title: Benign Paroxysmal Positional Vertigo after Dental Procedures: A Population-Based Case-Control Study.
abstract: BACKGROUND
  Benign paroxysmal positional vertigo (BPPV), the most common type of vertigo in the general population, is thought to be caused by dislodgement of otoliths from otolithic organs into the semicircular canals. In most cases, however, the cause behind the otolith dislodgement is unknown. Dental procedures, one of the most common medical treatments, are considered to be a possible cause of BPPV, although this has yet to be proven. This study is the first nationwide population-based case-control study conducted to investigate the correlation between BPPV and dental manipulation.
  
  
  METHODS
  Patients diagnosed with BPPV between January 1, 2007 and December 31, 2012 were recruited from the National Health Insurance Research Database in Taiwan. We further identified those who had undergone dental procedures within 1 month and within 3 months before the first diagnosis date of BPPV. We also identified the comorbidities of the patients with BPPV, including head trauma, osteoporosis, migraine, hypertension, diabetes, hyperlipidemia and stroke. These variables were then compared to those in age- and gender-matched controls.
  
  
  RESULTS
  In total, 768 patients with BPPV and 1536 age- and gender-matched controls were recruited. In the BPPV group, 9.2% of the patients had undergone dental procedures within 1 month before the diagnosis of BPPV. In contrast, only 5.5% of the controls had undergone dental treatment within 1 month before the date at which they were identified (P = 0.001). After adjustments for demographic factors and comorbidities, recent exposure to dental procedures was positively associated with BPPV (adjusted odds ratio 1.77; 95% confidence interval 1.27-2.47). This association was still significant if we expanded the time period from 1 month to 3 months (adjusted odds ratio 1.77; 95% confidence interval 1.39-2.26).
  
  
  CONCLUSIONS
  Our results demonstrated a correlation between dental procedures and BPPV. The specialists who treat patients with BPPV should consider dental procedures to be a risk factor, and dentists should recognize BPPV as a possible complication of dental treatment.
authors.affiliation: Department of Neurology/Neuro-Medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.|School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Tzu-Pu
authors.initials: TP
authors.lastname: Chang
authors.affiliation: Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Yueh-Wen
authors.initials: YW
authors.lastname: Lin
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.
authors.forename: Pi-Yu
authors.initials: PY
authors.lastname: Sung
authors.affiliation: Department of research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.
authors.forename: Hsun-Yang
authors.initials: HY
authors.lastname: Chuang
authors.affiliation: Department of Dentistry, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.
authors.forename: Hsien-Yang
authors.initials: HY
authors.lastname: Chung
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.
authors.forename: Wen-Ling
authors.initials: WL
authors.lastname: Liao
mesh_terms: D000328:Adult; D000368:Aged; D065635:Benign Paroxysmal Positional Vertigo / Q000453:epidemiology* / Q000209:etiology*; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D011476:Prosthodontics; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology