Dizzy 5 days after tooth extraction

Can Dental Work Cause Vertigo?

Q1. I recently had all my teeth scaled at the periodontist to remove the plaque and tartar from above and below my gum line. This involved a lot of injections, a tooth extraction, and an implant at the same time. I also recently went to a regular dentist for some fillings and a crown. All of that took a lot of injections. Do you think the vertigo I’m now experiencing could be related to all this dental work? At the hospital doctors think it is the cause of my condition. Is that possible?

With vertigo you typically have a whirling sensation or a feeling that your surroundings are whirling around you, causing you to lose your balance or feel dizzy. Related symptoms can include sweating, abnormal eye movements, nausea, or vomiting.

Most of the causes of vertigo relate to the brain or the inner ear and various medical conditions having vertigo as a symptom. In addition, vertigo can be caused by migraine headaches, an injury to the ear or head, a noncancerous growth near the eardrum, taking too much medicine or overmedicating, or imbibing in too much alcohol. Although I have never heard of it before, I guess it is possible that too much dental work could cause vertigo, especially as you appear to have had a lot of work done at each appointment. I am also not aware of vertigo being a side effect of dental anesthesia nor have I seen it in dental literature, but, again, that doesn’t mean it’s not a possibility.

Just in case the dental treatment has caused your vertigo due to inflammation, nerve damage, or trauma, I would certainly advise you to stop any dental treatment at this time. In addition, you should reassess any medications you are taking that could be affecting you. I would also speak to a local dentist and possibly even a neurologist to see if they can help pinpoint the cause of your problem and what steps you can take to treat it. I always advise patients to go with the obvious, and in your case, you have had considerable dental work.

Q2. I just had all four wisdom teeth removed. The doctor suggested not smoking for 10 days. Why is that suggested?

As we all know, smoking, in general, is bad for you. After the extraction of four wisdom teeth, there are sutures placed, bone often grafted in the sockets, large areas of swelling, and bleeding and blood clotting associated with the procedure.

There are a number of scientific reasons as to why smoking after a mouth operation is bad for you:

  1. Smoking increases bone loss and therefore also reduces the amount of bone that is regenerated after surgical procedures like the removal of wisdom teeth.
  2. The heat of smoke can affect your body’s blood-clotting performance and can cause bleeding.
  3. Cigarettes have 4,700 chemical compounds, including 60 known carcinogens. Post-op smoking is especially bad because these chemicals may cause periodontal disease, which causes bone loss and requires more surgery.
  4. Smoking increases the risk of tooth loss after surgery.
  5. Smoking causes a decrease in the body’s inflammatory response, which affects the healing of wounds and the regeneration of bone and gingiva, the blood vessels surrounding your teeth.
  6. Cigarettes decrease gingival blood flow. This also slows down the inflammation process, which heals the area and prevents infection.

After an operation as extensive as having all four wisdom teeth removed at once, it is critical to stay away from the heat, nicotine, and associated problems that cigarette smoking can cause.

Q3. I am almost 60 and have never had pearly white teeth, even as a child. I have my teeth cleaned every six months and use peroxide each morning to keep the worst of the discoloration at minimum. True, I am a tea and coffee drinker, and it exacerbates the problem, but why have my teeth always had a “natural” yellowish tinge? Any suggestions?

It’s true that some people’s teeth are naturally whiter than others. This can be genetic, though outside factors, such as inadequate root-canal treatments, can also discolor teeth. I have also found that most teeth do get darker or more yellow with age. Fortunately, there are different options available to help whiten your teeth. You can:

  • Bleach your teeth with over-the-counter products like whitening strips.
  • Bleach your teeth at your dentist’s office, using follow-up trays and a peroxide solution for two to three weeks.
  • Bleach your teeth with power-bleaching products in a dental office. This can whiten teeth within one to two hours.
  • Cover your teeth with a whiter bonding material.
  • Cut your teeth back and place laminates or veneers over them.
  • Cut back tooth enamel and place full crowns over your teeth.

Obviously, these methods range from inexpensive over-the-counter treatments to more costly, extravagant measures, like placing laminates or crowns on your teeth. Ultimately, the choice depends on what it is that you desire and what you can afford. Some people go to great lengths to achieve the beautiful smile they have always wanted, and many dentists are qualified to perform the required cosmetic work. It is important to seek advice and discuss your options with a competent dentist who regularly performs cosmetic dentistry. Before you schedule any treatments, make sure you are comfortable with this person and that you are able to see samples of the cosmetic work that he or she has done.

Q4. A friend of mine had a laser process to have her teeth whitened, and she said it was incredibly painful and not at all what she expected. Do all teeth-whitening processes hurt? Would one of those drugstore do-it-yourself kits be less painful? Are they any good?

There are many ways to whiten your teeth. One option is to have your dentist add or remove tooth structure (such as porcelain laminates) but a much less costly choice is to use a bleaching agent (typically hydrogen peroxide and carbamide peroxide).

There are three popular bleaching methods, each with pros and cons. The least expensive involves over-the-counter (OTC) bleaches you can use at home without professional help. A two-week course typically costs about $20, and entails applying a liquid whitening agent, either with a one-size-fits-all tray or by applying strips to the teeth. OTC products contain low concentrations of hydrogen peroxide (3 to 6 percent) so they need to be applied more frequently or for longer periods of time than methods used by your dentist. They do work, but it takes longer to see the results. Plus, peroxide is acidic and can irritate gum tissue as well as cause tooth sensitivity, especially to cold. My advice is to work with your dentist so he or she can supervise your care. A professional can also determine the underlying reason for staining and help select the best whitening method.

