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Niu Y, Chen Y, Li W, Xie R, Deng X. Electromagnetic interference effect of dental equipment on cardiac implantable electrical devices: A systematic review. Pacing Clin Electrophysiol 2020; 43:1588-1598. [PMID: 32852847 DOI: 10.1111/pace.14051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The electromagnet interference (EMI) effect resulting from using dental equipment near cardiovascular implantable electronic devices (CIEDs) is controversial based on in vitro and in vivo studies. We aimed to summarize the available evidence to investigate the safety of using dental equipment on patients with CIEDs. METHODS An electronic search was performed in PubMed, Embase, MEDLINE Ovid, and the Cochrane Library for relevant studies published between January 2000 and May 2020. The search strategy centered on terms related to dental devices and CIEDs. Two independent reviewers determined the final inclusion of the studies in the systematic review. The EMI effect was summarized based on different dental instruments detected in in vitro or in vivo studies. RESULTS The primary search identified 84 articles, and 18 studies were finally included in this systematic review after exclusions. Most in vitro studies (n = 12) reported background noise or severe EMI affecting CIED function at a close distance from the lead tip or at a high sensitivity setting of CIEDs. In in vivo studies (n = 6), EMI that altered CIED function was not detected at clinical distance and sensitivity settings. The summary, based on electronic apex locators, ultrasonic devices, and electric pulp testers, demonstrated the compatibility of these common dental devices with CIEDs. CONCLUSIONS This systematic review indicates that most dental instruments can be used safely in routine dental practice. The EMI effect of dental equipment depends on the exposure distance and lead-related parameters of the CIEDs.
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Affiliation(s)
- Yuting Niu
- Faculty of Stomatology, The First Clinical Medical School, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Yufei Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjing Li
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ruiqin Xie
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xuliang Deng
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
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2
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AlRahabi MK, Ghabbani HM. Influence and safety of electronic apex locators in patients with cardiovascular implantable electronic devices: a systematic review. Libyan J Med 2019; 14:1547071. [PMID: 30458679 PMCID: PMC6249593 DOI: 10.1080/19932820.2018.1547071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/01/2018] [Indexed: 11/13/2022] Open
Abstract
The widespread use of cardiovascular implantable electronic devices has increased concerns regarding using electronic apex locators in patients with these devices. This systematic review investigated the effects and safety of using electronic apex locators in patients with cardiovascular implantable electronic devices. METHODS An electronic search in the Cochrane Library, PubMed (MEDLINE), ScienceDirect, and Scientific Electronic Library Online (Scielo) databases for relevant articles published between December 2000 and December 2018 was performed. The search strategy centered on terms related to electronic apex locators use during root canal treatment in patients with cardiovascular implantable electronic devices. RESULTS Seven studies (five in vitro and two in vivo) fulfilled the inclusion criteria for this review. It was found that electronic apex locators can be used safely in patients with cardiovascular implantable electronic devices, when general precautions are followed. CONCLUSIONS Although the present review suggests that electronic apex locators can be used safely in patients with implantable cardioverter defibrillators, consultation with patients' cardiologists remains advisable.
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Affiliation(s)
| | - Hani M. Ghabbani
- College of Dentistry, Taibah University, Madinah Al Munawwarah, Saudi Arabia
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3
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Latest Concepts in the Endodontic Management of Patients with Cardiovascular Disorders. Eur Endod J 2019; 4:86-89. [PMID: 32161893 PMCID: PMC7006545 DOI: 10.14744/eej.2019.70288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 01/17/2023] Open
Abstract
There are several cardiovascular interventions that need special considerations in the provision of treatments within the scope of endodontics. If these interventions are not carefully identified, diagnosed, and considered in the overall treatment plan for the patient, they may result in fatal conditions. These include hypertension that causes fatal cardiac disorders, such as angina pectoris, ischemic heart diseases, and myocardial infarction, and also cerebrovascular diseases; congestive heart failure; infective endocarditis, valvular diseases, and carrying pacemakers; and the use of antiplatelet and anticoagulant drugs that are commonly prescribed for patients who have experienced heart stroke. The aim of this article is to review the newest recommendations for patients with these disorders who require endodontic treatments.
