Upon reorientation of the head relative to gravity, the cupula is weighted down by the dense particles, thereby inducing an immediate and sustained excitation of semicircular canal afferent nerves. This condition is termed cupulolithiasis.There is evidence in the dental literature that malleting of an osteotome during closed sinus floor elevation, otherwise known as osteotome sinus elevation or lift, transmits percussive and vibratory forces capable of detaching otoliths from their normal location and thereby leading to the symptoms of BPPV.BPPV can be triggered by any action that stimulates the posterior semi-circular canal including:
Looking up or down
Following head injury
Sudden head movement
Rolling over in bed
Tilting the headBPPV may be made worse by any number of modifiers which may vary among individuals:
Changes in barometric pressure – people may feel increased symptoms up to two days before rain or snow
Lack of sleep (required amounts of sleep may vary widely)
StressAn episode of BPPV may be triggered by dehydration, such as that caused by diarrhea. For this reason, it commonly occurs in people with post-operative diarrhea induced by post-operative antibiotics.BPPV is one of the most common vestibular disorders in people presenting with dizziness; a migraine is implicated in idiopathic cases. Proposed mechanisms linking the two are genetic factors and vascular damage to the labyrinth.Although BPPV can occur at any age, it is most often seen in people older than the age of 60.
Signs and symptoms
Symptoms:

Paroxysmal—appears suddenly, and in episodes of short duration: lasts only seconds to minutes
Positional—is induced by a change in position, even slight
Vertigo—a spinning dizziness, which must have a rotational component
Torsional nystagmus—a diagnostic symptom where the top of the eye rotates toward the affected ear in a beating or twitching fashion, which has a latency and can be fatigued (vertigo should lessen with deliberate repetition of the provoking maneuver): nystagmus should only last for 30 seconds to one minute
Pre-syncope—(feeling faint) or syncope (fainting) is unusual, but possible
Visual disturbance—due to associated nystagmus, making it difficult to read or see during an attack
Nausea—is often associated
Vomiting—is common, depending on the strength of vertigo itself and the causes for this illnessMany people will report a history of vertigo as a result of fast head movements. Many are also capable of describing the exact head movements that provoke their vertigo. Purely horizontal nystagmus and symptoms of vertigo lasting more than one minute can also indicate BPPV occurring in the horizontal semicircular canal. The spinning sensation experienced from BPPV is usually triggered by movement of the head, will have a sudden onset, and can last anywhere from a few seconds to several minutes. The most common movements people report triggering a spinning sensation are tilting their heads upward in order to look at something and when rolling over in bed.People with BPPV do not experience other neurological deficits such as numbness or weakness. If those symptoms are present, a more serious etiology, such as posterior circulation stroke or ischemia, must be considered.