The next level up is having your primary dentist take impressions of your mouth and make a custom tray that delivers the appropriate concentration of bleaching agent for your specific tooth color. This method allows for the use of greater concentrations of peroxide, ranging from 10 to 20 percent, and costs anywhere from $350 to $850. Bleaching trays work well (and fairly quickly) for most people. Another advantage: Any sensitivity can be quickly diagnosed, allowing your dentist to back off on the duration or frequency of the applications. (Most sensitivity in all methods goes away with time.)

The fastest, easiest method is power bleaching by a dental professional. This is sometimes called laser bleaching, but it’s not an accurate name. There are no lasers involved — tool is a light lamp, which activates the bleaching agent. The concentration is 25 to 35 percent, which is considerably higher than the other two methods. Because of that, this technique can — in some cases — cause severe gum sensitivity and pain, but you get instant results in one visit. And it is pricey, ranging from $500 to $1,200.

When I had my own teeth whitened, I opted for the custom tray made by my dentist. I still have it, and when I need a touch-up, I can easily — and less expensively — undergo another couple of bleaching sessions.

Learn more in the Everyday Health Dental Health Center.

Dry Socket

What is dry socket?

Dry socket, or alveolar osteitis, is a painful complication of the healing process following tooth extraction that results in exposure of the space where the tooth was formerly located. Dry socket occurs when the protective blood clot that forms at the site of tooth extraction falls out, is damaged, or dissolves. This exposes the bone in the area of the empty tooth socket and causes severe discomfort. Dry socket occurs in 3% to 5% of tooth extractions (Source: Simple Steps).

Dry socket is a painful condition that requires prompt treatment by a dentist or oral surgeon, especially when bare bone is visible. Proper treatment of dry socket usually resolves the pain associated with the condition and promotes healing at the site of tooth extraction.

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Seek prompt medical care if you have severe or worsening pain after a tooth extraction, if you see exposed bone at the site of tooth extraction, or if the tissue around the site of extraction is gray and dry. Prompt medical attention can make you more comfortable and prevent more serious complications of dry socket.

What are the symptoms of dry socket?

Symptoms and signs of dry socket include severe pain following tooth extraction, gray-colored tissue around the site of extraction, or lack of a blood clot at the site of extraction.

Common oral symptoms of dry socket

Dry socket symptoms generally occur within a few days of tooth extraction and are usually limited to the oral cavity. Oral symptoms of dry socket may come and go or may be continuous. These symptoms include:

  • Bad breath or foul odor in the mouth

  • Bleeding from the site of extraction

  • Bone visible inside the site of extraction

  • Dental abscess

  • Gray or dead-looking tissue surrounding the extraction site

  • Pain at the extraction site

  • Unpleasant taste in the mouth

Other common symptoms of dry socket

Left untreated, dry socket can result in more serious symptoms outside of the mouth. These symptoms include:

  • Earache

  • Pain in other parts of your head and face on the same side as the tooth extraction

  • Swollen lymph nodes in the neck

Serious symptoms that might indicate a life-threatening condition

Left untreated, dry socket can lead to a serious or life-threatening infection. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms including:

  • Difficulty breathing

  • Dizziness or vertigo

  • Fever and chills

  • Nausea, which may be described as feelings of wooziness, queasiness, retching, sea-sickness, car-sickness, or an upset stomach

  • Severe swelling of the jaw

  • Vomiting

What causes dry socket?

After a tooth is extracted, a blood clot fills the hole left by the tooth. The normal healing process takes place underneath this clot. In the normal healing process, tissue regrowth replaces the blood clot. In some cases, the clot may come loose or dissolve, which exposes the tooth socket to the environment. In addition to causing severe pain, this exposure can slow down or reverse normal healing and lead to severe infections.

What are the risk factors for dry socket?

A number of factors increase the risk of developing dry socket. Not all people with risk factors will get dry socket. Risk factors for dry socket include:

  • Diabetes
  • Poor dental hygiene
  • Smoking
  • Tooth extraction
  • Use of oral contraceptives

Reducing your risk of dry socket

If you have a tooth extracted, it is important to follow the directions provided by your dentist or oral surgeon. Eating certain foods, including hard or sticky foods, can dislodge the protective clot.

You may be able to lower your risk of dry socket by:

  • Avoiding hard or sticky foods after a tooth extraction
  • Following your dentist’s recommendations after tooth extraction
  • Maintaining good dental hygiene
  • Not drinking from a straw or spitting excessively after a tooth extraction
  • Rinsing with chlorhexidine solution following tooth extraction
  • Stopping smoking prior to and for two weeks after tooth extraction

How is dry socket treated?

The treatment of dry socket begins with seeking care from your dentist. Dry socket can be diagnosed by a simple examination by your dentist, who will determine a treatment plan specifically for you.

Medications for treatment of dry socket

Dry socket is typically treated with prescription pain-relieving medication, often in the form of medicated dressings that are applied to the teeth. Antibiotics may also be prescribed if an infection is present.

Examples of medical treatments for dry socket include:

  • Antibiotics, such as penicillin or erythromycin

  • Over-the-counter pain-relieving and fever-reducing medications, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol)

  • Prescription pain relievers or medicated dressings. These dressings may need to be changed every day for several days, either at home or by your dentist.

In addition to medical treatment, your dentist will inspect and clean the dry socket. If you are experiencing severe pain, a local anesthetic may be used. Getting prompt treatment and completing all the medication prescribed by your dentist are important in preventing complications or recurrence.