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4
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Conde-Mir I, Miranda-Rius J, Trucco E, Lahor-Soler E, Brunet-Llobet L, Domingo R, Tolosana JM, Mont L. In-vivo compatibility between pacemakers and dental equipment. Eur J Oral Sci 2018; 126:307-315. [PMID: 29972599 DOI: 10.1111/eos.12534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2018] [Indexed: 11/29/2022]
Abstract
In-vitro studies suggest that electromagnetic interference can occur under specific conditions involving proximity between electronic dental equipment and pacemakers. At present, in-vivo investigations to verify the effect of using electronic dental equipment in clinical conditions on patients with pacemakers are scarce. This study aimed to evaluate, in vivo, the effect of three commonly used electronic dental instruments - ultrasonic dental scaler, electric pulp tester, and electronic apex locator - on patients with different pacemaker brands and configurations. Sixty-six consecutive non-pacemaker-dependent patients were enrolled during regular electrophysiology follow-up visits. Electronic dental tools were operated while the pacemaker was interrogated, and the intracardiac electrogram and electrocardiogram were recorded. No interferences were detected in the intracardiac electrogram of any patient during the tests with dental equipment. No abnormalities in pacemaker pacing and sensing function were observed, and no differences were found with respect to the variables, pacemaker brands, pacemaker configuration, or mode of application of the dental equipment. Electromagnetic interferences affecting the surface electrocardiogram, but not the intracardiac electrogram, were found in 25 (37.9%) patients, especially while using the ultrasonic dental scaler; the intrinsic function of the pacemakers was not affected. Under real clinical conditions, none of the electronic dental instruments tested interfered with pacemaker function.
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Affiliation(s)
- Isabel Conde-Mir
- Servei d'Odontologia, Centre d'Atenció Primària Montnegre, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Jaume Miranda-Rius
- Departament d'Odontoestomatologia, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Hospital Dentistry & Periodontal Medicine Research Group, Institut de Recerca Sant Joan de Déu (IRSJD), Fundació Sant Joan de Déu, Barcelona, Spain
| | - Emilce Trucco
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques, August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Cardiology, Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - Eduard Lahor-Soler
- Departament d'Odontoestomatologia, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Hospital Dentistry & Periodontal Medicine Research Group, Institut de Recerca Sant Joan de Déu (IRSJD), Fundació Sant Joan de Déu, Barcelona, Spain
| | - Lluís Brunet-Llobet
- Hospital Dentistry & Periodontal Medicine Research Group, Institut de Recerca Sant Joan de Déu (IRSJD), Fundació Sant Joan de Déu, Barcelona, Spain.,Servei d'Odontologia, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Rebeca Domingo
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques, August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José M Tolosana
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques, August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Lluís Mont
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques, August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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5
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Wynne C. Endodontics in Systemically Compromised Patients. COMMON COMPLICATIONS IN ENDODONTICS 2018. [PMCID: PMC7121600 DOI: 10.1007/978-3-319-60997-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A substantial number of people in today’s world are elderly and as the incidence of a number of pathologies increases with age, it is predicted to produce millions of individuals with systemic medical conditions that can affect oral health and subsequent dental treatment. The dental management of these medically compromised patients can be sometimes problematic in terms of oral complications, dental therapy, and emergency care. One of the challenges faced by dental specialists today is the assessment and management of these patients. As mentioned in detail in Chap. 12, geriatric patients are much more likely to be at least partially dentulous having a complex medical history and the use of multiple medications.
