Hearing aids and cochlear implants at the dentist raise one genuine device safety question, electrosurgery, and a long list of comfort and communication questions, and the two device types need different plans. The clearest piece of evidence available is a 2002 study published in the Journal of Endodontics, which tested dental equipment against cochlear implants in a laboratory model. The electric pulp tester, the apex locator, the electrocautery unit and 50 panoramic x-rays all carried negligible risk. The electrosurgery unit, run at power level 7, destroyed the implant circuitry. That is the single finding worth carrying into an appointment.
Key takeaways
- Hearing aids have no documented risk from dental equipment. The issues are feedback, amplified noise and comfort.
- Cochlear implants have one real contraindication in dentistry: monopolar electrosurgery, which manufacturers say must never be used in the head and neck.
- Dental x-rays, including panoramic images and CT scans, are explicitly listed as safe with cochlear implants by the manufacturer.
- Whether to remove the external processor for ultrasonic scaling is genuinely unsettled. Manufacturer advice is precautionary, and a published reply argued the evidence does not support it.
- Turning a hearing aid off does not make the appointment silent, because scaler and handpiece noise is partly conducted through bone.
- Agree a hand signal for stop before anything starts, because once a device is out you may not hear the next instruction.
Two different devices, two different problems
Most articles on this topic merge hearing aids and cochlear implants into one paragraph, and that is the main reason the advice out there is unhelpful. A hearing aid is an external amplifier sitting in or behind the ear. A cochlear implant has an internal component surgically placed under the skin, with magnets and electronics, plus an external sound processor held on by a magnet. The internal part is what makes certain equipment a question.
Between July 2000 and June 2023, 25,611 cochlear implant devices were implanted in Australia, rising from about 200 a year to more than 1,400 a year before plateauing after 2016. Estimated uptake among adults who might be eligible is around 10.5 per cent. As at 30 June 2023 there were around 180,000 Hearing Australia clients fitted with a hearing device. Advocacy modelling puts the number of Australians living with hearing loss at about 3.6 million, though that figure comes from modelling rather than a government statistical release.
What the noise is actually like
The two loud pieces of equipment are the ultrasonic scaler used for cleaning and the high-speed handpiece used for cutting. Ultrasonic scalers work at 20 to 50 kilohertz and have been measured at roughly 87 to 107 decibels A-weighted. Cavitron-type scalers have been measured at 84 to 98 dBA, high-speed handpieces average 70 to 82 dBA with peaks around 105 dBA, and high-volume suction sits around 86 to 89 dBA. The reference occupational limit is 85 decibels averaged over eight hours.
Those ranges are wide for a reason, and any single number quoted as how loud it will be for you is close to meaningless. Measurements shift with where the microphone sits, the age of the equipment, the tip design, the power setting and the acoustics of the room. Most published figures come from dental school clinics.
One point matters more than the decibels. Scaler noise reaches you two ways: through the air, and through the tooth and jaw, because the tip is physically chipping against the tooth. Bone-conducted sound bypasses the ear canal entirely. So switching a hearing aid off reduces the noise but does not remove it, and nobody should promise you silence.
Hearing aids: in or out
There is no published evidence that dental equipment damages hearing aids. The entire convention of taking them out is about comfort and feedback, not safety. That leaves you with a real trade-off, and it is worth deciding it deliberately rather than at the last second with a bib already clipped on.
Reasons people leave them in
You can hear instructions, warnings and questions, and the difference between almost done and open a little wider. For a check-up, an impression or a simple filling, most people leave them in and are fine.
Reasons people take them out
Amplification does exactly what it is designed to do, which means a scaler or a handpiece gets amplified too. Lying back changes the fit slightly, and the plastic of a bib or a chair headrest close to the microphone can set off whistling feedback. Many people find a long cleaning appointment more comfortable with the aid switched off or removed.
A middle option works well: leave the device in for the talking parts, then switch it off or remove it for the noisy parts, with the dentist pausing to hand it back before explaining the next step. If you take an aid out, put it in a case rather than a pocket or the arm of the chair.
Cochlear implants: what the guidance actually says
Electrosurgery is the one to flag
Manufacturer and specialist group guidance is consistent. Monopolar electrosurgery must never be used in the head and neck region, including in dental surgery, and bipolar must never be used within 2 centimetres of the implant. That matches the 2002 laboratory finding above. Electrosurgery is not part of routine dentistry, but it can appear in gum surgery and some soft tissue procedures, so it needs to be on your record beforehand. A 2024 ear, nose and throat paper has argued the monopolar risk is smaller than assumed, so the position may soften, but current manufacturer guidance is what practices follow.
X-rays are fine
Cochlear states that all its Nucleus implants may be subjected to standard dental and diagnostic x-rays, including dental panoramic images and CT scans. This is the question patients ask most often, and the answer is reassuring and specific.
The ultrasonic scaler question is unsettled
Here the honest answer is that the profession disagrees. A 2015 letter in the British Dental Journal advised removing the external processor when ultrasonic cleaning equipment is used. A right of reply in the same journal argued the restriction was not adequately supported by the literature. Neither side produced clinical evidence of damage. What the manufacturer describes is possible interference in the audio signal near equipment producing electromagnetic fields, which is a signal and processor issue rather than evidence that scaling harms the implant. Ultrasonic scaling is not contraindicated. Removing the processor as a precaution is reasonable, and so is leaving it on.
