Objectives: The aim of the present study is to systematically evaluate the current
literature for the effect of ultrasonic devices, ultrasonic scalers in particularly, on
cardiac pacemakers and ICDs to add evidence based knowledge regarding health
risks of patients wearing these devices when treated with ultrasonic scalers.
Materials and methods: To conduct this systematic review the guidelines for the
Transparent Reporting of Systematic Reviews and Meta-analyses were used
(PRISMA statement). The National Library of Medicine, Washington DC (MEDLINEPubmed)
was selected in search of appropriate papers for this study. The search
was conducted starting from the earliest records until 04 May 2016. The structured
search strategy aimed at any published paper that evaluated the effect of ultrasonic
scalers on the functioning of pacemakers and/ or ICDs.
Results: The MEDLINE-Pubmed search resulted in 642 abstracts with one in
duplicate, a total of 641 abstracts remained. A total of 630 articles were excluded
after screening by title and abstract. The remaining 11 articles, consisting of in vivo
and in vitro studies, were selected for full text reading and all were eligible for the
purpose of this study. One additional paper was found eligible after reference
checking the list of the included studies. Considerable heterogeneity was observed in
the in vitro and in vivo studies. Therefore a quantitative analysis of the data was not
possible. A descriptive format was used to analyse the pooled data.
In five out of ten in vitro studies EMI (electromagnetic interference) with pacemaker
and/or ICDs was found when using ultrasonic dental scalers. This occurred when the
handle of the ultrasonic scaler was in close proximity towards the device in three of
those studies. In the remaining two studies interference at larger distances was
detected, but this was most probably because of interference with the telemetry
connection between pacemaker/ICD and the cardiac programmer device. None of
the in vivo studies demonstrated EMI in pacemakers and/or ICDs affecting the
functioning of these devices when using ultrasonic scalers. Interference with cardiac
programmers was also found to occur in vivo.
Conclusion: The findings of this literature study suggest that it is safe to use
ultrasonic scalers with patients who are fitted with a pacemaker and/or ICD. There is
no evidence these devices interfere with normal cardiac device function or damage
the device properties when interference takes place. When maintaining the
precaution distance of 10-15 cm. towards the cardiac device, no significant effect on
these devices is observed when using ultrasonic dental scalers.
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