In‐vivo compatibility between pacemakers and dental equipment

Abstract

In-vitro studies suggest that electromagnetic interference can occur under specific conditions involving proximity between electronic dental equipment and pacemakers. At present, in-vivo investigations to verify the effect of using electronic dental equipment in clinical conditions on patients with pacemakers are scarce. This study aimed to evaluate, in vivo, the effect of three commonly used electronic dental instruments - ultrasonic dental scaler, electric pulp tester, and electronic apex locator - on patients with different pacemaker brands and configurations. Sixty-six consecutive non-pacemaker-dependent patients were enrolled during regular electrophysiology follow-up visits. Electronic dental tools were operated while the pacemaker was interrogated, and the intracardiac electrogram and electrocardiogram were recorded. No interferences were detected in the intracardiac electrogram of any patient during the tests with dental equipment. No abnormalities in pacemaker pacing and sensing function were observed, and no differences were found with respect to the variables, pacemaker brands, pacemaker configuration, or mode of application of the dental equipment. Electromagnetic interferences affecting the surface electrocardiogram, but not the intracardiac electrogram, were found in 25 (37.9%) patients, especially while using the ultrasonic dental scaler; the intrinsic function of the pacemakers was not affected. Under real clinical conditions, none of the electronic dental instruments tested interfered with pacemaker function.

Electromagnetic interference effect of dental equipment on cardiac implantable electrical devices: A systematic review

“…No interference of dental electrical devices was found affecting the function of CIEDs in four clinical studies 21–25 . Three in vivo studies found background noise and electrocardiogram noise while using a gutta‐percha heating device, ultrasonic dental scaler, EPT, and EAL at a preset sensitivity 24–26 …”

“…Among these 18 selected studies, 12 were in vitro and six were in vivo studies. Table 1 summarizes the details and results of the in vitro studies, 7,10–20 while the main characteristics of the in vivo studies are shown in Table 2 21–26 …”

“…Six in vivo studies 21–26 (Table 2) investigated 10 dental devices in 12‐66 patients with PMs or ICDs. Patients dependent on PMs were excluded for safety in all six in vivo trials.…”

“…The exposure parameters of PMs and ICDs were simply described in all in vivo studies. In five of six studies investigating PMs, 21,22,24–26 the baseline PM settings were not changed, and only electric noise was observed in three studies, with no effect on PM function 24–26 . Two studies 21,25 repeated the experiment after setting to maximum sensitivities in both atrial and ventricular leads, and no EMI effect on PM functions was observed in one study 21 .…”

“…However, the testing was performed at an extreme setting of PM parameters: unipolar mode, with the sensitivity value lowered to 0.5–1 mV from a clinical setting. The other three types of EALs were identified as inducing no interference with PMs or ICDs 22,26 …”