About one in three Australians over 85 lives with a pacemaker or implantable cardioverter-defibrillator (ICD), and that number is only growing as the population ages. For most of these patients, a routine dental appointment is entirely straightforward. But a small number of dental tools can, in theory, interact with a cardiac device, and knowing which ones matter, and which do not, makes for a calmer visit for everyone involved.
Key Takeaways
- Most dental treatment, including check-ups, fillings, cleans and dental X-rays, is considered low risk for patients with a pacemaker or ICD.
- The main genuine precaution is monopolar electrosurgery or electrocautery used close to the device, which manufacturer and cardiology guidance consistently advises avoiding or managing with bipolar alternatives.
- Ultrasonic scalers, electric pulp testers and apex locators are generally regarded as low risk at typical working distances, though some device manufacturers still recommend caution.
- Dental X-rays, including panoramic and CBCT imaging, are not considered a device risk.
- Always tell your dental team about your device, its make and model if you know it, and check anything device-specific with your cardiologist or device clinic.
Why cardiac devices come up in dental conversations at all
Pacemakers and ICDs are sensitive to electromagnetic interference (EMI). Sources of strong EMI, such as certain surgical electrosurgery units, can in rare cases cause a device to misread the heart's activity or, in an ICD, trigger an inappropriate response. This is well documented in medical and surgical settings generally, not specifically a dental problem, but because a few dental instruments use electrical current, it is worth understanding which ones are actually relevant.
The one genuine contraindication: monopolar electrosurgery
Monopolar electrosurgery and electrocautery units, which pass a concentrated electrical current through tissue to cut or coagulate, are the piece of dental and oral surgery equipment most consistently flagged in device manufacturer and cardiology guidance as needing caution around a pacemaker or ICD. Where electrosurgery is genuinely needed for a procedure, dental and specialist teams typically avoid monopolar units near the device or use bipolar electrosurgery instead, which contains the current between two closely spaced electrodes rather than passing it through the wider body. This is a well-established general precaution rather than a rare edge case, so it is worth mentioning early if any procedure involving soft tissue cutting or coagulation is planned.
Equipment generally considered lower risk
Several other pieces of dental equipment generate some electrical or electromagnetic activity, and patients understandably ask about them. Ultrasonic scalers, used for routine cleans and periodontal treatment, are generally considered low risk at the distances used in normal dental work, though some device manufacturers are cautious and may suggest keeping the device on the opposite side of the body from an older or particularly sensitive unit. Electric pulp testers and apex locators, used to test nerve vitality or measure root canal length, are typically viewed the same way. None of these carry anywhere near the same level of concern as monopolar electrosurgery, but because guidance can vary by device model and age, it is reasonable for your dental team to note your device on file and, if there is any doubt, confirm with your device clinic before a specific procedure.
Dental X-rays, panoramic imaging and CBCT
Dental X-ray machines, whether a small intraoral X-ray, a panoramic (OPG) scan or cone-beam CT (CBCT) imaging, do not pose a device risk. These machines produce ionising radiation for imaging rather than the kind of electromagnetic interference that affects pacemaker or ICD function, and they are not on the list of equipment that cardiology or manufacturer guidance flags as a concern. If a dental X-ray or scan is recommended as part of your treatment plan, having a pacemaker or ICD is not, on its own, a reason to avoid it.
What to tell your dental team
Before your appointment, or at the very start of it, let the practice know that you have a pacemaker or ICD. Useful details include when it was fitted, the manufacturer and model if you have that information (often on a card provided by your device clinic), whether you have had any recent device checks or firmware updates, and whether your cardiologist has given you any specific precautions in the past for medical or dental procedures. This lets your dentist plan appropriately, particularly if any electrosurgery, extraction or minor oral surgery is being considered.
Appointment logistics worth considering
Most patients with a well-controlled pacemaker or ICD do not need special appointment scheduling. That said, some patients feel more comfortable with shorter appointments, particularly soon after a new device is fitted or after any recent adjustment, simply to manage general anxiety and fatigue rather than any specific device risk. If you have a combination of a cardiac device and other health considerations, such as diabetes or being on blood thinners, it is worth mentioning all of these together so your dental team has the full picture, not just the device itself.
MRI referrals and device-related imaging
Dental treatment occasionally leads to a referral for an MRI, for example to investigate jaw joint problems or nerve symptoms. Because MRI uses a strong magnetic field, any MRI referral for a patient with a pacemaker or ICD needs to involve your cardiology or device team first, since some older devices are not MRI-conditional and modern MRI-conditional devices still need specific scanning protocols. Your dentist would typically flag this need in a referral letter rather than making the call independently, and the MRI provider will also check device compatibility as standard practice.
Frequently asked questions
Can I have a dental clean or scale with a pacemaker?
Yes, routine cleans and scales, including with an ultrasonic scaler, are generally considered low risk. Let your dental team know about your device so they can note it and answer any device-specific questions you may have.
Is it safe to have a dental X-ray with an ICD?
Dental X-rays, panoramic scans and CBCT are not considered a risk to pacemaker or ICD function, since they work on a different principle to the electromagnetic interference that can affect these devices.
Do I need to turn off or reprogram my device before a dental visit?
Generally no, for routine dental care. Reprogramming or deactivating a device is a decision for your cardiologist or device clinic, and would typically only be discussed if a specific procedure, such as significant oral surgery involving electrosurgery, is planned.
What should I do if I do not know my device's make or model?
Check any device identification card provided when it was fitted, or contact your cardiologist or device clinic, who can confirm these details. It is helpful to bring this information to future dental visits.
Are there any dental materials I should avoid with a cardiac device?
There is no general restriction on standard dental materials such as fillings, crowns or dentures for pacemaker or ICD patients. Any material-specific questions are best discussed directly with your dental team based on your individual health history.
Should I tell my dentist even if my device was fitted years ago?
Yes. Device details, model updates and any cardiology guidance can change over time, and your dental team needs current information at each visit to plan treatment appropriately.
If you have a pacemaker or ICD and are due for a check-up or have a treatment question, the team at Lumi Dental can talk through what to expect at your appointment. Because advice can be specific to your device model and cardiac history, it is also worth checking directly with your cardiologist or device clinic if you have any doubts. For current new patient offers, see our current deals, or learn more about general check-ups at our general dentistry page. You may also find our guide to hearing aids, cochlear implants and dental treatment useful, along with our article on overcoming dental anxiety and our piece on diabetes and gum disease, since many patients managing a cardiac device are also managing other health conditions their dental team should know about.
