Perioperative care of patients undergoing an epidural spinal cord stimulator for angina

The impact of dental devices on neurostimulators

Spinal cord stimulation has been a therapeutic option for chronic pain for over 40 years. The neurostimulator (NS) is a device consisting of three primary components: an electrode array configured either as a paddle or wire; an implantable pulse generator (IPG) consisting of a minicomputer, a transceiver/antenna, an electrical generator, and a battery; and insulated wiring connecting the electrode to the IPG. The electrode array can be implanted into the epidural space overlying the dorsal spinal cord or along a peripheral nerve. The device generates pulsed electrical signals that stimulate the underlying dorsal columns of the spinal cord resulting in the perception of paresthesia by the patient. When overlapped with painful areas, the paresthesia can help decrease the patient's level of pain. The increased applications and indications for this technology enhance the likelihood that the NS patient will be seen in the dental practice. Therefore, the purpose of this study was to investigate whether electromagnetic interference of the NS occurred during the operation of the apex locator, the electric pulp tester (EPT), or the electrocautery unit. An NS was implanted into the epidural space of a human cadaver. The dental devices were used intraorally, and the implant's circuitry was tested after each trial. Two apex locators, two EPTs, and one electrocautery unit were tested. Seventy trials were used by each dental device on each tissue. Using the exact binomial method of determining confidence intervals, the probability of damage to the NS by any of the devices was negligible.