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6
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Dadalti MTDS, da Cunha AJLA, Araújo MCPD, Moraes LGBD, Risso PDA. Electromagnetic interference of dental equipment with implantable cardioverter defibrillators. Acta Odontol Scand 2017; 75:584-587. [PMID: 28799814 DOI: 10.1080/00016357.2017.1364419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Implantable cardioverter defibrillators (ICDs) are subject to electromagnetic interference (EMI). The aim of this study was to assess both the EMI of dental equipments with ICDs and related factors. MATERIALS AND METHODS High- and low-speed handpieces, an electric toothbrush, an implant motor and two types of ultrasonic devices were tested next to an ICD with different sensitivity settings. The ICD was immersed in a saline solution with electrical resistance of 400-800 ohms to simulate the resistance of the human body. The dental equipments were tested in both horizontal (0°) and vertical (90°) positions in relation to the components of the ICD. The tests were performed with a container containing saline solution, which was placed on a dental chair in order to assess the cumulative effect of electromagnetic fields. RESULTS The dental chair, high- and low-speed handpieces, electric toothbrush, implant motor and ultrasonic devices caused no EMI with the ICD, irrespective of the program set-up or positioning. No cumulative effect of electromagnetic fields was verified. CONCLUSIONS The results of this study suggest that the devices tested are safe for use in patients with an ICD.
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Affiliation(s)
| | | | - Marcos César Pimenta de Araújo
- a Department of Clinical Dentistry, School of Dentistry , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Luis Gustavo Belo de Moraes
- c Department of Cardiology, School of Medicine , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Patrícia de Andrade Risso
- a Department of Clinical Dentistry, School of Dentistry , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
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7
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Gómez G, Jara F, Sánchez B, Roig M, Ferrer R, Duran-Sindreu F. Safety concerns of Piezoelectric Units in Implantable Cardioverter Defibrillator. J Oral Maxillofac Surg 2017; 76:273-277. [PMID: 28732223 DOI: 10.1016/j.joms.2017.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE Evidence-based research appears to conflict on the potential risk of electromagnetic interference (EMI) between piezoelectric units (Pzs) and implantable cardioverters and defibrillators (ICDs). The purpose of this study was to observe whether the EMI produced by Pzs is hazardous for ICDs. MATERIALS AND METHODS A cross-sectional study of 6 Pzs was conducted in vitro for EMI using an ICD system. To simulate the human body's electrical resistance, electrographic recordings were made of the ICD and lead that were immersed in a bath of saline solution. The variables investigated were the presence of EMI, the distance between the ICD and the Pz, and signal intensity, damage, and type of damage to the ICD and lead. Each series of tests was repeated 3 times, beginning with a 15-second baseline recording (control), until all recording conditions had been covered. Each Pz was recorded under the following conditions: less than 2 cm from the tip of the ICD lead; less than 2 cm from the ICD; less than 2 cm from the lead body and coils; and 15 cm from the lead or the ICD (R4). RESULTS In the positive control (direct contact between the lead or the ICD with the Pz switched on), the ICD detected electrical activity as false heart activity. However, after covering all test conditions, no EMI was produced by the Pzs. CONCLUSION No EMI or permanent changes in the functioning of the ICD were detected in vitro.
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Affiliation(s)
- Gonzalo Gómez
- Professor, Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Fernando Jara
- Private Practitioner, Pacemaker Unit, Intensive Care Department, Hospital Mútua Terrassa, Barcelona, Spain
| | - Baltasar Sánchez
- Private Practitioner, Pacemaker Unit, Intensive Care Department, Hospital Mútua Terrassa, Barcelona, Spain
| | - Miguel Roig
- Department Head, Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ricard Ferrer
- Department Head, Private Practitioner, Pacemaker Unit, Intensive Care Department Hospital, Mútua Terrassa, Barcelona, Spain
| | - Fernando Duran-Sindreu
- Department Head, Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
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8
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Miranda-Rius J, Lahor-Soler E, Brunet-Llobet L, Sabaté de la Cruz X. Risk of electromagnetic interference induced by dental equipment on cardiac implantable electrical devices. Eur J Oral Sci 2016; 124:559-565. [PMID: 27748971 DOI: 10.1111/eos.12313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 01/09/2023]
Abstract
Patients with cardiac implantable electrical devices should take special precautions when exposed to electromagnetic fields. Proximity to equipment used in clinical dentistry may cause interference. This study evaluated in vitro the risks associated with different types/makes of cardiac devices and types of dental equipment. Six electronic dental tools were tested on three implantable cardioverter defibrillators and three pacemakers made by different manufacturers. Overall, the risk of interference with the pacemakers was 37% lower than with the implantable cardioverter defibrillators. Regarding the types/makes of cardiac devices analysed, that from Boston Scientific had a five-fold greater risk of interference than did that from Biotronik [prevalence ratio (PR) = 5.58]; there was no difference between that from Biotronik and that from Medtronic. Among the dental equipment, the electric pulp tester had the greatest risk of inducing interference and therefore this device was used as the benchmark. The electronic apex locator (PR = 0.29), Periotest M (PR = 0.47), and the ultrasonic dental scaler (PR = 0.59) were less likely to induce interference than the electric pulp tester. The risk was lowest with the electronic apex locator. Pacemakers presented a lower risk of light to moderate interference (PR = 0.63). However, the risk of severe electromagnetic interference was 3.5 times higher with pacemakers than with implantable cardioverter defibrillators (PR = 3.47).
