The Hidden Risk in the Dental Clinic: Noise Exposure, Hearing Loss, and Tinnitus in Dentistry

Author's note: "As an audiologist, I often encounter dentists and dental nurses presenting with noise‑induced hearing loss and/or tinnitus. This can be attributed to long-term exposure to noisy dental procedures over years of clinical practice. Infrequently, I may also see dental patients who report acute acoustic trauma associated with dental procedures. In these cases, symptoms such as tinnitus, sound sensitivity and/or hearing loss might arise following prolonged treatment sessions, most notably extended drilling or dental cleaning. This latter finding appears to be less well documented in the literature, and awareness of this potential risk as well as measures to mitigate such risk among dental professionals seems to be inconsistent".

Occupational hazards in dentistry are commonly associated with musculoskeletal disorders, visual strain, and exposure to biological agents. Far less visible—but increasingly recognised within the scientific literature—is the impact of chronic noise exposure from dental equipment. High‑speed drills, ultrasonic scalers, suction devices, and polishing systems generate sound levels capable of contributing to noise‑induced hearing loss (NIHL) and tinnitus in both dental professionals and some patients.

This article considers peer‑reviewed evidence of noise exposure associated with dental drilling, scaling, and polishing, and examines the cumulative auditory risks faced by both patients and dental staff over the course of their careers. Evidence‑based strategies to mitigate these risks for both clinicians and patients are offered.

Noise‑Induced Hearing Loss and Tinnitus: An Overview

Noise‑induced hearing loss (NIHL) can arise from from damage to cochlear hair cells and auditory synapses following repeated or excessive sound exposure. Permanent NIHL is irreversible and may progress in severity (further sensorineural damage) with continued exposure (Hartland et al., 2023). Tinnitus—a perception of sound such as ringing, buzzing, or hissing in the absence of an external stimulus—is frequently associated with NIHL and can occur even when hearing levels (as tested by conventional pure‑tone audiometry) remain within "normal" limits (Zhang et al., 2025).

Experimental and epidemiological studies demonstrate that repeated exposure to sound levels exceeding approximately 85 dB significantly increases the risk of cochlear damage, particularly when exposure is chronic and cumulative (Vagevuur and Brand, 2024). Importantly, intermittent exposure patterns—typical of dental practice—do not eliminate this risk. It's also worth pointing out here that an individual's biological threshold for auditory damage [or the triggering of tinnitus] may vary significantly and isn't always well predicted.

Noise Exposure from Dental Drilling and Polishing

High‑speed dental handpieces are a major source of occupational noise. Measurements conducted in clinical and educational settings consistently report sound levels ranging from 70 dB to above 90 dB, particularly when handpieces operate in conjunction with high‑volume suction systems (Kataria, 2023).

A scoping review published in the British Dental Journal found that many commonly used dental devices generate noise levels approaching or exceeding recommended occupational exposure limits, particularly during restorative and prosthodontic procedures (Vagevuur and Brand, 2024). Because dentists work in close proximity to the noise source—often with the ear positioned within 30–50 cm of the handpiece—the effective exposure may be considerably greater than ambient sound measurements alone suggest. It is also fair to point out that along with the dentist, the patient will too get a dose of noise exposure as a recipient of the treatment - albeit most likely as a one-off experience.

Ultrasonic Scaling and Auditory Risk

Ultrasonic scalers present a distinct auditory hazard due to their high‑frequency acoustic output, which can extend beyond the frequency range most critical for speech perception. Clinical studies have demonstrated that ultrasonic scaler use can induce immediate, measurable changes in auditory function.

Chopra et al. (2016) reported significant temporary threshold shifts and reductions in otoacoustic emissions immediately following scaler use, indicating acute cochlear stress. Although these changes were reversible/temporary in the short term, repeated temporary threshold shifts are increasingly believed to contribute to permanent cochlear synaptopathy over time.

