The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

Letter to the Editor

Editor, – I refer to the article 'Dealing with dizziness' (Aust Prescr 2005;28:94-7). I wish to recount a personal experience where, following dental treatment during which my head and neck were held in a rotated position for some time, I suffered an acute, but fortunately brief episode of severe dizziness and recall feeling 'queer' when given the all clear to sit up. Two days later I was confined to bed for 36 hours with an acute episode from which I recovered completely. Subsequent doppler studies revealed no evidence of compromised cerebral circulation. Is it possible that unusual posturing of one's head during dental therapy could be another cause of an acute episode of dizziness?

Judy Rice
Pharmacist
Adelaide

Author's comments

Dr Mark Paine, the author of the article, comments:

The scenario is very suggestive of benign paroxysmal positional vertigo. The positioning of the patient during the dental treatment is very similar to the Hallpike positioning manoeuvre. While a bout of positional vertigo is usually brief, there may be after-effects causing persisting low grade dizziness which may last hours to days. To be certain about this diagnosis, it is essential to examine the patient during the episode.

ADA comments

Dr M. McCullough, Australian Dental Association, comments:

An acute feeling of dizziness following prolonged dental treatment is not uncommon in dental practice. Sudden changes in blood pressure following postural changes after prolonged periods in a supine dental chair may be responsible. Usually, if patient and dentist are aware of this possibility, then treatment procedures can be kept to shorter duration, with rest breaks during the procedure.

Postural hypotension is unlikely to explain the episode occurring two days after the dental procedure. Possible explanations to consider include tooth extraction and subsequent haemorrhage with breakdown of haemostasis, infection and acute dental pain causing decreased nutrition or hydration.