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Affiliation(s)
- Jaume Miranda-Rius
- Departament d'Odontostomatologia, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Eduard Lahor-Soler
- Departament d'Odontostomatologia, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Lluís Brunet-Llobet
- Servei d'Odontologia, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Xavier Sabaté de la Cruz
- Servei de Cardiologia, Unitat d'Arítmies, Hospital de Bellvitge, Departament de Ciències Clíniques, Facultat de Medicina, i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
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9
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Electromagnetic interference of endodontic equipments with cardiovascular implantable electronic device. J Dent 2016; 46:68-72. [PMID: 26765669 DOI: 10.1016/j.jdent.2015.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/20/2015] [Accepted: 12/29/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Assess the electromagnetic interference (EMI) of endodontic equipment with cardiovascular implantable electronic devices (CIEDs) and related factors. METHODS The laser device, electronic apex locators (EAL), optical microscope, endodontic rotary motors, gutta-percha heat carrier (GH), gutta-percha gun and ultrasonic device were tested next to CIEDs (Medtronic and Biotronik) with varied sensitivity settings and distances. CIEDs were immersed in a saline solution to simulate the electrical resistence of the human body. The endodontic equipment was tested in both horizontal and vertical positions in relation to the components of the CIED. The tests were performed on a dental chair in order to assess the cumulative effect of electromagnetic fields. RESULTS It was found no EMI with the Biotronik pacemaker. EALs caused EMI with Medtronic PM at a 2 cm distance, with the NSK(®) EAL also affecting the Medtronic defibrillator. GH caused EMI at 2 cm and 5 cm from the Medtronic defibrillator. EMI occurred when devices were horizontally positioned to the CIED. In the majority of the cases, EMI occurred when the pacemaker was set to maximum sensitivity. There was cumulative effect of electromagnetic fields between GH and dental chair. CONCLUSIONS EALs and GH caused EMI which ranged according to type and sensitivity setting of the CIEDs and the distance. However, no endodontic equipment caused permanent damage to the CIED. The use of GH caused a cumulative effect of electromagnetic fields. It suggests that during the treatment of patients with CIEDs, only the necessary equipments should be kept turned on. CLINICAL RELEVANCE Patients with CIEDs may be subject to EMI from electronic equipment used in dental offices, as they remain turned on throughout the treatment. This is the first article assessing the cumulative effect of electromagnetic fields.
