If hearing loss were ‘officially’ considered a disability, it would rank as the highest disability class in the world.1 Hearing loss ranks as the second most common work-related illness/injury and in New Zealand alone has affected nearly 20% of the population with a yearly cost of approximately $5 billion.²

Dentists today can directly relate and identify colleagues who have suffered hearing loss in one or both ears, yet what have they done about it? We all accept greying hair as a result of aging, so too have we accepted the notion that our hearing will slowly fade as we age as a result of being a dentist. However this thinking is flawed; hearing loss, specifically noise-induced hearing loss (NIHL) which affects our profession is 100% preventable. Given the option of protecting one of our five senses from permanent and irreversible damage or doing nothing, many dentists have chosen inaction (to their detriment), and our governing and regulatory bodies have not taken a clear stance and advocated the use of hearing protection. It is common sense that dentists should take practical steps to prevent avoidable hearing damage. In addition, noise that can lead to hearing damage is a workplace health and safety matter and under the Health and Safety at Work Act (2105) practitioners have an obligation to act.³

Compared to other health professionals, dentists have significantly worse hearing levels.⁴ This holds true for all ages and genders when compared to the general population.⁵ NIHL causes permanent damage as soon as 10-15 years from exposure, and studies have shown the hearing capacity of dentists to be equivalent to people decades older, age-for-age. One of the biggest reasons NIHL affects dentists so directly is that hearing loss is a cumulative issue.⁶ Small exposures to damaging sounds for short  periods may seem harmless at first, however over time this exposure has the potential to damage hearing as much as having a bullet fired next to the ear. Consider the cumulative effect of 25 minutes using the high-speed handpiece, suction and/or ultrasonic use per patient, multiple times each day, 4-5 days a week, over a 35-year career. In fact, over the course of one’s career a dentist likely spends more hours in the dental environment than anywhere else, and even when outside the office often engages in noise ‘rich’ activities. This accumulative noise exposure slowly damages hearing and often is not noticed this until it’s too late. Sound familiar?

The damaging effects of noise go beyond the ear. Exposure to chronic high levels can directly lead to significant systemic health issues like cardiovascular disease and depression.⁷ chronic noise exposure may reduce productivity; increases stress, and interfere with communication and concentration. The body’s response to chronic noise exposure can cause sympathetic and endocrine responses which may adversely impact sleep patterns with detrimental effects on overall health and well-being.⁴ One of the easiest and accessible ways of protecting against hearing loss is through the use of hearing protection.

Several published studies have demonstrated the risk to dental practitioners of NIHL.^8,9 The American Dental Association recommended the use of hearing protection in the dental operatory, and many other publications have highlighted the risks and made similar recommendations.⁸ These recommendations should not be ignored.

Traditional foam earplugs result in muffling of sounds and compromise the ability to communicate with patients and staff. Studies have shown that these issues are the primary reason why hearing protections not used.¹⁰ Other solutions like noise-cancelling headphones are not practical in the clinical environment as they are big, bulky, and compromise effective communication, while “passive” ear plugs with filters help with decibel exposure but still create muffling and lack clarity. Conversely, “active” ear plugs are now an available solution which offer protection without the challenges posed by other forms of hearing protection.^11,12 Active hearing protection utilizes electronic microchip technology to isolate and compress high level damaging sounds while still maintaining an “open ear” response to enable  normal’ hearing. Communication remains clear and unaffected, and hearing damage is prevented, an ideal scenario for the dental environment.

Practicing dentists are strongly urged to consider the long-term detrimental effects of dental clinic noise exposure and to take the simple, practical step of protecting themselves and their staff from this workplace hazard.

REFERENCES

1. Hearing loss an “invisible” and widely uninsured problem. CNN.com. July 2012
2. Deloitte Access Economics, Social and Economic Costs of Hearing Loss in NZ, 3 Dec 2016
3. Health and Safety at Work Act 2015 available at http://www.legislation.govt.nz/act/public/2015/0070/52.0/DLM5976660.html

4. Willersausen B, Callaway A et al. Hearing assessment in dental professionals and other academic professionals from an urban setting. Head Face Med 2104;10(1) doi: 10.1186/1746-160X-10-1

5. Lehto TU, Laurikainen ET et al. Hearing of dentists in the long run: A 15-year follow-up study. Community Dent Oral Epidemiol 1989;17:207-211.

6. Theodoroff SM, Folmer RL Hearing loss associated with long-term exposure to high-speed dental handpieces. Gen Dent 2015;63(3):71-76.

7. Serafni F, Biasi CSL et al. Sound intensity and audiometric findings in the odontologic practice Proceedings of the 30th Congress of the Neurootological and Equilibriometric Society, 2003.
8. Noise Control in the dental operatory. Council on Dental Materials and Devices. J Am Dent Assoc 1974;89(6):1384-1385.
9. Cooperman HN. Deafness to the dentist caused by high speed handpieces. Pak Dent Rev 965:15(3);108-110
10. Reddy RK, Welch D et al Hearing protection use in manufacturing workers: a qualitative study. Noise Health 2012;14(59):202-209
11. Clinician’s Perspectives on Hearing Protection Devices. ADA Professional Product Review, Oct 2016, V11 (2) available at https://www.dentalinnovationsllc.net/wp-content/uploads/2017/08/ADA-PPR-Oct-2016. pdf.
12. Spomer J, Estrich CG et al. Clinical Perceptions of 4 Hearing Protection Devices. Clinical & Translational Research 2017;2(4):363-369.