Dental Treatment

First things first…. YES, you can have dental treatment including fillings, crowns, implants and extractions just to name a few and YES, you can see the hygienist for routine and deep scaling appointments.

When going to the dentist with a heart condition and worrying if the treatment you are about to receive is safe or appropriate… just remember the dentist or hygienist is generally more scared or anxious than you!

No dental professional wants to treat a patient incorrectly or inappropriately for their general dental wellbeing, but especially not for the treatment to be detrimental to their medical health.

It is the most commonly encountered concern in the dental practice as to whether the equipment and instruments are safe to use on us with heart issues especially those of us with ICDs.  You should be safe in the knowledge that no dentist or hygienist would commence treatment unless they believe it to be entirely safe.

Firstly, as soon as you inform the dental practice of your condition they will ensure the following for treatment….

If you need local anaesthesia then they will use a “plain” anaesthetic which contains no adrenaline or additives to prevent any palpitations that may occur (which happens in patients all the time with no heart related illness). They will take no chances with this first step. It can take longer to work and you may need more of it but it is safe. This is also the same for any patient with known high blood pressure.

They will immediately check all their equipment to make sure it’s compatible.  Rest assured, if a dentist ever refuses treatment for you it is for YOUR safety as they know that their equipment isn’t compatible or safe with ICDs.

There are some pieces of equipment (mainly dental ultrasonic scalers) that use electromagnetic fields to function, but because technology is improving all the time there will be fewer dental practices that won’t be able to treat someone with an ICD.

Equipment routinely used that is completely safe include:

  • the amalgamator that mixes your filling material
  • a curing light that sets the filling (this is UV light only)
  • pulp testers that check the vitality of teeth before a root filling is carried out and can be quite disconcerting to have in your mouth.
  • dental X-rays

Patients also ask, and worry about electric toothbrushes. These are also completely safe.

When being treated you are placed in a surgery away from decontamination areas which use ultrasonic machines for cleaning instruments.

A Piezon scaler

Hygienists will change to Piezon scalers to ensure safety or use hand scalers only. Ultrasonic scalers cannot be used on patients with an ICD, but most dentists will have Piezon scalers now for this reason. Ask if they have a Piezon scaler which is safe.

The above are the typical safe varieties used in practices today. If in doubt, ask your hygienist if they have one of these. Several studies have been conducted and the following is just one excerpt from a recently published result to confirm that Piezon scalers are safe.

Some hygienists will STILL prefer to hand scale as they feel more comfortable avoiding anything mechanical just in case.  Piezon scalers are completely safe, but the lead must never be draped across the ICD site which, unless the hygienist is doing something very wrong, should never happen!

Other concerns that patients report is that they feel vibration with the normal high speed and slow speed drills used for treatment. Yes, you will feel a little vibration, everyone does, but again this is completely safe with no interference with an ICD. These are not electromagnetic or ultrasonic devices, just bone shakers as they rattle away inside your tooth. Sorry! Too much information if you’re dental phobic.

Dentists and hygienists may still insist on doing some of their treatment by hand avoiding some of the instruments and equipment that they could use. Again, this is for safety, but mainly because they are too worried to use the equipment, just in case! Any dental health professional will err on the side of caution and avoid anything that they feel may be a problem, to alleviate your fears, but mainly theirs! It is a very sad, litigious age we live in today which puts so much pressure on professional people just trying to do a good job. They are aware that the biggest risk to those of us with ICDs is stress as this may be the trigger and why the ICD is required in the first place so removing any stress inducing practice is fundamental to the patient and the dental team.

Therefore, no matter which dentist you go to they all work very similarly but all have their own worries and concerns. So, if your friend was treated fine, but your dentist has said no, it doesn’t mean you are not able to be treated or the dentist is doing anything wrong, but they may not fully understand what an ICD is (trust me most don’t, but this is improving as more of us have them so dentists are seeing ICDs in practice more and more). Talk to them and help them to understand. They will appreciate it.

Patients also worry that they may need antibiotics before or after treatment. Again, this is not required. There is no risk of device- related infection so there’s no need for prophylactic antibiotics. Obviously, some patients may be on anticoagulants and this is a concern for dental professionals due to excessive bleeding, but there are guidelines that they should follow and so it should be fine.