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10
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Shah AH, Khalil HS, Kola MZ. Dental management of a patient fitted with subcutaneous Implantable Cardioverter Defibrillator device and concomitant warfarin treatment. Saudi Dent J 2015; 27:165-70. [PMID: 26236132 PMCID: PMC4501466 DOI: 10.1016/j.sdentj.2014.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/18/2014] [Accepted: 11/19/2014] [Indexed: 11/16/2022] Open
Abstract
Automated Implantable Cardioverter Defibrillators (AICD), simply known as an Implantable Cardioverter Defibrillator (ICD), has been used in patients for more than 30 years. An Implantable Cardioverter Defibrillator (ICD) is a small battery-powered electrical impulse generator that is implanted in patients who are at a risk of sudden cardiac death due to ventricular fibrillation, ventricular tachycardia or any such related event. Typically, patients with these types of occurrences are on anticoagulant therapy. The desired International Normalized Ratio (INR) for these patients is in the range of 2–3 to prevent any subsequent cardiac event. These patients possess a challenge to the dentist in many ways, especially during oral surgical procedures, and these challenges include risk of sudden death, control of post-operative bleeding and pain. This article presents the dental management of a 60 year-old person with an ICD and concomitant anticoagulant therapy. The patient was on multiple medications and was treated for a grossly neglected mouth with multiple carious root stumps. This case report outlines the important issues in managing patients fitted with an ICD device and at a risk of sudden cardiac death.
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Affiliation(s)
- Altaf Hussain Shah
- Department of Preventive Dental Sciences, Salman bin Abdulaziz University, AlKharj, Saudi Arabia
| | - Hesham Saleh Khalil
- Department of Maxillofacial Surgery, College of Dentistry, King Saud University, Saudi Arabia
| | - Mohammed Zaheer Kola
- Department of Prosthodontic Dental Sciences, College of Dentistry, Salman bin Abdulaziz University, AlKharj, Saudi Arabia
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11
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Moraes AP, Silva EJ, Lamas CC, Portugal PH, Neves AA. Influence of electronic apex locators and a gutta-percha heating device on implanted cardiac devices: an in vivo study. Int Endod J 2015; 49:526-32. [PMID: 26105663 DOI: 10.1111/iej.12487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 06/17/2015] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the potential for electromagnetic interference (EMI) of electronic apex locators (EALs) and a gutta-percha heating device (HD) in patients with implantable cardiac pacemakers (ICPs) or cardioverter-defibrillators (ICDs). METHODOLOGY Two types of EALs (Romiapex A-15 and Novapex) and a HD (Touch'n Heat) were tested in patients followed in an outpatient clinic for cardiac arrhythmias. The heart rhythm was monitored on a computer screen during all experimental phases. After baseline data collection, the patient held each appliance (turned on) for 30 s, simulating their clinical use. If background noise was detected on the cardiac monitor, the sensitivity of the ICP/ICD was lowered by the cardiologist to evaluate the intensity of the detected EMI. RESULTS Twelve patients were evaluated (5 female and 7 male), and in nine instances, background noise in their cardiac devices related to the use of the endodontic devices was detected (6 patients). After lowering the sensitivity of the cardiac implants, three patients had more severe EMI in six instances, including pauses in ICP function. The presence of a symptomatic or asymptomatic pause was related to the patient's underlying heart rhythm. The HD device produced background noise more often compared to EALs. These were associated with more severe types of EMI. CONCLUSION The EALs and gutta-percha HD were capable of causing background noise detection or pauses in cardiac implants in vivo. The use of electronic dental devices nearby patients with cardiac implants should be carefully considered in clinical practice.