What you can do to improve your dry socket

You should contact your dentist if you had a tooth extraction and think you may have a dry socket. Before seeing your health care provider, you may be able to reduce the discomfort associated with your dry socket by:

  • Rinsing your mouth with warm salt water

  • Taking over-the-counter pain relievers or pain relievers prescribed by your dentist or oral surgeon following extraction

  • Using ice packs on the cheek next to the dry socket to decrease pain and swelling

What are the potential complications of dry socket?

Dry socket is usually not life threatening. However, left untreated, dry socket may lead to an abscess, potentially resulting in serious complications, including bone, heart or lung infections. Because of the potential for complications, it is important that you see your dentist or oral surgeon if you suspect dry socket after a tooth extraction.

You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of dry socket are very rare but may include:

  • Cellulitis (infection of the skin)

  • Dental abscess

  • Endocarditis (infection of the heart chambers or valves)

  • Mediastinitis (infection of the area around the lungs and heart)

  • Meningitis (infection or inflammation of the sac around the brain and spinal cord)

  • Osteomyelitis (bone infection)

  • Pneumonia

  • Sepsis (life-threatening bacterial blood infection)

  • Tooth loss

Why is My Toothache Accompanied by Dizziness?

Toothaches are painful conditions that can result from a variety of reasons. While the most common symptoms of toothaches include throbbing pain, swelling, sore jaw and gum tenderness, other complications may also occur, including headache and dizziness. Certain diseases and conditions may contribute to feelings of dizziness and or lightheadedness when experiencing toothache pain, as can the side effects of certain medications. Dizziness following root canal treatment and wisdom tooth extraction are also possibilities.

Wisdom Tooth Headache

Having your wisdom teeth removed may cause a painful recovery, particularly if the tooth was impacted or the root was twisted. Pain following wisdom teeth removal is pretty standard, as is facial swelling. Performing certain actions, such as frequently rinsing the mouth with warm water, helps prevent infection. “Wisdom tooth headaches” occur due to inflammation and pain around jaw joints and muscles, which may subsequently cause dizziness, eye and ear problems.

Root Canal Complications

Complications from a root canal procedure may result in inner ear issues and feelings of dizziness or vertigo. Problems generally occur when dealing with an inexperienced practitioner or when a root canal instrument breaks. Severely-curved canals may result in incomplete filling. Overfilling is another complication, as is canal perforation. An instrument breaking during a root canal procedure is rare.

Infection resulting from root canal complications may cause dizziness, however reaction to certain pain medications following such treatment may also cause dizziness or lightheadedness.

Tooth Infection

A tooth infection may occur due to wisdom teeth or root canal complications, but can also occur from tooth abscesses and other problems. Abscesses usually result in root canal procedures, however pain and dizziness may still occur prior to treatment. Damage to the labyrinth, or the small, fluid-filled structure found in the inner ear that helps control balance, is generally the reason for dizziness. This is due to severe tooth infections that spread to the ear nerves. Other tooth infection symptoms include:

  • Tooth sensitivity to hot and cold
  • Throbbing pain
  • Gum and face swelling
  • General discomfort

Other Reasons for Toothache-Related Dizziness

Other reasons for toothache and subsequent dizziness include:

  • Ear canal infection
  • Chronic sinusitis
  • Chronic anemia
  • Type 2 Diabetes
  • Middle ear infection
  • Heat exhaustion
  • Type 1 Diabetes
  • Migraine headache
  • Swimmer’s Ear


Your dentist will likely prescribe a broad-spectrum antibiotic to kill the bacterial infection causing toothache pain, dizziness and any other symptoms. If toothache pain is related to wisdom teeth or root canal complications, additional procedures may be required. This is particularly likely in root canal extractions if the canal was not filled up completely or the procedure was otherwise performed incorrectly.

Anxiety and the inability to sleep are also common when dealing with a severe toothache. Your dentist may therefore prescribe sleep aids to help you rest as you recover from the infection. However, such medications may also cause dizziness among other side effects.

Whatever the cause of your toothache and accompanying dizziness, it is essential to see your dentist if symptoms do not subside after a few days. Should pain and other effects worsen, contact your dentist to schedule an emergency visit as soon as possible. Have a friend or family member drive you for best results.

We’ve successfully treated many people who have had decades of headaches, migraines, facial pain, jaw pain, ear aches, dizziness and ringing ears. As a dentist with advanced training in realignment, we see far beyond your teeth and gums. When the jaw joints are stressed or stained, a domino effect occurs, which typically encompasses a reaction in the function of adjoining parts.

In addition to intensive training in bite alignment, we’ve incorporated advanced methods designed to detect the source of TMJ disorders. The diagnostic process is comfortable and thorough for sufficient information that accurately determines your symptoms’ source. Once the source is determined, we’ll make recommendations to help you overcome these problems and resume your life without often-debilitating symptoms.

Having a healthy, appealing smile is a tremendous benefit to your overall health and well-being. However, it is equally important that muscles, joints, bones and teeth work together properly – not just for your comfort, but to avoid problems down the road. These include grinding and clenching teeth during sleep, broken and chipped teeth, and worn teeth. These repairs can be costly and time-consuming.

If you have experienced ear ringing, dizziness, sore jaw joints or frequent headaches or migraines, call (219) 987-5733 for a consultation. We’ll discuss the best ways to determine the true source of your problems and help you regain a healthy smile!

Headaches, Migraines, Clenching, Dizziness Could Be From TMJ

The reason we have periodic checks on the alignment and air pressure of our vehicle’s tires is to maintain proper balance. When a wheel is off kilter, it not only wears down the tire more rapidly than normal, it affects the other tires .

Think of the balance in your jaw joints as similar to this. When one or both TMJ (temporo-mandibular) joints is not properly balanced, the disparity can extend to seemingly unrelated areas. Yet, the relationship is there if you understand the inter-workings. I’ll explain.

