(4) Folmer, R. Hearing Loos and High-Speed Dental Drills. http://www.medicalnewstoday.com/releases/49678.php
(5) Tinnitus: Theory and Management, J.B. Snow, ed. (2004) pp 115-7.
(6) Wilson RH, Witkowski CE, Wilson AA. Bilateral Idiopathic Sensorineural Hearing Loss Following Dental Surgery. J Am Acad Audiol.2009 Mar;20(3):180-6.”
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The above information is accurate and extremely important for everyone in order to prevent hearing loss and tinnitus. It is especially important for anyone who already suffers from these conditions. For more information, visit: TINNITUS CONTROL.
God Bless you,