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Affiliation(s)
- A P Moraes
- Escola de Ciências da Saúde, Universidade do Grande Rio, Duque de Caxias, Brazil
| | - E J Silva
- Escola de Ciências da Saúde, Universidade do Grande Rio, Duque de Caxias, Brazil
| | - C C Lamas
- Escola de Ciências da Saúde, Universidade do Grande Rio, Duque de Caxias, Brazil.,Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - P H Portugal
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - A A Neves
- Departamento de Odontopediatria e Ortodontia, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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12
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Lahor-Soler E, Miranda-Rius J, Brunet-Llobet L, Sabaté de la Cruz X. Capacity of dental equipment to interfere with cardiac implantable electrical devices. Eur J Oral Sci 2015; 123:194-201. [PMID: 25913780 DOI: 10.1111/eos.12183] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2015] [Indexed: 12/12/2022]
Abstract
Patients with cardiac implantable electrical devices should take precautions when exposed to electromagnetic fields. Possible interference as a result of proximity to electromagnets or electricity flow from electronic tools employed in clinical odontology remains controversial. The objective of this study was to examine in vitro the capacity of dental equipment to provoke electromagnetic interference in pacemakers and implantable cardioverter defibrillators. Six electronic dental instruments were tested on three implantable cardioverter defibrillators and three pacemakers from different manufacturers. A simulator model, submerged in physiological saline, with elements that reproduced life-size anatomic structures was used. The instruments were analyzed at differing distances and for different time periods of application. The dental instruments studied displayed significant differences in their capacity to trigger electromagnetic interference. Significant differences in the quantity of registered interference were observed with respect to the variables manufacturer, type of cardiac implant, and application distance but not with the variable time of application. The electronic dental equipment tested at a clinical application distance (20 cm) provoked only slight interference in the pacemakers and implantable cardioverter defibrillators employed, irrespective of manufacturer.
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Affiliation(s)
- Eduard Lahor-Soler
- Departament d'Odontostomatologia, Facultat d'Odontologia, Universitat de Barcelona, Barcelona, Spain
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13
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Maheshwari KR, Nikdel K, Guillaume G, Letra AM, Silva RM, Dorn SO. Evaluating the effects of different dental devices on implantable cardioverter defibrillators. J Endod 2015; 41:692-5. [PMID: 25726385 DOI: 10.1016/j.joen.2014.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/07/2014] [Accepted: 12/13/2014] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The implantable cardioverter defibrillator (ICD) is an electronic device that emits electrical signals to the heart via lead wires and electrodes. It is used for cardiac rhythm monitoring and treatment. Because electronic dental devices have been shown to produce electromagnetic fields, we hypothesize that they may interfere with ICD function. METHODS Nine dental devices (heat carrier, electronic apex locator, electric pulp tester, unipolar electrosurgery unit, electric motor, curing light, and 3 gutta-percha guns) were tested in this study for their ability to interfere with the function of 4 ICDs (2 single-chambered and 2 dual-chambered ICDs). ICD activity was monitored for 30 seconds using an ICD programmer (Medtronic 2090; Minneapolis, MN) and evaluated through an electrogram test strip printout. RESULTS Electromagnetic interference was detected with the electric motor, curing light, electric pulp tester, and electrosurgery unit although no electromagnetic disturbances were detected with these devices. No electromagnetic interferences were observed for the gutta-percha guns, heat carrier, and apex locator. However, the electrosurgery unit affected the dual-chambered ICD (Consulta CRT-D, Medtronic) and delivered therapies for fibrillation when no ventricular fibrillation was present. CONCLUSIONS Our results suggest that the electrosurgery unit produces electromagnetic disturbances with unwanted therapy delivery shock and potentially clinically significant outcomes.
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Affiliation(s)
- Kanwal R Maheshwari
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas
| | - Kian Nikdel
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Ariadne M Letra
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas
| | - Renato M Silva
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas
| | - Samuel O Dorn
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas.