The jaw joints are located on each side of the head just in front of the ears. They connect your lower jaw to the skull via sockets that rotate within these hinges. When the joints are in balance and moving properly, there is minimal stress on the joints. When an imbalance occurs, however, the potential problems can be far reaching.

Think about how often these joints are in motion. Every time you eat, drink, speak, or even lick your lips, these joints are moving.

TMJ disorder typically originates because of a misaligned bite. When the upper and lower teeth do not fit together harmoniously, the strain is transferred to the jaw joints. Bite alignment is the reason for worn or chipped teeth and the trigger for night-time clenching and grinding.

Worn Teeth Are A Common Symptom Of A Misaligned Bite And TMJ Disorder

Common symptoms of TMJ disorders are frequent headaches, migraines, jaw joint tenderness or pain, difficulty opening the mouth fully, ear ringing, dizziness, and jaw popping.

During sleep, the jaw tends to search for balance. In doing so, it can prompt the action of clenching and grinding. This can damage teeth and also cause strain to head and neck muscles, which can trigger headaches and migraines.

Chipped and broken teeth commonly result from teeth that do not meet correctly. In chewing, for example, the grinding motion relies on the unified interaction of the upper teeth and lower teeth. When one or more teeth are not meeting others harmoniously, they ‘hit wrong.’ Some ‘hits’ are such that teeth can break or chip.

In our office, we are trained to note signs of abnormal wear and tear on teeth and check jaw joint function to gauge harmony. However, many people do not associate some of the symptoms of TMJ disorder with bite misalignment (such as headaches or dizziness) and fail to mention them.

If you are experiencing headaches, feel you are clenching at night, or have any other problems mentioned above, please alert us. We’ll conduct a thorough, painless examination to check for signs of TMJ disorder. If TMJ disorder does exist, we will discuss treatment recommendations to resolve the problem in the most conservative manner possible.

In some cases, a small oral appliance worn during sleep can resolve the problem. Other cases may involve the reshaping of certain teeth or even the placement of crowns to adjust tooth height. Realigning teeth may be necessary for more complex needs, through orthodontics. For these cases, we will discuss the ease and comfort of realignment through Invisalign.

The balance in your mouth reminds me of a song many of us learned as children… “Your head bone’s connected to your neck bone and your neck bone’s connected to your shoulder bone and your…” Throughout the body, proper function depends on proper balance. Let’s protect your smile and everything it’s connected to with the balance it needs!

Call 910-254-4555 to begin with a no-charge consultation appointment.

Positional vertigo afterwards maxillary dental implant surgery with bone regeneration

Carlos Rodríguez Gutiérrez1, Enrique Rodríguez Gómez2

(1) Odontologist
(2) Otolaryngologist. Director of ENT department. Vitoria



Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo. It is caused by loose otoconia from the utricle which, in certain positions, displaced the cupula of the posterior semicircular canal.
BPPV most often is a result of aging. It also can occur after a blow to the head. Less common causes include a prolonged positioning on the back (supine) during some surgical procedures.
Additionally one can include in this ethiopathogenesis the positioning required during the maxillary dental implant surgery with bone regeneration related to a forced head positioning and inner ear trauma induced by dental turbine noise working in the maxillary bone.
Two cases of patients who suffered BPPV after undergoing maxillary dental implant with bone regeneration procedures are reported. Diagnosis and treatment are also described.

Key words: Positional vertigo, maxillary dental implant, bone regeneration.


El vértigo paroxístico benigno es el síndrome vertiginoso más frecuente, considerado como idiopático durante muchos años, desde hace algún tiempo se cree debido a la estimulación anómala del conducto semicircular posterior inducido por un fragmento de otolito que se desprende de la macula del utrículo, ocurriendo esto muy frecuentemente por traumatismos cráneo-faciales.
Dentro de esta etiopatogenia, podría estar el vértigo posicional que aparece después de la colocación de un implante dental, cuando al paciente se le somete a una intervención larga, como es la regeneración ósea, que además tiene que tener una posición cefálica forzada, con el ruido de la turbina en el maxilar superior, provocando todo ello un desprendimiento de partículas de laberinto del oído.
Presentamos dos casos a los que después de haber sido sometido a este tipo de intervención les aparece un cuadro de vértigo posicional que se le diagnostica y trata satisfactoriamente mediante maniobras de movimientos cefálicos.

Palabras clave: Vertigo posicional, implante dental en el maxilar superior con regeneracion osea.


Implantation of dental prosthesis in maxillary bones is an old technique, very developed at the current time, which can present some difficulties like a bone mass lack. In order to overcome such trouble, different procedures for increasing the alveolar crest are proposed, from maxillary sinus augmentation until guided bone regeneration (1,2).

Using this additional techniques the number of cases that can be treated increase, but the operation time becomes longer and thus the maxilla and inner ear trauma and head hyperextension could elicit a vertigo.

The BPPV was first described in 1921 by Bárány (3). He recognized several of the cardinal manifestations including vertical and torsional components of the nystagmus, its brief duration, and the fatigability of the nystagmus and vertigo. In 1952, Dix and Hallpike reported this entity in a large group of patients and described the maneuver for eliciting the classical pattern of nystagmus and its associated symptoms.

Two physiopathologic mechanisms can explain the BPPV: the cupulolithiasis mechanism by the deposition of otoconia on the cupula of the posterior canal, and the canalithiasis mechanism by the motion of free-floating material within the lumen of the posterior semicircular canal (4).

BPPV is probably the most common type of vertigo seen by the otolaryngologist. The ethiology remains unknown, while idiopathic, viral, ischemic and traumatic are the most acknowledged theories. About traumatic causes, traffic and occupational injuries are been reported, otherwise odontologist surgical causes aren’t to date.

