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John_addler

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 #1 

Dear Dr. Nagler,

Thank you for all you do here!

I have to go see a dentist for a check-up, clean and maybe fillings, how should I prepare? What can I get them to do to minimize potential increases in tinnitus? Earplugs or muffs? What is the best advice to get through a dental appointment without increasing tinnitus?! I have heard some horror stories about drills and ultrasonic devices so I admit to being very nervous about this upcoming appointment!

Thank you again for all your help and support,

John

Dr. Nagler

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 #2 
Hello John. You have asked a very good question, and I'll get to it shortly.

But first, if I may, you wrote [in part]: "I have heard some horror stories about drills and ultrasonic devices ..." Where exactly did you hear these horror stories?

Stephen M. Nagler, M.D.

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The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
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David McCullough quoting Wilbur Wright
John_addler

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 #3 
Dear Dr. Nagler,

Thank you for your response,

I found details of stories like this below:

https://www.healthcareguys.com/2018/05/31/dental-work-and-tinnitus-heres-what-you-need-to-know-and-how-technology-is-improving-dentistry/

https://www.kyrenefamilydentistry.com/blog/tinnitus-and-your-teeth/

http://familydentalofteravista.com/2017/11/22/tinnitus-teeth-know/

https://www.dentalacademyofce.com/courses/1466/pdf/noiseinducedhearingloss.pdf

And of course the forum that we have agreed not to name has a glut of people who swear to the negatives of a dentist visit from first hand experience,

Very best,

John
Dr. Nagler

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 #4 
Hi John -

Sorry it's taken me a few days to get back to you.

To answer your question about how to prepare for your dental appointment, I would bring three pair of earplugs.

The problem for you in terms of drilling and instrumentation lies in the fact that in addition to the noise of the drill entering your ear, which can be mitigated with the use of proper ear protection, there is the phenomenon of bone conduction to be considered - as the sound of the drill is transmitted directly to your cochlea through your teeth, mandible, maxilla, and bones of the face and skull. Since there is no way to prevent bone conduction from occurring, Dr. Jack Vernon (1922-2010) recommended as a compromise explaining to your dentist that you have tinnitus and asking him or her to stop drilling for ten seconds after every five seconds of drilling.

Why the other two pair of earplugs? Well, the fact of the matter is that noise-induced hearing loss is a function not only of the decibel level of noise exposure, but also the length of time of that exposure. And that puts your dentist and chair assistant at a much greater risk from their day in and day out exposure than the risk is to you from your thirty minutes or so in the chair. So the additional plugs are a gift from you to them!

All the best with it!

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Dave1972

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 #5 
Hi Dr. Nagler,

I might need a root canal and then a crown for it.  Two procedures done on different days, of course.  I talked to the root canal specialist (highly regarded in my area) and he said the drilling would only last a few minutes.  My dentist would do the crown, but the filing/shaving to fit the crown could be 10-15 minutes.  I had a crown and root canal done in 2003 for a different tooth and my ears were fine as far as I can recall, but I didn't have Tinnitus then either. 

When I suggested to both of them about doing the dental work in bursts, they didn't seem too receptive after I explained my Tinnitus and concern of spiking from the dental work.  However, for a root canal and crown, I'm not sure of those short bursts are as feasible as compared to a drill for a filling.  I told my dentist how ear plugs wouldn't work well for reasons your mention, but then he mentioned "muffs".  He admitted his hearing was shot from the drilling noise (has been practicing for 40+ years).  Any thoughts on how I should proceed if I need this work?  The crown almost concerns me more.

Although my dentist didn't recommend it, an implant is always an option which tends to be less noisy from what I've read.

I did have the plaque scaling done a few years ago by the hygentist and was okay.

Thanks,

Dave

 
Dr. Nagler

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 #6 
Let me answer your question in two ways.

From me personally, I honestly don’t give any of this stuff a second thought. I have had a considerable amount of dental work done over the past years (yes, including since the onset of my tinnitus some 24 years ago), and I do not take any precautions at all in that regard. I do not use earplugs, nor do I ask the dentist to do the work in bursts as recommended in Post #4 above. Am I taking a risk? Perhaps, but I also know that it takes a considerable amount of noise exposure over a considerable amount of time to result in appreciable auditory damage, which is my main concern. What about the dental work causing an increase in the volume of my tinnitus irrespective of whether or not it causes actual auditory damage? I just refuse to conduct my life around what might possibly cause an increase in the volume of my tinnitus, dental work included.

But that’s me. The question is what about you? And here the answer is very simple. You have made what I believe to be a totally reasonable request of a person you have entrusted with your dental health. If he is not willing to be sensitive to your needs, I’d fire the jerk and find somebody who is worthy of your trust.

Hope this helps.

Stephen M. Nagler, M.D.



__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
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Dr. Nagler's Tinnitus Corner is provided for education and information only. It is not intended for the purpose of providing medical care and should in no way substitute for appropriate in-person consultations with qualified healthcare professionals. By using this site, participants agree to hold Dr. Nagler and Atlanta Tinnitus Consultants, LLC harmless with respect to any loss, injury, claim, liability, or damage arising from following the postings herein.