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14
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Sung EC, Brar LK, Chung E, Kubak B, Carlson M, Deng M, Friedlander AH. Dental treatment in the cardiothoracic intensive care unit for patients with ventricular assist devices awaiting heart transplant: a case series. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:194-201. [DOI: 10.1016/j.oooo.2014.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 04/07/2014] [Accepted: 04/17/2014] [Indexed: 12/01/2022]
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Interference of Electronic Apex Locators with Implantable Cardioverter Defibrillators. J Endod 2014; 40:277-80. [DOI: 10.1016/j.joen.2013.07.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/25/2013] [Accepted: 07/28/2013] [Indexed: 12/13/2022]
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Napp A, Joosten S, Stunder D, Knackstedt C, Zink M, Bellmann B, Marx N, Schauerte P, Silny J. Electromagnetic interference with implantable cardioverter-defibrillators at power frequency: an in vivo study. Circulation 2013; 129:441-50. [PMID: 24163067 DOI: 10.1161/circulationaha.113.003081] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The number of implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac death is continuing to increase. Given the technological complexity of ICDs, it is of critical importance to identify and control possible harmful electromagnetic interferences between various sources of electromagnetic fields and ICDs in daily life and occupational environments. METHODS AND RESULTS Interference thresholds of 110 ICD patients (1-, 2-, and 3-chamber ICDs) were evaluated in a specifically developed test site. Patients were exposed to single and combined electric and magnetic 50-Hz fields with strengths of up to 30 kV·m⁻¹ and 2.55 mT. Tests were conducted considering worst-case conditions, including maximum sensitivity of the device or full inspiration. With devices being programmed to nominal sensitivity, ICDs remained unaffected in 91 patients (83%). Five of 110 devices (5%) showed transient loss of accurate right ventricular sensing, whereas 14 of 31 (45%) of the 2- and 3-chamber devices displayed impaired right atrial sensing. No interference was detected in 71 patients (65%) within the tested limits with programming to maximum sensitivity, whereas 20 of 110 subjects (18%) exhibited right ventricular disturbances and 19 of 31 (61%) subjects exhibited right atrial disturbances. CONCLUSIONS Extremely low-frequency daily-life electromagnetic fields do not disturb sensing capabilities of ICDs. However, strong 50-Hz electromagnetic fields, present in certain occupational environments, may cause inappropriate sensing, potentially leading to false detection of atrial/ventricular arrhythmic events. When the right atrial/right ventricular interferences are compared, the atrial lead is more susceptible to electromagnetic fields. CLINICAL TRIAL REGISTRATION URL http://clinicaltrials.gov/ct2/show/NCT01626261. Unique identifier: NCT01626261.
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Affiliation(s)
- Andreas Napp
- Department of Internal Medicine I (Cardiology, Pneumology, Angiology) (A.N., C.K., M.Z., B.B., N.M., P.S.) and Research Center for Bioelectromagnetic Interaction at the Institute of Occupational Medicine; former at the Institute of Hygiene and Environmental Medicine (S.J., D.S., J.S.), University Hospital RWTH Aachen, Aachen, Germany; and Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands (C.K.)
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Gomez G, Jara F, Sánchez B, Roig M, Duran-Sindreu F. Effects of piezoelectric units on pacemaker function: an in vitro study. J Endod 2013; 39:1296-9. [PMID: 24041395 DOI: 10.1016/j.joen.2013.06.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 05/17/2013] [Accepted: 06/29/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The use of piezoelectric units on patients with pacemakers is generally discouraged, although there is no empirical evidence of the effects of current piezoelectric units on pacemaker activity in vitro. METHODS Four piezoelectric units (Piezosurgery3, Piezotome, Piezotome2, and Variosurg) and 2 magnetostriction units (Piezotome and Piezotome2) were tested for electromagnetic interference (EMI) with the SENSIA SESR01 pacemaker from Medtronic. The pacemaker, with a single electrode, was immersed in a saline-solution bath and adjusted between 400 and 800 ohms to simulate the electrical resistance of the human body and to register and to produce electrographic recordings. The pacemaker was tested with each ultrasonic device to analyze the presence of EMI at different distances, with the ultrasound switched on, switched off, and during operation. If any of the devices produced interference, the characteristics of the interference were categorized. RESULTS In the positive control (direct contact between either the electrode or the generator and the ultrasound device when this was switched on), the pacemaker detected electrical activity as false heart activity. When all the scenarios and distances had been covered, no EMI was produced by the ultrasound units. CONCLUSIONS No EMI was detected during the testing of the piezoelectric or magnetostriction units in this in vitro model of pacemaker use.
