Pacemaker

Pacemaker

Dental treatment and Pacemakers implanted devices

Pacemakers and Implanted cardiac devices (ICD) are used to regulate pacing for cardiac bradyarrhythmias associated with damaged heart muscle. They consist of a battery generator contained in a small metal box (approx. 4 x 4 cm) implanted subcutaneously, below the clavicle. the battery generator is attached to 1 or 2 thin wires (leads) that pass into the venus circulation into the heart to monitor heart rate and deliver the pacing impulse as required. And the ICD delivers a cardioversion / defibrillation current.

Most of who have implanted cardiac devices was provided with a device identification card by their cardiologist. The card identifies the model number, manufacturer and contacts in case of emergency those informations will assist oral healthcare providers in identifying any contraindications for proceeding with any dental treatment.

All patients who have an implantable cardiac pacemaker or cardioverter–defibrillator should be encouraged to carry the manufacturer’s identification card with them at all times and oral health care providers should document the following in the patient’s record, manufacturer of the device, model number, serial number, date of implantation and mode of operation.

In regards for dental treatment recieved by who implanted cardiac devices I would say that there are no reports in the literature of any complication occurred with patients recieved any dental treatment but those devices has been a source of controversy.

Heart infection(Bacterial Endocarditis)

The American Heart Association classified the pacemaker and ICD as a negligible risk factor for bacterial endocarditis and no recommendation was issued for prophylactic antibiotic coverage for any dental treatment. Although theoretically speaking there is risk of bacterial endocarditis due to the presence of the pacemaker as a foreign material in the circulatory system.

Mobile or Microwavinterference(Electromagnetic Interference)

Most devices nowadays are designed with safeguards such as electronic filters or shields that insulate and isolate th device in the presence of electromagnetic interference (EMI). but strong electromagnetic signals may interfere temporary with the function of Pacemakers and ICDs. Most dental procedures do not involve strong electromagnetic signals and are unlikely to interfere with a shielded pacemaker or ICD. The following are considered safe : dental hand pieces;dental radiographs composite curing lights; piezo electricsonic and scalers. There is some evidence that, older ultrasonic scalers, (Cavitron) scalers, (TENS) transcutaneous Electrical Nerve Stimulators and ultrasonic cleaning baths caused some interference with implanted cardiac devices when tested in in-vitro setting and placed at close proximity less than 6 inches. Exposure to magnetostrictive scalers causes temporary increase in pace rate but the pacemaker is not easily damaged and usually resumes normal operation as soon as the external interference ends. Until now, there is no reported incidences of dental equipment interference with the operation of a cardiac pacemaker .

Auto Toothbrushes

Most of the Auto toothbrushes are battery operated and powered and there are no known or reported interactions from ,only one precaution was issued by one cardiac implant manufacturer for the use of sonic toothbrushes with a battery charger.The caution was to maintain a distance of at least 6 inches between battery charger unit and the implanted device and to have a distance greater than 1 inch between the toothbrush and the implanted device.

Dental Local Anesthetic

Adrenalin /Epinephrine or other vasoconstrictors are contraindicated in all cardiac arrhythmias including pacemakers and implanted defibrillators but can be used with caution (minimum dose with monitoring) .

Signs and Symptoms of Pacemaker Malfunction

Unusual activity or discomfort from their implanted device, difficulty in breathing, dizziness, light-headache, changes in pulse rate, swelling in chest, ankles, arms, wrists, chest pain, hiccoughing, and muscular twitching.

What shoud you do in case of Malfunction

In the event of a suspected malfunction, turn off all suspected sources of interference and activate your medical emergency protocol, mostly the implanted cardiac device will return to normal function. The incident should be reported to the cardiologist to determine the need for a medical follow-up.