Current therapy for BPPV is organized around repositioning maneuvers that, in cases of canalithiasis, use gravity to move canalith debris out of the affected semicircular canal and into the vestibule. For posterior canal BPPV, the maneuver developed by Epley is particularly effective in more than 88% of cases in eliminating BPPV (5,6).


Two clinical cases are reported. In both patiens tests of vestibular function were performed: positional testing and videonystagmography. Other neurological studies and audiological tests were also done (7).

Inspection for spontaneous nystagmus and assessment:

– Romberg testing
– Segmentary tests
– Babinski’s test
– Inspection for spontaneous and positional nystagmus using Frenzel lenses

Videonystagmography (VNG):

VNG is an electrophysiological test for assessing nystagmus. This recording technique is based on the corneoretinal potential (difference in electrical charge potential between the cornea and the retina). The eye acts as an electrical dipole oriented along its long axis. Movement of this dipole relative to the surface electrodes produces an electrical signal corresponding to eye position.

By the use of this technique one can obtain recording of spontaneous and gaze-evoked nystagmus, positional, saccade and caloric testings.

Caloric testing remains the most useful laboratory test in determining the responsiveness of a labyrinth. It is one of the few tests that allows one labyrinth to be studied independently of the other. The stimulus can be applied relatively easily with techniques that are commonly available.

Clinical cases study

Case 1

31 years old woman, no relevant previous medical records, who was advised for maxillary dental implanting. Bone regeneration technique was proposed because increased maxillary sinus size, consequent decreased alveolar crest and bone mass lack.

After the operation the patient complained of vertigo and nausea lasting one minute and a nystagmus was observed. Next day symptoms repeated related to hyperextension head movements.

ENT exam was normal. Spontaneus vestibulometry tests, pure tone threshold and supraliminar audiometry tests all were right.


– Saccades: normal pattern
– Smooth pursuit: normal pattern
– Dix-Hallpike’s manoeuver (positional testing): positive response to the right side.
– Caloric testing : left directional preponderance.

The result suggested canalithiasis and cupulolithiasis from right posterior semicircular canal.

The patient was diagnosed of BPPV and undergone Epley’s manoeuver, then the symptoms disappeared. There was no recurrence.

Case 2

62 years old man, who was advised for doing nine implants on the maxilla. Because of bone mass lack at the alveolar crest, a maxillary sinus augmentation was performed. The operation time became longer due to this additional technique and the head position forced by the neck hyperextension required.

After surgery ending, the patient had a sudden vertigo, nystagmus and its associated symptoms, for a few seconds. These symptoms repeated twice, eliciting with head movements, returning to normality in minutes, but remaining some kind of dizziness.

Neurological studies and audiological tests performed were right.


– Saccades: normal pattern
– Smooth pursuit: normal pattern
– Dix-Hallpike’s manoeuver (positional testing): right hanging head position induced binocular nystagmus to the left.
– Caloric testing : right unilateral weakness.

Left posterior semicircular canal BPPV was diagnosed. Epley’s manoeuver was done and repeated for two days, then the symptoms disappeared.


BPPV is characterized by vertiginous episodes with nystagmus remaining seconds, elicited by a particular head position (7).

There are some conditions in the presented cases: supine position (lying on the back) and head and neck hyperextension, prolonged time on that position during the operation, inner ear trauma induced by dental turbine noise working in the maxillary bone.

The referred conditions can induce loose otoconia from the utricle to the posterior semicircular canal. The movement for returning head to its regular position can bring those otoconia on the cupula of the posterior canal, eliciting the vertigo (8). Hypofunction and directional preponderance of the affected side were confirmed by spontaneus vestibulometry and videonystagmography tests.

We conclude that BPPV may be a complication of the maxillary implants surgery, specially when a bone regeneration technique is required because of the prolonged time of forced position that patient has to maintain.

In the described cases, the onset of vertigo happened immediately after the implant surgery, so we think there can be a cause related to, based on the clinic exams and responsiveness to treatment (Epley’s manoeuver) (9,10).

There are a lot of articles in the medical literature (11,12) that confirm the role of several sorts of traumatism causing BPPV, but we did not find any reporting positional vertigo after maxillary dental implant surgery with bone regeneration.

We propose that the dental surgeon should consider that possibility in some cases like the referred in this article to avoid this complication shortening the time of the operation or doing it in two separated phases.

1. Anítua E. Ensanchamiento de cresta en el maxilar superior para colocación de implantes: Técnica de los osteotomos. Actualidad Implantologica 1995;7:59-63

2. Moy PK, Lundgren S, Colmes RE. Maxillary sinus augmentation. Histomorphometric analys of graft material for maxillary sinus floor augmentation. J Oral Maxillofac Surg 1993;51:857-61

3. Suárez H. Síndromes vestibulares periféricos retrolaberinticos. En: Suárez C. Tratado de otorrinolaringología y cirugía de cabeza y cuello. Madrid: Proyectos Médicos; 1999. p. 1558-71.

5. Epley JM. The canalith repositioning procedure: For treatment of bening paroxysmal positioning vertigo. Otolaryngol Head Ned Surg 1992;107:339-47

6. Woodworth BA, Gillespie MB, Lambert PR. The canalith repositioning procedure for benign positional vertigo: a meta-analysis. Laryngoscope 2004;114:1143-6.

7. Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). Canadian Medical Association Journal 2003;169:681-93.

8. Yakinthou A, Maurer J, Mann W. Benign paroxysmal positioning vertigo: diagnosis and therapy using video-oculographic control. Orl. Journal of Oto-Rhino-Laryngology 2003;65:290-4.

