Treatment planning and dental technology for patients with implanted cardiac devices

Implantable cardiac devices are increasingly common in the dental patient population. These devices include cardiac pacemakers, implantable cardioverters-defibrillators, and combination designs. To safely follow through with treatment, the clinician first must identify the patient's underlying medical condition warranting the device and consider the condition as well as the device in determining diagnosis, drug selection, appointment length, follow-up, and outcome expectations. Modern implantable devices are engineered to be resistant to electromagnetic field changes in the day-to-day activities of the wearer, and little of the technology used in dentistry today has been shown to create an electromagnetic field strong enough to have the potential to affect performance of an implantable cardiac device. The dentist should use the greatest caution with electrocautery devices and choose a bipolar system whenever possible. Consulting with a patient's cardiologist or general physician is a prudent step for the practitioner prior to undertaking a treatment plan that requires multiple or long appointments to accomplish and utilizes technology that produces an electromagnetic field.