Dental Devices

Hi, my wife had 2 cable pacemaker installed 3 years ago due to AV full block. She is pacemaker dependent. During dental treatment, the pacemaker is put in asynchronous mode so that the devices do not interfere. It's annoying that to get it asynchronous each dental session. I consulted with different cardiologist. He said that there is no need, with recent technologies there is no need to set asynchronous mode while dental treatment. Anyone have similar experience? Thanks for your responses in advance.


10 Comments

Dental

by docklock - 2023-03-10 17:18:10

Not sure what extent "dental treatment" consists of.  I think your wife's dentist and her cardiologist need to have a meeting of the minds to straighten this issue out.  

Dental treatment

by Penguin - 2023-03-10 17:55:06

I have received similar advice to you re: modern pacemakers and insignificant interactions between pacemakers and dental equipment.  However, I don't have the same diagnosis as your wife and this and the type of treatment planned may be relevant.  There may be exceptions.

Dentists and dental hygienists are wary of pacemakers. My dentists have always asked for a letter from the EP / Cardiologist which explains any risk / interactions between dental equipment which they routinely use and the device.  Once they have this they are usually happy to proceed with routine treatment and cleaning. The ultra-sonic cleaning device is often the biggest concern. 

Sometimes they ask for a further letter if there's significant treatment or use of specialist equipment or sedative drugs planned. 

If you are concerned that your EP and dentist are being over cautious you could check with the pacemaker manufacturer who may have written advice for dentists and hygienists. 

 

Dental Treatment

by Stache - 2023-03-10 17:55:22

I have a dual chamber heart pacer with both wires and do not have to put my pacer in asynchronous mode for my dental work (root canal).  My pacer is hardened as are most.  Mine was installed two years ago and I have a manual that covers this as well as MRIs that I have had two.  Your dentist needs to update his working knowledge on pacemakers in my opinion.

 

Dental

by Lavender - 2023-03-10 18:09:23

Spent my career in the dental office. There's no problem with dental treatments for the most part with pacemakers. Electro surgery might interfere as well as potentially ultrasonic scalers, or apex locators when having a root canal. I'm wondering just who in your wife's dentist office is qualified to change the pacemaker mode? Listen to her cardiologist. We never asked for a letter from any pacemaker wearer nor does my personal dentist ask that. 

Dentist

by AgentX86 - 2023-03-11 00:00:18

I had to have a couple of teeth removed shortly after I got my pacemaker.  The dentist (thus oral surgeon) needed a clearance letter from my cardiologst, which was no problem.  In it he indicated that there was no problem with any device found in a dental office.  They do have a note in my file. I see it on the screen (mounted on an arm in front of the chair) with the x-rays and such.

Dentists, like other medical types, need to CYA.

Varying Experiences

by Penguin - 2023-03-11 05:52:01

Sounds like there are variable experiences out there! I guess it depends on your dentist and their experience with pacemakers. Mine have wanted a letter for their file - presumably 'just in case' there's an issue. Cardiologists have always been happy to provide this. 

I'm not sure which device you have, but for the avoidance of doubt this is what Boston Scientific say, 

https://www.bostonscientific.com/content/dam/bostonscientific/quality/education-resources/english-a4/EN_ACL_Dental_Equipment_20090202.pdf

You will need to paste the link into your browser. The advice is pretty comprehensive.  

* Note: Below is an amended response for complete clarity. Text is taken from the document link above. 

* 'During electrocautery use, Boston Scientific defibrillators can be temporarily deactivated and a pacemaker can be programmed to pace asynchronously. The physician who monitors the patient’s implantable device should be contacted to discuss the use of electrocautery and the potential impact of these programming options. Reference device Instructions for Use manuals or the A Closer Look article, Electrocautery and Implantable Device Systems for further instructions / precautions when using electrocautery during dental procedures. This information is available through CRM Technical Services or on Boston Scientific’s website.'7

The link to the 'closer look article' can be found via the following website path. (see below)

'7 A Closer Look article, Electrocautery and Implantable Device Systems website path: bostonscientific-international.com > Product Performance Resource Center > A Closer Look Articles > select language > EMI (left side bar).'

This 'may' help you understand why your wife's dental care is being conducted in this manner.  As always check with the dentist / EP. 

Dentistry

by piglet22 - 2023-03-11 06:33:01

I would agree with all the comments.

My very old medical records paper bundle used to have a very prominent red sticker on the top "NO DIATHERMY OR MRI"

That was 18 years ago, but things have moved on.

My Medtronics Ensura Surescan is MRI safe and I was assured by the PM medics that dental procedures including ultrasonic descalers are safe.

But as ever, best to check.

The dentist is probably looking to protect themselves from any undue legal action, understandably, but the dentist needs to listen to your concerns and take advice from the cardio people.

Interestingly, as part of my professional and hobby electronics work, I use an ultrasonic bath to clean components.

One day, I noticed one of the components, a Light Emitting Diode (LED) was lighting up despite the fact there was no power on the board.

I raised this with an electronics forum and the general consensus was that this was the electro-acoustic affect and the high frequency sound waves generated in the bath were causing a small voltage to be generated on the board enough to light the LED.

The hygienist had never heard of this and it does account for the unpleasant jarring you can get on sensitive teeth.

Unlikely to affect the PM, but worth knowing.

Another side effect of electrical and electronics is the occasional shock.

Yes I know I shouldn't, but I can confirm that a painful 240-volt AC finger shock had no effect on the PM, but the air was blue.

never heard of that

by Tracey_E - 2023-03-11 14:12:32

Cautery is an issue but just a cleaning or basic procedure there is no reason for any precautions. I've been paced since 1994 and have never experienced this or heard of a need for it. 

Dental treatment

by Artos - 2023-03-11 14:23:23

Thanks very much for your comments. We go same hospital where our cardiologist and dentist works. We used to go first cardiologist to set the pacemaker asynch. mode, after dental treatment set the pacemaker normal pace mode. We will consult again our cardiologist.

dental treatment

by new to pace.... - 2023-03-13 12:35:53

I see you are in Turkey.  For me here in Florida,USA, i see the dentist in her offiice for the cleaning without any problems.  Not a hospital visit.

new to pace

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