9. Del Rio M, Arriaga MA. Benign positional vertigo: prognostic factors.Otolaryngology – Head & Neck Surgery 2004;130:426-9.

10. Simhadri S, Panda N, Raghunathan M. Eficacy of particle repositioning maneuver in BPPV: a prospective study. American Journal of Otolaryngology. 2003;24:355-60.

11. Motamed M, Osinubi O, Cook JA. Effect of mastoid oscillation on the outcome of the canalith repositioning procedure. Laryngoscope 2004;147:1296-8.

12. Kiyofumi Gyo MD. Benign paroxysmal positional vertigo as a complication of postoperative bedrest. Laringoscope 1998;108:332-3.

Received: 18-07-2006
Accepted: 30-12-2006

Lightheadedness At The Dentist Could Prove Serious

This condition is known as vasovagal syncope and lead author of the study, Rubia Kapusta, DDS, MS, explains that both dentists and patients should be aware of the signs and be prepared in case it occurs. Vasovagal syncope is characterized by a loss of consciousness and muscle tone, which typically are preceded by non-specific symptoms that last anywhere from a few seconds to a minute. These symptoms result from alterations in the nervous system that can include dizziness, lightheadedness, paleness, palpitations, nausea, sweating, hyperventilation and changes in vision.

According to Dr. Kapusta, “Any patient who experiences a syncope reaction may have an underlying cause that can predispose him or her to a life-threatening situation.”

It is considered the most common clinical problem that occurs among patients of all ages, affecting 3.5 percent of the general population. Emotional stress, anxiety, pain, fatigue and being in a hot and crowded environment can lead to vasovagal syncope.

“It is not uncommon for patients to experience some anxiety when visiting their general dentist,” says AGD spokesperson, Melvin Pierson, DDS. “Yet, there are ways to lessen the possibility of an anxiety-related incident.” Dr. Pierson encourages patients to discuss with their general dentist any fears they may have, and when seeing a dentist for the first time, schedule a preliminary visit.

“Asking questions and requesting informational materials can help you get a better understanding of your dental service or treatment,” says Dr. Pierson. “General dentists are trained to answer questions and tell you what to expect to help you feel comfortable.”

If the signs and symptoms of vasovagal syncope do occur, the dental procedure will be immediately stopped and treatment provided as soon as possible.

Are TMJ and Vertigo Related?

As if the tenderness, popping and clicking of TMJ weren’t enough, TMJ can also cause symptoms related to vertigo. That’s because TMJ affects the joints of the jaw, which are located in front of the ears. The effects of TMJ can spread to the ears, including the sensitive inner ears that control your sense of balance. As a result, you may experience dizziness.

If you frequently experience TMJ and vertigo, see a dentist or a physician.

TMJ and Related Symptoms

TMJ is an abbreviation of temporomandibular joint, which is the joint where your jaw attaches to your skull. When this area becomes inflamed or misaligned, it causes symptoms like popping noises or locking of the jaw when you open your mouth, tenderness and pain, headaches, neck pain and facial pain.

Occasionally, people with TMJ experience additional symptoms like tinnitus and dizziness, which may point to an inner ear issue.


According to the University of California San Francisco Medical Center, an attack of vertigo feels as though you or your surroundings are moving. The sensation feels like “spinning, whirling or moving vertically or horizontally,” and you may also experience involuntary eye movements, nausea, hearing loss and other symptoms.

Vertigo is caused by problems in the inner ear, which is a sensitive part of your ear close to the temporomandibular joint.

TMJ and Vertigo

The TMJ Association explains how TMJ and vertigo are related: The inner ear contains the sensors that tell your brain about your body’s position and movement. When your jaw joint is inflamed, as it is with TMJ, the inflammation can also reach the inner ear. Consequently, the inflammation disrupts the signals to the brain about your body’s position in space, leading to symptoms of vertigo.

Treatments for TMJ and Vertigo

People who often experience vertigo as a result of their TMJ should avoid driving and other activities where dizziness puts themselves or others in danger. See a dentist or a physician for advice on treatments that alleviate the symptoms of TMJ, like dental splints, massage, anti-inflammatory medications and relaxation techniques.

TMJ often resolves by itself without treatment, but your dentist can also help you alleviate the pain and manage the difficulties of the condition. If opening your mouth wide enough to brush and floss your teeth is difficult or painful, rinse daily with Colgate Total Advanced Pro-Shield mouthwash, which kills 99 percent of germs on contact, freshens breath and helps prevent gingivitis.

Vertigo isn’t a common complication, but in some cases, it could be related to your TMJ. Remember to tell your dentist or physician all your symptoms so that they can help find the best solution to your problem.

Ask the Dentist: Jaw misalignment due to poor bite or grinding can cause vertigo

EVER felt like you have just stepped out of a washing machine? This is how some vertigo sufferers describe their annoying episodes which can give earaches, ringing in the ear, amplified sounds, dizziness, spinning, balance problems, nausea and even cause them to fall over.

So, what has vertigo got to do with the mouth? Well your jaw joints are millimetres from your ear canals. The inner ears contain several structures that play a large role in balance. They house a small structure known as the labyrinth that is a key component of the body’s vestibular system. The vestibular system is how humans keep their balance and includes the eyes, nerves, bones, and joints.

The labyrinth contains fluid, which moves around as you move, and that sends messages to the brain about balance. When any of this gets disrupted, the brain can misinterpret the signals and that gives off the feeling of vertigo or dizziness.

In health the jaw joints move around harmoniously and are in balance with your teeth, jawbones, facial muscles and nerves. If you have a bite problem or grind your teeth the jaw joint can move out of alignment and start to put backward pressure up towards the ear.