Diathermy, therapeutic ultrasound and magnets
Therapeutic diathermy and therapeutic microwave radiation should not be used anywhere on the body of someone with a cochlear implant. Therapeutic ultrasound should not be applied over the implant site and is recommended only below the head and neck. Keep the implant or headset magnet more than 5 centimetres away from other medical devices, and never place a transmitter coil magnet directly over a pacemaker, an implanted defibrillator or a programmable shunt valve.
MRI, if you are ever referred for one
MRI is neither simply safe nor simply impossible with a cochlear implant. It is conditional and device specific. Most Nucleus implants can be scanned at 1.5 tesla, often with a firm pressure bandage, and 3.0 tesla is permitted following the manufacturer's per-implant guidelines. The internal magnet can be removed as an outpatient procedure if needed. Anyone referring you for an MRI, including for jaw joint imaging, should contact your implant centre first.
Dental equipment and your hearing device
| Equipment | Cochlear implant | Hearing aid | What to agree with the team |
|---|---|---|---|
| High-speed handpiece | No device risk. Noise is partly bone conducted | May cause feedback. Many people switch off | A stop signal, and a pause before the drill starts |
| Ultrasonic scaler | Manufacturers advise removing the external processor. Damage is not demonstrated and the advice is contested | Feedback and amplified noise. A comfort decision | Whether you remove the processor, and how you will be signalled |
| Dental x-ray, panoramic or CT | Explicitly safe per manufacturer guidance | No interaction | Nothing beyond the usual |
| Electrosurgery or electrocautery | The one real contraindication. Monopolar never in the head and neck | No interaction | Tell the team before any gum or soft tissue surgery |
| Electric pulp tester and apex locator | Negligible risk in laboratory testing | No interaction | Nothing, but mention the implant anyway |
| MRI referral | Conditional and device specific. Implant centre first | Remove before the scan | That the referrer contacts your implant centre |
| Suction | No device risk | Feedback possible | Ask for suction pauses if it bothers you |
Agree the signals before anything starts
The practical problem with removing a hearing device is not the removal. It is the ten minutes afterwards, when you cannot hear the instruction to close a little or the warning that cold water is coming. A couple of minutes at the start fixes most of it.
- Agree one signal for stop, usually a raised hand, and confirm the dentist will stop immediately rather than finishing the step.
- Agree a second signal for I need a break or I want to say something.
- Ask for the plan for the whole appointment before your device comes out, in the order it will happen.
- Ask for a tap on the shoulder or a hand in your line of sight before anything new touches your mouth.
- Ask for post-treatment instructions in writing, because that conversation usually happens while you are still getting the device back in.
- Say which side hears better, so the team can speak to that side and stay in your field of view.
Mentioning the device when you book, rather than when you sit down, lets the team plan the order of the visit around the noisy parts.
What this article deliberately does not cover
This page is about the devices and the equipment. It is not a guide to communication access more broadly. If you are deaf or hard of hearing and want the wider picture, including how to make a dental practice workable without relying on lipreading behind a mask, our article on dental visits with sensory impairment covers that ground. If you use Auslan or need a spoken language interpreter, our guide to interpreters and language support at the dentist explains how to arrange one and what to expect. Those two articles handle access. This one handles equipment.
For context on the appointment itself, our piece on what to expect at a scale and clean walks through the steps and the sounds in order. If the noise is part of a wider unease about dental visits, our article on managing dental anxiety covers that separately.
Common questions
Do I have to take my hearing aids out at the dentist?
No, there is no rule requiring it. There is no evidence that dental equipment damages hearing aids, so the decision is about comfort. Many people leave them in for examinations and take them out or switch them off for cleaning and drilling, then put them back for the discussion afterwards.
Will the dentist drill damage my hearing aid?
There is no published evidence that it will. The drill is a noise and feedback problem rather than a damage problem. If you are worried about the device being knocked or dropped, ask for a case to put it in rather than leaving it on the chair.
Can I have a scale and clean with a cochlear implant?
Yes. Ultrasonic scaling is not contraindicated with a cochlear implant. Manufacturer guidance suggests removing the external sound processor as a precaution against audio interference, though a published reply in the British Dental Journal argued the literature does not support the restriction. Hand scaling is an alternative if you would prefer to keep the processor on.
Is a dental x-ray safe with a cochlear implant?
Yes. Cochlear states that its Nucleus implants may be subjected to standard dental and diagnostic x-rays, including panoramic images and CT scans. Laboratory testing exposed an implant to 50 panoramic radiographs with negligible risk. Tell the team you have an implant anyway, so it is on your record.
Why do my hearing aids whistle at the dentist?
Feedback happens when amplified sound leaks back into the microphone. Lying back in the chair changes how the aid sits, and a bib, a headrest or a hand close to your ear reflects sound straight into it. Repositioning the aid, lowering the volume, or removing it for the noisy part usually settles it.
If you wear a hearing device and want a dental team that will plan the appointment around it, the team at Lumi Dental sees new patients in Melrose Park and there is a current new patient special listed on our current deals page. Mention the device when you contact the practice so a longer appointment can be set aside.
This article is general information only and is not personal advice. Cochlear implant guidance is specific to the device model, so check with your implant centre or audiologist about your own implant.
