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Cardiac pacemakers

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Pacemaker therapy

There are different types of pacemaker devices, which are applied corresponding to the main disease (arrhytmias).
  1. Demand-pacemaker
    • anti-bradycardia pacemaker
    • they are activated when intrinsic cardiac electrical activity is inappropriately slow or absent
  2. implantable internal cardiac defirillator (ICD)
    • anti-tachycardia pacemaker
    • they are activated upon ventricular tachycardia, ventricular fibrillation or -flatter
Patients have a permanent pacemaker identification card providing information about type and programming of their particular model.
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Possible sources of pacemaker interference in the dental office

As a basic principle:
Closeness of magnetic, electric and electromagnetic fields interfere with the pacemaker function.
  • Electric motors with collectors
    common drive motors in the dental office does not interfere with pacemakers
  • Electrosurgical procedure
    Usual electrosurgical management can interfere with pacemaker function.
    Electrosurgical units within 2 m distance to the pacemaker (independently from walls) can cause life-threatening pacemaker complications (ventricular fibrillation).
    → therefore, heart monitor controlling and availability of a defibrillator are mandatory
  • Acupuncture with alternating voltage
  • Ultrasonic scalers
    Opinions at this point are equivocal.
    There is consensus in that piezoelectronical ultrasonic scalers do not interfere with pacemakers (Trenter et Walmsley 2003).
    Electromagnetic ultrasonic scalers inhibit pacemaker up to a distance of 37.5 cm. (Miller et al.1998).
Certain electrosurgical and ultrasonic instruments interfere with pacemakers.
Prior to use of such dental devices in patients with cardiac pacemaker, the cardiologist, threating the patient should be consulted.

Procedures that do not interfere with cardiac pacemakers

(Miller et al.1998)
  • Electric pulp testing
  • Composite curing lights
  • Dental handpieces
  • Electric tooth brush
  • Microwave oven
  • Dental chair
  • Dental lamp
  • Radiography unit


sources

  • Miller CS, Leonelli FM, Latham E (1998)   Selective interference with pacemaker activity by electrical dental devices   Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 85:33-6
  • Trenter SC, Walmsley AD (2003)   Ultrasonic dental scaler: associated hazards   J Clin Periodontol 30:95-101