It’s thought that the jaw joint may move the skull bone that surrounds the ear just enough to move the labyrinth out of position slightly. So, whenever any misalignment or inflammation occurs in the jaw joint, this is how the labyrinth fluid gets disrupted.

People with bite problems often have a condition called TemporoMandibular Dysfunction (TMD) and experience symptoms like popping noises or locking of the jaw on opening, tenderness and pain, headaches, neck pain and facial pain.

Reports show that 90 per cent of those with TMD also have a neck issue. Tight muscles in the neck may affect blood flow through a neck artery which enters the skull to supply the inner ear. Neck and shoulder tightness can lead to symptoms of vertigo.

It’s important to realise that there are many, many causes of vertigo, like infections, blood vessel and nerve problems, an injury, side effects from medicines and migraines, to name but a few. So, it’s critical to consult your doctor if you have vertigo.

If other causes have been ruled out, your TMD can be examined by a dentist who has experience in joint problems. The problem in the bite can be addressed by wearing a special bite guard and restoring the teeth to a more harmonious shape and chewing pattern.

Dizziness & Jaw Joints – A Surprising But Common Connection

posted: February 26, 2015

Feeling dizzy is a rare occurrence for most people. It can happen when one stands quickly when their blood pressure is low. Or, it may be the result of some prescriptions who have dizziness as a side effect.

However, the most common cause of persistent dizziness is a problem with the inner ear. What is not commonly connected to dizziness is the Temporo-mandibular Joint (TMJ, or jaw joint) ability to trigger inner ear inflammation.

The middle ear contains the vestibular nerve and a structure that is responsible for maintaining your sense of balance. In close proximity is the jaw joint. TMJ Disorder is a chronic problem that causes a variety of pain and discomfort, including migraines, headache, earache, painful chewing, jaw clicking, night-time clenching and grinding, worn teeth and dizziness. TMJ Disorder, which is the result of jaw misalignment, affects balance by triggering inflammation of the muscles and ligaments around the middle ear.

Fortunately, there are effective methods to resolve TMJ-related symptoms. In some cases, minor tooth reshaping can remedy the misalignment. In more severe cases, the bite can be rebalanced with crowns on selected teeth, orthodontic treatment or a simple oral appliance worn during sleep.

Until your problem is resolved, it is important to stay safe when a dizzy spell occurs. When you feel a dizzy spell coming on, when possible, stop what you’re doing and lie down. Otherwise, take deep breaths and try to relax the muscles of the face and mouth. You may also try focusing on a fixed point for several minutes. This sends signals to your brain that can help stabilize balance.

TMJ Disorder will not improve without treatment. If you are experiencing any of the symptoms mentioned above, call toll free 1-877-966-9009 to arrange a free consultation. Here, we can discuss options that may work best for your needs.

In the days after Christopher Schutzius, 17. underwent root canal surgery, there were moments when he seemed invigorated and fine, and others when he complained of feeling achy and tired, his foster family in Blue Island said.

When he laid down on the couch in the living room on Tuesday and refused to move, his family became concerned and called an ambulance, said his foster sister Candace Garcia.

They were shocked when Schutzius was placed on life-support and later died at MetroSouth Medical Center in Blue Island.

“It’s just crazy,” she said. “He had his whole life in front of him.”

Schutzius died of sepsis, a toxic infection, following the root canal, the Cook County medical examiner’s office ruled after an autopsy Thursday.

Several medical experts said it is rare for serious complications to occur because of a root canal. It’s too early to determine whether the dental procedure led to sepsis or whether other complications were involved, said the experts, who are not familiar with the details of Schutzius’ case.

His death has devastated his foster family and his biological relatives and is being investigated by the dental office where the surgery was performed, officials there said. The state Department of Financial and Professional Regulation investigates any medical procedure that results in an “adverse outcome,” said agency spokeswoman Susan Hofer. The Department of Children and Family Services is conducting a neglect investigation, which is routine when a foster child dies.

Schutzius, a senior at Eisenhower High School who was to graduate in May, was pronounced dead just after 11 a.m. Wednesday, more than a week after undergoing the dental procedure at Dental Dreams in Blue Island.

The youth lost a filling while eating caramel candy in January, according to his two foster siblings, Candace Garcia, 20, and Richard Garcia, 23. He went alone to the dental office on Feb. 1 to have the filling replaced and ended up having a root canal performed.

The family believes the procedure was unnecessary.

“They saw he was by himself and he didn’t have a parent with him and took advantage,” Richard Garcia said.

But the fact that Schutzius’ filling fell out indicated that the tooth probably was already decaying because of infection and that a root canal likely was necessary, said Dr. Christopher S. Wenckus, head of the endodontics department at the University of Illinois at Chicago’s College of Dentistry, and Dr. Clara M. Spatafore, president of the American Association of Endodontists.

Wenckus said deaths or serious complications following root canals are “horribly uncommon.”

“In all the years that I’ve done this, I have not personally seen anything where there’s been a direct link between a root canal being done and a patient dying,” he said. “These things can happen, but they’re extremely rare.”

Root canal surgery is a very common, safe procedure, Wenckus and Spatafore said.

Throughout the week, the young man applied an over-the-counter pain medication to numb the soreness, Candace Garcia said. He complained of not feeling well, and asked to stay home from school on Monday.

That day he got up, showered and got himself dressed and ate his meals as usual. But on Tuesday, he was weak and didn’t look like himself, which prompted his family to call for help.

“I wouldn’t wish this on anybody,” Candace Garcia said as she sat, holding a portrait of the teenager who she said she loved like a brother.