Further evidence comes from a matched‑pairs design study involving dental hygienists, which identified statistically significant differences in high‑frequency hearing thresholds (6–10 kHz) between professionals routinely exposed to ultrasonic noise and age‑matched non‑exposed controls (Suedbeck et al., 2024). High‑frequency hearing loss is widely regarded as an early marker of NIHL.

Prevalence of Hearing Loss and Tinnitus in Dental Professionals

The association between dental practice and hearing impairment is well established in the peer‑reviewed literature. A systematic review in Occupational Medicine found that 82% of included studies reported a positive association between dental practice and hearing loss, with years of clinical experience emerging as a consistent risk factor (Hartland et al., 2023). This finding supports a cumulative dose–response relationship between dental noise exposure and auditory damage.

Similarly, a scoping review in the British Dental Journal concluded that hearing loss—assessed using both subjective reports and objective audiometric measures—appears more prevalent among dental personnel than among control populations (Vagevuur and Brand, 2024). Several studies also identified asymmetrical hearing loss, often worse in the left ear, attributed to operator positioning relative to noise‑generating equipment.

Tinnitus is particularly common. Zhang et al. (2025) reported tinnitus in approximately 40% of dental professionals, alongside audiometric thresholds exceeding age‑adjusted norms in a substantial proportion of participants. These data indicate that tinnitus represents a significant occupational health concern within dentistry rather than an incidental complaint.

Potential Auditory Risks for Patients

Although occupational exposure represents the primary concern, patients also experience significant acoustic stimulation during dental procedures. Dental noise reaches the inner ear not only through air conduction but also via bone conduction through the mandible and skull, potentially increasing perceived loudness (Kataria, 2023). These sounds cannot be attenuated through the use of ear plugs.

Most patient exposure is short‑term; however, individuals undergoing repeated procedures—such as orthodontic or periodontal treatment—may experience transient auditory symptoms, including temporary tinnitus or sound sensitivity. Patients with pre‑existing auditory disorders, hyperacusis, or anxiety related to noise may be particularly vulnerable (Chopra et al., 2016).

Long‑Term Occupational Consequences for Dentists

Dentistry presents a distinctive occupational noise profile characterised by repeated, short‑duration exposures extending across decades of professional practice. Evidence suggests this exposure pattern is sufficient to cause cumulative cochlear damage, particularly at higher frequencies (Dierickx et al., 2021).

Population‑based research on occupational noise exposure has shown that prolonged work in noisy environments is strongly associated with hearing difficulty and persistent tinnitus, even after adjustment for age and other confounding factors (Palmer et al., 2002). This reinforces concerns that dental professionals—whose exposure may not always exceed regulatory limits in a single day—remain at genuine long‑term risk.

Strategies to Mitigate Noise Exposure in Dental Practice Hearing Protection for Dental Professionals

Peer‑reviewed reviews consistently recommend the use of hearing protection devices (HPDs) as part of hearing conservation strategies in dentistry (Hartland et al., 2023; Vagevuur and Brand, 2024). While traditional foam earplugs may interfere with communication, filtered or musician‑style earplugs attenuate harmful sound levels while preserving speech perception and situational awareness, making them more suitable for clinical use.

Despite their effectiveness, uptake among dental professionals remains low, largely due to under‑recognition of risk and limited emphasis within dental education (Dierickx et al., 2021). Regular baseline and follow‑up audiometric monitoring has therefore been recommended to improve awareness and detect early, subclinical changes.

Administrative Controls and Work Pattern Modifications

Noise exposure in dentistry is intermittent but chronic. Administrative strategies such as regular breaks between noisy procedures, task rotation, and avoidance of prolonged continuous ultrasonic scaler use may reduce cumulative cochlear stress (Vagevuur and Brand, 2024).

Evidence suggests that repeated short‑term threshold shifts may contribute to long‑term cochlear damage even when hearing appears to recover between episodes (Chopra et al., 2016). Adequate recovery intervals may therefore be protective. Routine maintenance of dental equipment is also important, as poorly serviced handpieces emit higher sound levels than properly maintained devices (Kataria, 2023).

