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Oral surgery

Vertigo after tooth removal

Sir, a 26-year-old white woman presented with bilateral recurrent pericoronitis in relation to distoangularly impacted lower wisdom teeth. The patient underwent surgical removal of both of these teeth under local anaesthesia, with an interval of four weeks between each tooth. The surgical procedure lasted less than an hour in both sessions from start to finish. At a virtual consultation three days after the second procedure, to remove the lower left wisdom tooth, the patient complained of moderate pain, restricted mouth opening and, surprisingly, nausea. The patient related the symptoms of nausea to taking analgesia on an empty stomach. She was reassured and was advised to maintain good oral hygiene.

Subsequently, the patient then noted new-onset dizziness and worsening nausea, exacerbated with movement and imbalance. She denied any previous history of otological symptoms and treatment nor any recent history of trauma. She was brought in to the emergency department and admitted for 24 hours, where she was monitored and administered prochlorperazine. Her balance improved and she was discharged with an oral course of antiemetics, which she discontinued due to spontaneous improvement.

Our literature review revealed only four publications which have reported vertigo after isolated dental extractions.1,2,3,4 Few other reports have noted post-operative vertigo in patients who have had maxillary surgery and dental implant placements.5,6 Some of the factors considered by these authors to be causative include prolonged surgical time, use of rotary tools, application of osteotomes/surgical mallets and presence of comorbidities. In the case described, a surgical drill was used to remove bone. Prolonged mouth opening during dental procedures is a well-known risk factor for temporomandibular disorders which can present with otological symptoms. Finally, we haven't ruled out the possibility of coincidence in presentation of these symptoms, although this does not explain or help the patient's debilitation. We found this case interesting and worth discussing to understand the pathophysiology of this odd relationship.

References

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    Yilmaz H B, Erdogan R B, Paksoy M, Sanli A. Sudden hearing loss and vertigo after tooth extraction successfully treated with combined therapy including HBO2: a case report. Undersea Hyperb Med 2015; 42: 603-606.

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    Kaplan D M, Attal U, Kraus M. Bilateral benign paroxysmal positional vertigo following a tooth implantation. J Laryngol Otol 2003; 117: 312-313.

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Correspondence to R. O´Rorke, N. Khan, H. Makar or S. Mumtaz.

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O´Rorke, R., Khan, N., Makar, H. et al. Vertigo after tooth removal. Br Dent J 231, 148 (2021). https://doi.org/10.1038/s41415-021-3343-y

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