Dual Chamber Pacemaker and Dental Crown Placement
A dual chamber pacemaker is NOT a contraindication to receiving a dental crown. Dental crown procedures can be safely performed in patients with pacemakers, including dual chamber devices, with appropriate precautions regarding electromagnetic interference from certain dental equipment 1.
Key Safety Considerations
Equipment That Requires Precautions
The primary concern during dental procedures relates to electromagnetic interference from specific dental devices, not the crown procedure itself:
- Electrosurgical units can inhibit pacemaker function up to 10 cm distance and require the most caution 2
- Ultrasonic scalers may interfere with dual-chamber pacemaker sensing at distances of 17-23 cm from the generator or leads 3
- Ultrasonic cleaning systems can affect dual-chamber pacemaker activity at 15-23 cm 3
- Battery-operated composite curing lights may inhibit pacing activity at 2-10 cm from the device 3
Safe Dental Equipment
Most routine dental equipment poses no risk and can be used without restriction 2, 3:
- High-speed and low-speed handpieces
- Dental radiography units
- Electric pulp testers
- Amalgamators
- Electric toothbrushes
Clinical Management Protocol
For Standard Crown Preparation
No special precautions are needed for basic crown preparation using standard handpieces and impression materials, as these do not generate electromagnetic interference 2, 4.
When Electrocautery Is Required
If electrosurgical equipment must be used during the procedure 1:
- Use bipolar electrocautery systems preferentially over unipolar systems to minimize electromagnetic interference
- Apply electrocautery in short bursts only, keeping power output to minimum required levels
- Position the ground plate to complete the electrical circuit away from the pacemaker generator
- Maintain physical distance between the electrocautery device and pacemaker
For Pacemaker-Dependent Patients
If the patient is pacemaker-dependent and significant electromagnetic interference is anticipated 1:
- Consider reprogramming the device to asynchronous mode (VOO or DOO) before the procedure
- Alternatively, place a magnet over the pacemaker during equipment use to activate asynchronous pacing
- Ensure continuous ECG and pulse monitoring throughout the procedure
Post-Procedure Care
Pacemaker interrogation is generally not necessary after routine crown procedures unless 1:
- The patient is pacemaker-dependent
- Significant electrocautery was used
- Any symptoms or concerns arose during the procedure
Evidence Quality and Practical Implications
A prospective clinical study of 32 patients (12 pacemakers, 20 ICDs) found that commonly used electrical dental devices did not cause clinically significant interference with sensing and pacing functions, though minor telemetry interference without clinical impact was noted with ultrasonic equipment 4. This represents the highest quality evidence available, demonstrating that modern dental procedures are safe for pacemaker patients when basic precautions are followed.
The bottom line: Crown placement itself poses no contraindication. The dentist should simply maintain awareness of which dental devices may cause electromagnetic interference and keep them at appropriate distances from the pacemaker generator and leads during use 2, 3, 4.