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Affiliation(s)
- Gonzalo Gomez
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
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Maiorana C, Grossi GB, Garramone RA, Manfredini R, Santoro F. Do ultrasonic dental scalers interfere with implantable cardioverter defibrillators? An in vivo investigation. J Dent 2013; 41:955-9. [PMID: 23948395 DOI: 10.1016/j.jdent.2013.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/02/2013] [Accepted: 08/03/2013] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To test the in vivo effects of an ultrasonic dental scaler on various implanted cardioverter defibrillator (ICD) models. METHODS 12 consecutive patients with ICDs had continuous both electrocardiogram monitoring and device interrogation to detect interferences during the use of an ultrasonic dental scaler. RESULTS No interferences were detected by any ICD. Evaluation of the electrocardiograms for each patient failed to show any abnormalities in pacing during testing. CONCLUSION The results of this study suggest that the routinary clinic use of piezoelectric dental scalers do not interfere with the functioning of any of the tested ICDs. CLINICAL SIGNIFICANCE Ultrasonic dental scalers have been suspected of electromagnetic interference (EMI) with the normal functioning of ICDs and the use of this type of equipment for patients with these devices has been controversial. This is the first in vivo study to investigate EMI of ICD activity during the operation with ultrasonic dental scaler.
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Affiliation(s)
- Carlo Maiorana
- School of Oral Surgery, Dental Clinic, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Gomez G, Duran-Sindreu F, Jara Clemente F, Garofalo RR, Garcia M, Bueno R, Roig M. The effects of six electronic apex locators on pacemaker function: an in vitro study. Int Endod J 2012; 46:399-405. [PMID: 23062015 DOI: 10.1111/iej.12000] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 08/25/2012] [Indexed: 11/26/2022]
Abstract
AIM To assess the effects of six electronic apex locators (EALs) on pacemaker function in vitro. METHODOLOGY Six EALs (Mini Apex Locator®, Dentaport ZX®, Novapex®, Raypex5®, Root ZX mini®, and Justy II®) were tested for electromagnetic interference (EMI) with one pacemaker (Saint Jude Medical). The pacemaker, with a single electrode, was immersed in a saline solution bath adjusted to 400-800 hms to simulate the electrical resistance of the human body and to register the activity by the system. The pacemaker was tested with each of the EALs to analyse the presence of EMI with the EAL switched on, the EAL switched off and during EAL operation. Each series of tests began with a 15-second baseline recording (R0) and continued until all the recording conditions had been covered. The conditions were as follows: R1: recording with the lead of the EAL <2 cm from the tip of the electrode; R2: recording with the lead of the EAL <2 cm from the generator; R3: recording with the lead of the EAL <2 cm from the sensing arc; and R4: recording with the lead of the EAL 15 cm from the sensing arc. If any of the EALs produced interference, its characteristics were categorized. RESULTS When the lead of the EAL was <2 cm from the tip of the electrode, the majority of the EALs tested produced only background noise. Only one (the Mini Apex Locator) resulted in EMI that was detected as false heart activity. When the EAL was <2 cm from the generator, just one EAL detected background noise (the Mini Apex Locator). When the EAL was <2 cm from the sensing arc or 15 cm from the sensing arc, the recordings were not affected by any of the EALs. There were no significant differences amongst the EALs analysed with respect to the production of EMI. CONCLUSIONS EMI occurred when the EALs were placed close to the tip of the electrode and occasionally when close to the pacemaker; however, no EMI was detected when the EALs were placed near to or 15 cm from the sensing arc in this laboratory experimental model.
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Affiliation(s)
- G Gomez
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
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Affiliation(s)
- Balraj Singh
- Department of Internal Medicine, East Tennessee State University, TN, USA
| | - Jasmeet Singh
- Boston Medical Center, Boston University School of Medicine, Boston, MA
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Crossley GH, Poole JE, Rozner MA, Asirvatham SJ, Cheng A, Chung MK, Ferguson TB, Gallagher JD, Gold MR, Hoyt RH, Irefin S, Kusumoto FM, Moorman LP, Thompson A. The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the Perioperative Management of Patients with Implantable Defibrillators, Pacemakers and Arrhythmia Monitors: Facilities and Patient Management. Heart Rhythm 2011; 8:1114-54. [DOI: 10.1016/j.hrthm.2010.12.023] [Citation(s) in RCA: 253] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Indexed: 11/26/2022]
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