The boy’s foster mother, Laura Serna, said she was too distraught to talk to reporters and had been advised by officials with DCFS not to discuss the case. Schutzius’ biological mother, Barbara Schutzius, of Alsip, did not return calls.

Dr. Sameera Hussain, the owner of the clinic and a licensed dentist from Oak Brook, read a prepared statement but declined to answer questions.

“We learned today through media reports that a patient who was recently treated at our clinic has later passed away,” Hussain said inside her office at the clinic. “We were shocked to hear this news and express our deepest condolences to the family. We are conducting a thorough review of his treatment, and we’ll provide further details as they become available to us.”

Dental Dreams LLC, is based in Chicago and operates dental clinics in Illinois and five other states. It employs more than 150 dentists and 500 other workers, according to the company’s website.

A dentist who worked for Dental Dreams in Illinois and Massachusetts claims in a pending 2009 whistleblower lawsuit that he was fired after refusing to follow orders from the chain’s Chicago managers to perform “medically unnecessary” treatments on patients in order to boost profits.

Schutzius was placed in foster care in 2008, a spokesman for DCFS said. He and his two younger siblings had been living with Serna, a close family friend and the children’s godmother, since then.

“Chris was a wonderful kid,” Candace Garcia said. He wanted to finish school and study to become an auto mechanic, she said.

“It’s a hard loss for us,” said Joe Serna, 14, Schutzius’ foster brother. “He was so young and it happened so fast. It’s unreal.”

Tribune reporter Liam Ford contributed to this report

5 Signs You May Have An Infection After A Root Canal

Many patients are curious about whether or not they can get an infection after a root canal. Although it is rare, it is in fact possible to get a mild to serious infection after a root canal procedure. It is important to be aware of and recognize symptoms of infection early on to ensure the infection does not spread or lead to additional complications.

Here are the 5 things you should be on the lookout for after a root canal treatment.

Persistent or Reoccurring Pimple on the Gums

Often, prior to a root canal a patient will have a pimple or abscess on the gums near the tooth with or without pain. Often this pimple will release pus or fluid. Once a root canal is complete this abscess should get smaller and eventually disappear. If the abscess remains more than seven to ten days after the root canal procedure, you may have an infection and you should contact your endodontist or dentist immediately.

Persistent Feeling of Lethargy

Feeling a little tired or run down is normal after a root canal. However, a few days after treatment you should feel your energy come back to normal levels. If you remain tired after seven to ten days, or if you are feeling increasingly tired, contact your endodontist or dentist.

Area Around the Tooth and Gums Feels Hot

Often an infected area will feel warm to hot. If the area around the tooth and gum where the root canal procedure feels abnormally warm inform your dentist or endodontist immediately.


A temperature over 99.5 degrees is one of the most common signs of infection. If you have a fever after a root canal treatment, contact your endodontist or dentist immediately.

Persistent Pain

Pain or soreness for a few days after a root canal, especially in the area of the affected tooth and gums, is normal. However, if the pain worsens or is prolonged more than 3 days you should return to your dentist or endodontist.

If you experience any of these symptoms it is important that you contact your dentist or endodontist. With an infection, the faster it is identified and treated, the smaller the risk of further complications. Live in the Richmond, Virginia area and have questions about root canals before or after treatment? Contact us, we are happy to answer your questions.

Feeling weird after root canal. PLEASE HELP..

So a few years ago tooth #10 had to have a root canal (the one between the front tooth and the canine) and after i had it done, an abscess formed on the gum above the tooth and I had to go back in (don’t know if they redid the root canal; do they do that to fix an abscess?) in any case, it hurt a lot for a long time after the root canal, but eventually it calmed down.
A few months ago, the tooth started hurting again. It didn’t look inflamed or swollen or anything, but I was sure it was probably infected, so I went to my dentist and had the root canal redone, but this time she did it in two appointments. The first appointment, she injected Novocaine into my palette and afterwards, I went home feeling fine. The next day I was incredibly dizzy, but I didn’t think anything of it. I was still in a lot of pain, so I was more concerned about that. After a few more days, the dizziness hadn’t gone away and I was still in pain, so I called my dentist and she gave me antibiotics. She SAID the pain would clear up within 24 hours, but of course it hurt for the next week or so.
Three weeks later the pain had died down but I was STILL really really dizzy. Not just when moving either; it was a constant dizziness. Eyes closed, lying down in a dark room and I felt like I was on a merry-go-round -_-
I went for my second appointment still feeling dizzy. I asked my dentist, but no one could seem to give me any kind of answer. (another strange thing is that when she was finishing up the canal, I was having a LOT of pain when she was drilling into the empty root of my tooth. Since the anesthetic wasn’t taking affect on my tooth, they had to inject it into the tooth itself, which was so painful I ended up crying in the chair. How could I be in THAT much pain if there’s no nerve in the tooth?!)
So she finished it up and I suffered through another week of dizziness, but finally, eventually it died down and I wasn’t AS dizzy anymore. However, the pain never fully went away. Sometimes i still get zaps of pain in this tooth and it really hurts to tap on it.
Now it’s about a month later and I’m dizzy again, getting constant headaches, the tooth hurts on and off, my tongue and lip twitch and tremble from time to time and sometimes the feeling of twitching extends to the whole right side of my face.
My question is what the heck they’ve done to me. Did the needle in the palette damage the lingual nerve? Is the tooth secreting toxins and poisoning my head? I did a lot of research on root canals because of this and I’ve read all about how much damage they can cause because they can house so much bacteria in the empty tooth root.
I’m thinking about getting the tooth removed all together, but since it’s a front tooth I’m very hesitant. Money’s an issue also….
FYI I’m a 21 year old female. 125 lbs.

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