Are dental procedures safe with cardiac devices? 

Yes, dental procedures are generally very safe for patients with a pacemaker or an implantable cardioverter defibrillator (ICD). Modern cardiac devices are designed with robust shielding that protects them from the electrical equipment used in most dental surgeries. Maintaining good oral health is actually a clinical priority for heart patients, as gum disease and tooth infections can increase the risk of bacteria entering the bloodstream and affecting the heart. 

In this article, you will learn about the precautions your dentist should take, the safety of common dental tools, and whether you need antibiotics before your appointment. We will also discuss the importance of communication between your dental and cardiology teams to ensure your device remains unaffected during treatment. 

What We’ll Discuss in This Article 

• The safety of ultrasonic scalers and dental drills. 

• Clinical guidelines regarding antibiotic prophylaxis for heart patients. 

• How to manage local anaesthesia and adrenaline. 

• Precautions for electromagnetic interference in the dental surgery. 

• The link between oral health and the prevention of endocarditis. 

• Triggers and warning signs to watch for during dental work. 

• Essential information to share with your dentist before treatment. 

Safety of dental tools and equipment 

The majority of modern dental tools, including high speed drills and X ray machines, do not produce enough electromagnetic interference to affect a cardiac device. In the past, there were concerns about ultrasonic scalers, which use high frequency vibrations to clean teeth. However, clinical studies have shown that as long as the equipment is modern and the cables are not draped directly over your chest, the risk of the device misinterpreting the signal is extremely low. 

Your dentist will usually keep the power unit of the ultrasonic scaler as far from your chest as possible. If you have an ICD, your dentist might choose to use manual scaling instead of ultrasonic tools as an extra precaution, although this is rarely a strict requirement. The key is for the dental team to be aware of the device location so they can manage their equipment cables safely. 

• High speed dental drills and X ray machines are completely safe. 

• Ultrasonic scalers are safe when cables are kept six inches away from the device. 

• Electronic apex locators used in root canal work are generally safe. 

• Electrosurgery units should be used with caution and avoided near the chest. 

Antibiotics and the risk of endocarditis 

A common question for heart patients is whether they need to take a dose of antibiotics before dental work to prevent a heart infection called endocarditis. Under current NICE guidelines in the UK, routine antibiotic prophylaxis is not recommended for most patients with a pacemaker or ICD. This is because the risk of developing an infection from the dental procedure is considered lower than the risks associated with the frequent use of antibiotics. 

However, there are exceptions. If you have a prosthetic heart valve, a history of endocarditis, or certain complex congenital heart conditions in addition to your device, your cardiologist may still recommend antibiotics. It is vital to confirm your specific clinical requirements with your cardiology team before undergoing any invasive dental work, such as an extraction or deep gum treatment. 

• Routine antibiotics are usually not required for simple pacemaker patients. 

• Patients with heart valves or prior infections may still need prophylaxis. 

• Good daily oral hygiene is the best way to prevent heart infections. 

• Always follow the specific advice provided by your own cardiologist. 

Local anaesthesia and adrenaline 

Most dental procedures require a local anaesthetic to numb the area. Some dental anaesthetics contain a small amount of adrenaline to help the numbness last longer and reduce bleeding. For most patients with a cardiac device, this small amount of adrenaline is safe and does not affect the heart rhythm or the device. 

However, if you have certain types of heart failure or a history of specific fast heart rhythms, your dentist may choose an adrenaline free anaesthetic. This is another reason why providing your dentist with a full list of your heart medications and your specific diagnosis is essential. They can then tailor the anaesthetic to be the safest possible option for your heart. 

• Adrenaline in local anaesthesia is safe for the majority of device patients. 

• Adrenaline free alternatives are available if your heart condition requires them. 

• Inform your dentist if you have recently experienced heart palpitations. 

• Your blood pressure may be monitored if a long procedure is planned. 

Managing electromagnetic interference 

While the risk is low, there are a few items in a dental office that can produce electromagnetic fields. These include electrosurgery units used for cutting gum tissue and some older types of pulp testers. Your dentist will avoid using these items directly over your pacemaker or ICD site. 

If your dentist needs to use an electrosurgery unit, they will use it in short bursts and keep the active tip as far from the device as possible. If you feel any dizzy spells, thumping in your chest, or if your ICD delivers a shock during the procedure, the dentist will stop immediately. This is a very rare occurrence, but being aware of the clinical triggers ensures a rapid and safe response. 

• Inform the dental team exactly where your device is implanted. 

• Ensure any electronic cables do not rest on your shoulder or chest. 

• Electrosurgery should be avoided if possible or used with extreme care. 

• Most modern dental chairs and lights are perfectly safe. 

The link between gum health and your heart 

Maintaining excellent oral health is one of the most important lifestyle habits for a patient with a cardiac device. Bacteria from inflamed gums or tooth decay can enter the bloodstream every time you chew or brush your teeth. In some cases, these bacteria can settle on the heart valves or the leads of your pacemaker, leading to serious clinical complications. 

By visiting your dentist regularly and managing plaque through daily brushing and flossing, you significantly reduce this risk. Preventing dental problems before they require invasive surgery is the best clinical strategy for protecting both your teeth and your heart device. 

• Gum disease is a significant risk factor for systemic heart inflammation. 

• Regular dental check ups help catch infections before they become serious. 

• Use a soft bristled toothbrush to avoid causing bleeding in the gums. 

• Flossing daily is essential for removing bacteria between the teeth. 

Differentiation: Routine cleaning vs invasive surgery 

It is helpful to distinguish between routine dental cleaning and invasive surgery like extractions or implants. Routine cleaning and fillings carry almost no risk of electromagnetic interference and a very low risk of infection. These can usually proceed without any special cardiology input. 

Invasive surgeries involving the jawbone or deep tissue require more planning. If you are on blood thinning medications like aspirin or warfarin for your heart condition, your dentist will need to check your clotting levels before performing an extraction. They may also consult with your cardiologist to decide if your medication needs to be temporarily adjusted to manage the risk of bleeding. 

Conclusion 

Dental procedures are safe for patients with cardiac devices when simple clinical precautions are followed. By informing your dentist about your pacemaker or ICD and keeping electronic equipment at least six inches from your chest, you can undergo most treatments without any risk to your device. Remember that a healthy mouth is a vital part of a healthy heart, so do not let your device prevent you from seeking regular dental care. 

If you feel faint, experience a racing heart, or if your ICD delivers a shock during a dental procedure, the dentist should stop treatment immediately and you should contact your cardiology clinic. 

Authority Snapshot 

This article was written by Dr. Rebecca Fernandez, a UK trained physician with an MBBS and extensive experience in cardiology and general surgery. Dr. Fernandez has managed heart patients through various clinical pathways within the NHS and emphasizes the importance of integrated care between dental and medical professionals. This guide follows current NICE and British Heart Foundation standards to provide safe and accurate information.