Dentist

Hello everyone,

I was at the dentist today. The hygienist told me that they are not allowed to use their ultrasound equipment on pacemaker recipients. This is news to me.Anyone have any comments.


6 Comments

Ultrasonic equipment

by Gemita - 2021-02-23 19:40:23

Edouard, while we wait for more knowledgeable members to give us an opinion, I thought I would let you know that my dental hygienist here in the UK will also not offer ultrasonic cleaning treatment because of my pacemaker.  It is their dental practice policy apparently.  But that suits me because she always uses hand instruments to do the scaling and she is incredibly thorough and gentle.  

Maybe you have already read about this but I attach a couple of links in case they are of help.  The second link is perhaps more current:-

https://jcda.ca/article/b113

https://www.ada.org/en/member-center/oral-health-topics/cardiac-implanted-devices-and-electronic-dental-instruments

Difference between theory and practice

by crustyg - 2021-02-24 05:16:08

Thanks for the interesting ADA URL, Gemita.  I've read most of it, and there seems to be a clear difference between theoretical and in-vitro research and real-world effects of significance.

My overall impression is that the early caution (arguably excessive), based on in-vitro research (can we see *any* effect/interference detected by the CIED - often yes), has been replaced by a more pragmatic acceptance (are there any clinically important adverse effects on CIEDs - hardly any).  A pulp-tester sounds nasty - my dentist just uses a probe and if I hit the ceiling then we know the pulp is still alive - and reminds me of 'Marathon Man', but worse.

Electroc-cautery (i.e. *not* hot-wire)/diathermy is *always* going to be a significant risk - all of the PM / CIED vendors have instructions to make their devices safe for RF diathermy - especially important in the head and neck - so close to the device. But I think you're already into Oral Surgery territory for that.  I can't imagine consenting to a procedure at my dentist's practice that might require diathermy - but my wisdom teeth are tiger country anyway (roots very close to inferior dental nerve).  My dentist declined to work on them - Oral Surgery dept or nothing.

Some of the more alarmist reports have been discarded: "A 2000 position paper (ref 22) by the American Academy of Periodontology warned “[m]agnetostrictive ultrasonic scalers should not be used by clinicians or on patients with a pacemaker” (ref 16)  though this warning was later retracted. (refs 1, 3, 23)."

So I can understand some dentists still being cautious, but modern ultrasound cleaner/descaler devices should be fine.  Of course, *my* opinion will cut no mustard with *your* dentist.  Show them the ADA URL and invite them to read it all.

dentists

by Tracey_E - 2021-02-24 09:02:34

My old dentist used it, was just careful to keep the cable well away from me.

My current dentist, who I consider much more up to date on the latest, has  no problems with it and I've never felt anything during cleanings. 

Pacemakers and Dental equipment

by Selwyn - 2021-02-24 16:59:17

The latest advice (2019), as noted by Gemita,  is at:

https://www.ada.org/en/member-center/oral-health-topics/cardiac-implanted-devices-and-electronic-dental-instruments

My dentist still will not use ultrasound near my PM. 15 inches seems to be the relevant distance.  Do you have a long neck?

 

heart device and dentist

by islandgirl - 2021-02-25 23:10:01

My dentist is a close friend and will not allow ultrasonic cleaning equipment on me (ICD/PM).  She also has massaging chairs she will turn on for me.  I trust her judgement.

 

 

no problems

by dwelch - 2021-03-09 10:11:07

My dentist uses it on me with no issues.  Now they keep the cable away from my pacer, lay it on the other side but in the past being over the device there were no issues.  Difficult to get signal strenths large enough over distance even a handful of inches the signal stregth drops heavily.  

But, despite that, individual dentists/offices/insurance companies, etc, may choose to not do it, it is their choice.  Likewise you can choose your dentist.

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