Equipment Selection and Alternative Technologies

Substantial variability exists in noise output between different dental handpieces and ultrasonic scaler models. Selecting lower‑noise equipment and using the minimum effective power settings where clinically appropriate may significantly reduce exposure (Vagevuur and Brand, 2024).

For patients with hyperacusis, distressing tinnitus, or marked sound sensitivity, alternative approaches may be appropriate. While not suitable for all clinical indications, laser‑based periodontal cleaning and caries management systems generally produce less acoustic and vibrational stimulation than rotary or ultrasonic instruments and may improve tolerability in selected cases (Chopra et al., 2016). Individualised treatment planning is particularly important for these patients.

Mitigating Noise Exposure for Patients

Patients—particularly those with known sound sensitivity—may benefit from filtered earplugs or noise‑attenuating headphones during dental procedures. Such measures can reduce discomfort from air-borne sounds. However, it should be noted that ear plugs do not attenuate sounds arriving via bone conduction i.e. drill and scaling tool vibrations stimulating the inner ear directly through the skull. To mitigate this, the dentist would need to consider the use of lower-noise equipment or shortening procedure length (duration of exposure) to mitigate risk.

Clear communication before and during procedures, including warning patients before activation of noisy equipment, may also reduce anxiety‑related exacerbation of tinnitus or hyperacusis (Zhang et al., 2025).

Conclusion

The peer‑reviewed evidence clearly demonstrates that dental drilling, ultrasonic scaling, and polishing generate noise levels capable of causing cochlear damage over time. Dentists and dental hygienists face a well‑documented occupational risk of noise‑induced hearing loss and tinnitus, driven by cumulative exposure to high‑frequency, high‑intensity sound across long careers. Patients, particularly those with sound sensitivity or auditory disorders, may also experience adverse effects.

Crucially, this risk is modifiable, at least in part. Through the adoption of hearing protection, structured work patterns, careful equipment selection, routine maintenance, and alternative technologies where appropriate, dental practices can significantly reduce the auditory burden on both clinicians and patients. Recognising dental noise exposure as a genuine occupational hazard is an essential step toward safeguarding long‑term auditory health.

References

Chopra, A., Thomas, B.S., Mohan, K. and Sivaraman, K. (2016) ‘Auditory and nonauditory effects of ultrasonic scaler use and its role in the development of permanent hearing loss’, Oral Health & Preventive Dentistry, 14(6), pp. 493–500.

Dierickx, M., Verschraegen, S., Wierinck, E., Willems, G. and Van Wieringen, A. (2021) ‘Noise disturbance and potential hearing loss due to exposure of dental equipment’, International Journal of Environmental Research and Public Health, 18(11), 5617.

Hartland, J.C., Tejada, G., Riedel, E.J., Chen, A.H‑L., Mascarenhas, O. and Kroon, J. (2023) ‘Systematic review of hearing loss in dental professionals’, Occupational Medicine, 73(7), pp. 391–397.

Kataria, S. (2023) ‘The sound of dentistry’, British Dental Journal, 235, p. 12.

Palmer, K.T., Griffin, M.J., Syddall, H.E., Davis, A., Pannett, B. and Coggon, D. (2002)

‘Occupational exposure to noise and the attributable burden of hearing difficulties in Great Britain’, Occupational and Environmental Medicine, 59(9), pp. 634–639.

Suedbeck, J., Ludwig, E.A., Blando, J. and Michalak, N. (2024) ‘Effects of ultrasonic use on hearing loss in dental hygienists: a matched‑pairs design study’, Journal of Dental Hygiene, 98(5), pp. 7–15.

Vagevuur, J.J. and Brand, H.S. (2024) ‘Occupational noise‑induced hearing loss among dental personnel: a scoping review’, British Dental Journal, 237, pp. 1–9.

Zhang, C., Young, A., Rodriguez, S., Schulze, K.A., Surti, B., Najem, F. and Hu, J. (2025) ‘Impacts of hazardous noise levels on hearing loss and tinnitus in dental professionals’, Journal of Occupational Medicine and Toxicology, 20(1), pp. 1–9.