Implanted Pacemaker Dental Precautions

The implantation of a pacemaker can affect your ability to safely undergo various medical tests and procedures. Dental procedures, X-rays, MRI’s, CAT scans, bone density tests, mammograms and ultrasounds can affected pacemakers because of the reaction of the energy waves involved in the tests and the electronic components of the pacemaker.


Dental Care

For you as a patient with an implanted heart device, dental care–like any specialized treatment–is a necessary and routine health care issue. Your dental care will almost always include X-rays, ultrasonic probes, drilling and other procedures that might produce high levels of electromagnetic energy. To avoid malfunctions to your implanted device and possible harm, it’s imperative to tell the technician in advance about the implantation. This is important even when a lead drape or other precaution shields the chest.

 Potential Interactions

There is a possibility that exposure to some dental equipment may temporarily affect the function of an implanted pacemaker or defibrillator. Electromagnetic interference (EMI) may occur when the electromagnetic field from one electronic device interferes with the operation of another electronic device. These electromagnetic signals have the potential to mimic the electrical activity of the heart, or be interpreted by the implanted pacemaker or defibrillator as electrical noise. Possible device responses to EMI include:

• Inhibition of pacing – pacing therapy not provided when needed

• Asynchronous pacing – pacing therapy provided at a fixed rate regardless of the heart’s need for therapy

• Inappropriate shocks – shock therapy provided when not needed

 Proactive Approach


According to the American Dental Association, studies show that as a dental patient with a pacemaker implant, you are particularly at risk for developing endocarditis. This infection or inflammation of the heart occurs as a result of bacteria that enter the bloodstream from the mouth.This is why, when a dental procedure is scheduled for you as a heart patient, skilled, experienced dentists will often take a proactive approach to help prevent you from developing this condition. Before any dental hygiene procedure, extraction or any other oral surgery, you will be given antibiotics to protect you as a heart patient. This can help prevent the bacteria from spreading to the bloodstream.

 General Dental Procedures and Equipment

The following information may be helpful when using line-powered equipment.

• Consider keeping equipment power sources and cables as far as possible from the implanted device and lead system to help minimize EMI. Avoid draping the equipment cables over the device implant site.

• Consider adjusting dental equipment to the lowest clinically acceptable energy setting. However, minimizing the equipment’s energy setting will not necessarily prevent EMI with the implanted pacemaker or defibrillator.

• If a pacemaker or defibrillator patient experiences symptoms such as light-headedness, increased heart rate, a defibrillation shock, or hears beeping tones from their device, moving away from the source of interference or turning it Off will usually allow the device to return to its normal mode of operation.

• Some manufacturers of dental equipment may contraindicate product use in patients implanted with a pacemaker or defibrillator.

• Patients should consult with the physician who monitors their device to discuss any concerns they might have regarding the potential for interference. Boston Scientific cannot assure the safe and effective operation of its implantable device with all possible types of dental equipment when used in combination.


Dental Equipment

Equipment Function & Potential Interactions

Drills and cleaning equipment Most dental drills and cleaning equipment should not affect cardiac device function.
Dental X-rays Most diagnostic tools using ionizing radiation, such as radiography (X-ray), have not been identified as sources of device interference or damage. Dental X-rays should not affect pacemaker or defibrillator function.
Ultrasonic dental scalers Ultrasonic dental scalers use fast vibrations to clean teeth through one of two energy conversion technologies:• Magnetorestrictive—uses a pulsing magnetic field applied to a metal “stack” that flexes to move tip in an elliptical pattern.

• Piezoelectric—uses pulsing voltage applied to ceramic crystals to move the tip in a reciprocating pattern.

Apex locators Apex locators are used by dentists to determine the length of the root canal space.Recent independent studies conducted to investigate the potential for EMI between dental equipment and pacemakers and/or defibrillators identified no interference from the apex locators tested.
Dental chairs with magnetic headrests Some dental chairs contain magnets located in the headrest. If the pacemaker or defibrillator is programmed not to respond to a magnet, patients may sit in these chairs. If the implanted device is programmed to respond to a magnet and: 

• The magnet power is less than 10 Gauss (1mTesla)—patients may sit in these chairs.

• The magnet power is greater than or equal to 10 Gauss (1mTesla)—patients should not sit in these chairs as device function/programming may be affected.


Electrocautery Electrocautery may temporarily affect the function of an implanted pacemaker or defibrillator.