Having a pacemaker or an implantable cardioverter-defibrillator (ICD) rarely changes what happens at a dental visit. Check-ups, cleans, fillings and X-rays go ahead as usual for most people. The main thing your dental team needs is to know the device is there, so they can keep certain electrical instruments at a sensible distance and avoid the one type of equipment that guidance treats with real caution.
Why electrical dental instruments come up at all
Pacemakers and ICDs read the heart's electrical signals. Strong electromagnetic interference near the device or its leads can, in rare cases, make it misread those signals. A pacemaker might briefly pause pacing, and an ICD could in theory respond as if there were a rhythm problem. Hospitals have managed this risk around surgery for many years. In dentistry, a handful of instruments use electrical current or vibration, so it is worth knowing which ones matter.
Lab tests found interference close up, real patients much less
Much of the worry comes from laboratory studies, where devices are tested on a bench with instruments held very close. One such study (Roedig and colleagues, Journal of the American Dental Association, 2010) found that an ultrasonic scaler, an ultrasonic cleaning bath and a battery-powered curing light interfered with pacemakers or ICDs at distances of a few centimetres up to about 23 centimetres. In the same tests, the electrosurgical unit, electric pulp tester, drills and an electric toothbrush did not alter pacing.
Studies in patients tell a calmer story. A systematic review of 18 studies (Niu and colleagues, Pacing and Clinical Electrophysiology, 2020) found that most bench studies reported interference only very close to the lead tip or at high sensitivity settings, while studies in patients did not detect interference that changed device function at normal working distances and settings. The authors concluded that most dental instruments can be used safely in routine practice, with distance and the device's lead settings being what matters.
Electrosurgery is the instrument guidance singles out
Electrosurgery units use electrical current to cut soft tissue or stop bleeding. The American Dental Association's summary on cardiac devices flags monopolar electrosurgery, where current travels through the body to a return pad, as a particular concern: laboratory studies have consistently shown clinically significant interference from it, and in operating theatres it is the most common source of interference. Where cutting or sealing soft tissue is needed in a patient with a device, the dentist may choose another method or a bipolar unit, which keeps the current between two closely spaced tips, and may seek advice from your cardiology team first.
Scalers, curing lights and other everyday tools
For the rest of the common equipment, the evidence points to low risk when sensible precautions are used:
- Ultrasonic scalers. Some bench tests showed interference with older magnetostrictive scalers. Piezoelectric scalers appear to be the safer type, and studies in patients have found little or no effect on pacing.
- Curing lights. An early bench study showed pacing inhibition very close to the device, but more recent studies have not found interference.
- Apex locators and pulp testers. These measure root canal length and test whether a nerve is alive. Studies in patients have mostly found only minor telemetry noise, although one study reported an interruption of pacing with two apex locator brands.
- Electric toothbrushes. Little or no risk.
The ADA summary cites a 2022 British Heart Rhythm Society guideline that interference from dental devices is not considered likely to pose a clinical risk at a distance of at least 15 centimetres. It also advises keeping electrical cords off the chest, turning equipment off when it is not in use, and observing patients with devices carefully during treatment. Because devices differ by model and age, your dentist may also check with your cardiologist or device clinic before particular procedures.
X-rays and 3D scans are aimed at the jaws
Dental X-rays, including panoramic (OPG) images and 3D cone-beam scans, use a beam directed at the teeth and jaws, well away from a device in the chest. They are not among the instruments flagged in dental guidance on cardiac devices, and having a pacemaker or ICD is not on its own a reason to avoid an X-ray your dentist recommends.
What to bring and what to mention
Tell the practice about your device when you book or at the start of the visit. Useful details are:
- whether it is a pacemaker, an ICD or a combined device
- the maker and model, often shown on the device card from your cardiology clinic
- when it was fitted and when it was last checked
- any precautions your cardiologist has given you for medical or dental procedures
- other conditions and medicines, especially blood thinners or diabetes treatment
If you take a blood thinner, never stop or skip a dose on your own before dental work. Your dentist will confirm the plan with your GP or prescriber. If you also manage diabetes, our article on diabetes and gum disease explains why gum health deserves extra attention.
Appointment timing
Most people with a well-functioning device need no special scheduling. Some prefer shorter visits soon after a device is fitted or adjusted, simply because they feel tired or anxious. If nerves are part of the picture, our guide to overcoming dental anxiety has practical suggestions.
If a dentist refers you for an MRI
Occasionally a jaw joint or nerve problem leads to an MRI referral. MRI uses a very strong magnetic field, so a scan in someone with a pacemaker or ICD has to be arranged with the cardiology or device team. Some older devices are not suitable for MRI, and newer MRI-conditional devices still need a specific protocol. Your dentist would flag the device in the referral, and the imaging provider checks compatibility as standard.
Common questions
Can I have a scale and clean with a pacemaker?
Yes, for most people. Your dentist or OHT can choose the type of scaler, keep it at a sensible distance from the device, or use hand instruments if your cardiologist prefers.
Do I need my device turned off or reprogrammed?
Generally not for routine dental care. Any change to a device is a decision for your cardiologist or device clinic and would usually only be discussed before surgery that involves electrosurgery.
Are fillings, crowns or dentures a problem?
No. Standard dental materials have no known effect on pacemakers or ICDs.
My device was fitted years ago. Do I still need to mention it?
Yes. Devices are replaced and updated over time, so give your dental team current details at each visit.
If you have a pacemaker or ICD and are due for a check-up, the team at Lumi Dental can talk through what to expect. Because advice can depend on your device and heart history, check with your cardiologist or device clinic if you have any doubts. See our current deals for new patient offers, or read about routine care on our general dentistry page. Patients with other implanted devices may find our guide to hearing aids, cochlear implants and dental treatment useful too.
