“PRECAUTIONS TAKEN

WITH PACEMAKER
PATIENTS USING
ULTRASONIC SCALER”

…………………………………………..
DR. PARTHA PROTIM SARKER
INTERN DOCTOR
DEPERTMENT OF
PERIODONTOLOGY
& ORAL PATHOLOGY
 INTRODUCTION

In our line of dentistry, we get patients fitted with

pacemaker. Most of us don’t even know whether
we can use ultrasonic scaler on patients with
pacemaker or not.This topic will clear this
dilemma and shade some lights on it.
WHAT IS ULTRASONIC Click icon to add picture
SCALER & HOW DOES
IT WORK
An ultrasonic scaler is a power-driven scaling
device that utilizes ultrasonic vibration to
break up hardened calculus deposits on
patient’s teeth. The vibration is driven by a
generator that converts electricity into
ultrasonic waves and creates an electro-
magnetic field.
 WHERE & HOW
THE
ELECTROMEGNATI
C FIELD
GENARATES
Ultrasonic scaler uses magnetostrictive property
of metal stack , converts the energy in a
magnetic field into mechanical energy.
Scientists have found that, the magnetic field
that interferes with the normal working ability
of a pacemaker, is created in the scaler and the
wire that connects the scaler with the machine .
WHAT IS PACEMAKER
& WHO USES IT

A pacemaker is a small device

that's implanted in the chest to
help control the heartbeat.
The most common reason
people get a pacemaker is :
1. Chest pain (also known as angina).
2. Tachycardia (This is an unusually fast
heartbeat ) more than100bpm.

3. Irregular heartbeat (arrhythmia)
4. Bradycardia ( Unusually slow
heartbeat) less than 60bpm.
 PARTS OF A
PACEMAKER

• There are 4 parts of a pacemaker:

• 1. Pulse generator.
• 2. One or more leads.
• 3. An electrode on each lead.
• 4. Battery.
EFFECTS OF ULTRASONIC
SCALER ON PATIENTS WITH
PACEMAKER
Ultrasonic scaler creates a magnetic field that
interferes with the fitted pacemaker.
Electromagnetic interference could cause the
pacemaker to:
– stimuli not provided when needed.
– pacing occurs at a fixed rate regardless of
the heart’s need for therapy.
– shock therapy provided when not needed.
 MANAGEMENT
We can take several precautions to reduce the
interference level produced by ultrasonic scaler. Some
are given below:
1. The hand piece and cables must be kept at least 6-9
inches (15-23 cm) away from any pacemaker.

2. We can use Piezoelectric scaler as it works by

creating vibrations caused by a quartz crystal in the
handpiece. It creates less interference than its
counterpart. We should keep it on low speed during
scaling.
4. We can use sonic scaler. Sonic scalers are driven
by compressed air and generates no interference to
the fitted pacemaker.
But this type of hand scalers are bit expensive than
ultrasonic scaler and not much available in our
country.

5. We should not use magnetic pillow on dental

chair headrest. Magnetic field generated from the
headrest, act as an amplifier of ultrasonic scaler
wave and inhibits pulse generators in pacemaker.
 CONCLUSION

Lastly we can say that, it’s not totally contradicted to do

scaling on a patient with fitted pacemaker. we can use
Piezoelectric scaler for patients with pacemaker as it poses
less threat than ultrasonic scaler. Moreover, we should not
use any sort of magnetic headrest pillow in any
circumstances.
 REFERANCES
1. ROEDIG JJ, SHAH J, ELAYI CS, MILLER CS. INTERFERENCE OF CARDIAC PACEMAKER AND IMPLANTABLE
CARDIOVERTER-DEFIBRILLATOR ACTIVITY DURING ELECTRONIC DENTAL DEVICE USE. J AM DENT ASSOC.
2010 MAY;141(5):521-6. DOI: 10.14219/JADA.ARCHIVE.2010.0224. PMID: 20436099.
2. WALMSLEY A D, WALSH T F, BURKE F J T ET AL. RESTORATIVE DENTISTRY. P 42. CHURCHILL LIVINGSTONE,
2002
3. PATIENT UK. PACEMAKERS AND PACING. LAST UPDATED SEPTEMBER 2014. AVAILABLE ONLINE AT
WWW.PATIENT.CO.UK/ DOCTOR/PACEMAKERS-AND-PACING.HTM# (ACCESSED JULY 2015).
4. MEDICINES AND HEALTHCARE PRODUCTS REGULATORY AGENCY (MHRA) WEBSITE. AVAILABLE ONLINE AT
WWW.MHRA.GOV.UK/ INDEX.HTM (ACCESSED JULY 2015).
5. BRAND H S, ENTJES M L, NIEUW AMERONGEN A V, VAN DER HOEFF E V, SCHRAMA T A. INTERFERENCE OF
ELECTRICAL DENTAL EQUIPMENT WITH IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS. BR DENT J 2007;
203: 577-579.
6. MILLER C S, LEONELLI F M, LATHAM E. SELECTIVE INTERFERENCE WITH PACEMAKER ACTIVITY BY
ELECTRICAL DENTAL DEVICES. ORAL SURG ORAL MED ORAL PATHOL ORAL RADIOL ENDOD 1998; 85: 33-36
 ACKNOWLEDGEMENT
1. DR. MD. ASHIF IQBAL
ASSOCIATE PROFESSOR & HEAD OF THE DEPARTMENT OF PERIODONTOLOGY
& ORAL PATHOLOGY.
2. DR. NAYNA BINTE SHAHABUDDIN
LECTURER OF THE DEPARTMENT OF PERIODONTOLOGY & ORAL PATHOLOGY.
3. DR. NAFISA TASNIM
LECTURER OF THE DEPARTMENT OF PERIODONTOLOGY & ORAL PATHOLOGY.