- Email: [email protected]
Electronic interference with cardiac devices
news items, photographs, and videos. Each one briefly described how a specific situation would be managed by the dentist. Discussion.—Users may have difficulty accessing appropriate dental trauma apps, since few offer sufficient information on how to manage trauma. Just one is recommended by the IADT. In addition, search engines key in on the specific title of the app and the description provided by the developer, which can present difficulties for users who may not use the exact terminology. Few of the apps provide clinical photographs and just one was designed for dental professionals.
Fig 1.——A screenshot from the AcciDent app showing illustrations of some traumatic dental injuries. (Courtesy of Djemal S, Singh P: Smartphones and dental trauma: The current availability of apps for managing traumatic dental injuries. Dent Trauma 32:52-57, 2016.)
offers a full range of clinical scenarios (Fig 1). A fee is charged for its download. A single source provided the remaining five apps, which were Chipped Tooth Solution, Dental Crown Repair, Fixing Cracked Tooth, Repairing the Front Tooth, and Solution to Broken Tooth. All were free downloads and contained some information relevant to their titles. In addition, they offered
Clinical Significance.—As with all things Internet, there is the danger of accessing information that is not accurate, since anyone can post nearly anything on sites. As a result, apps will present a range of quality of information, and users will have to do further research to verify its accuracy and trustworthiness. That said, dental practitioners need to be aware of what is out there and use these newer methods of communication to reach patients, who are often very knowledgeable about smartphones and other platforms. It is hoped that future apps will be developed with good-quality, evidence-based, and validated information and include video and social media links. Dental practitioners should also remember that the dental visit remains a very effective means of conveying education about dental trauma, especially for children, and shouldn’t be lost in the mix.
Djemal S, Singh P: Smartphones and dental trauma: The current availability of apps for managing traumatic dental injuries. Dent Trauma 32:52-57, 2016 Reprints available from S Djemal, Dept of Restorative Dentistry, King’s College Hosp Dental Inst, Bessemer Rd, London, SE5 9RW, UK: fax: þ02032995678; e-mail: [email protected]
Endodontics Electronic interference with cardiac devices Background.—Cardiovascular implantable electronic devices (CIEDs) such as pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) produce electronic
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Dental Abstracts
pulses to stimulate the heart and thereby regulate its rate. Electromagnetic waves emitted by electronic devices can affect how these cardiac devices function through
electromagnetic interference (EMI). Although today’s devices are well-shielded, dental and medical professionals know that magnetic resonance imaging machines and ionizing radiation devices should be avoided for patients with CIEDs. The endodontic office has a long list of electronic equipment that could interfere with CIED function. Although some of these devices have been studied to determine if they have this effect, others have not. In addition, factors that influence EMI effects have not always been included in the studies, nor have many investigations looked at the cumulative effect of multiple sources of EMI in the same environment as CIEDs. The production of EMI by endodontic equipment that affects CIEDs and related factors were investigated, also noting whether the proximity of the equipment to the CIED increased the interference. Methods.—The laser device, electronic apex locator (EAL), optical microscope, endodontic rotary motors, gutta-percha heat carrier (GH), gutta-percha gun, and ultrasonic device were tested next to CIEDs at various settings and distances. The CIEDs included a Medtronic PM, a Biotronik PM, and a Medtronic ICD. To simulate the electrical resistance of the body, the CIEDs were immersed in a saline solution. The electronic devices were tested in horizontal and vertical positions relative to the CIED components and in a dental chair to determine if the electromagnetic fields exert a cumulative effect on the CIEDs. Results.—None of the endodontic devices caused EMI with the Biotronic PM, but the Medtronic PM and ICD showed various effects related to the specific equipment, CIED sensitivity, and distance between the equipment and the CIED. The rotary motors, laser device, optical microscope, gutta-percha gun, and ultrasonic device produced no EMI with any CIED, so they appear to be safe. None of the devices produces permanent damage to the CIEDs, with the EMI found in the ‘‘background noise’’ category. The apex locators and GH produced EMI that varied depending on the type and sensitivity of the CIED as well as
the distance from CIED to the equipment. CIEDs with atrioventricular stimulation were used in this test; it could not be shown whether single- or dual-chamber devices were more susceptible to EMI. All of the apex locators caused EMI with the Medtronic PM set at its maximum sensitivity, with no effect at its minimum sensitivity setting. In addition, EMI was detected only when the dental equipment was placed horizontally to the components of the CIED, with no effect accompanying vertical placement. The tests were performed with the dental chair turned on, but all of the apex locators continued to cause EMI even after the chair was switched off. The GH had caused EMI with the chair on, but did not do so when it was turned off. Discussion.—Apex locators and GHs caused EMI with CIEDs that varied depending on distance, type of CIED, and sensitivity setting. As a result, endodontists should turn off electronic devices that are not necessary while treating patients who have CIEDs.
Clinical Significance.—The EMI caused by these endodontic devices was of a low level and produced no lasting effect on the CIEDs that were tested. However, to be safe, dentists should minimize the number of electronic devices that run during dental treatment of patients who have PMs or ICDs in place.
Dadalti MTS, da Cunha AJLA, Ara ujo MCP, et al: Electromagnetic interference of endodontic equipments with cardiovascular implantable electronic device. J Dent 46:68–72, 2016 Reprints available from PA Risso, 325, 2nd Floor Cidade Universitaria, Rio de Janeiro, RJ 21941-913, Brazil; e-mail: [email protected]
Antibiotic use Background.—The genetic changes that create drugresistant microbes have been linked to the excessive prescription of antibiotics by health care providers over the past decades. As a result, guidelines are being developed to indicate when antibiotics should and should not be prescribed for patients. These are evidence-based, relying mainly on randomized controlled clinical studies.
The indications for prescribing antibiotics for patients with endodontic infections to reduce pain were formulated from a systematic review of the literature. Methods.—An electronic search was conducted of the MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov databases, along with a hand search of the bibliographies
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Issue 5
2016
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Fig 1.——A screenshot from the AcciDent app showing illustrations of some traumatic dental injuries. (Courtesy of Djemal S, Singh P: Smartphones and dental trauma: The current availability of apps for managing traumatic dental injuries. Dent Trauma 32:52-57, 2016.)
offers a full range of clinical scenarios (Fig 1). A fee is charged for its download. A single source provided the remaining five apps, which were Chipped Tooth Solution, Dental Crown Repair, Fixing Cracked Tooth, Repairing the Front Tooth, and Solution to Broken Tooth. All were free downloads and contained some information relevant to their titles. In addition, they offered
Clinical Significance.—As with all things Internet, there is the danger of accessing information that is not accurate, since anyone can post nearly anything on sites. As a result, apps will present a range of quality of information, and users will have to do further research to verify its accuracy and trustworthiness. That said, dental practitioners need to be aware of what is out there and use these newer methods of communication to reach patients, who are often very knowledgeable about smartphones and other platforms. It is hoped that future apps will be developed with good-quality, evidence-based, and validated information and include video and social media links. Dental practitioners should also remember that the dental visit remains a very effective means of conveying education about dental trauma, especially for children, and shouldn’t be lost in the mix.
Djemal S, Singh P: Smartphones and dental trauma: The current availability of apps for managing traumatic dental injuries. Dent Trauma 32:52-57, 2016 Reprints available from S Djemal, Dept of Restorative Dentistry, King’s College Hosp Dental Inst, Bessemer Rd, London, SE5 9RW, UK: fax: þ02032995678; e-mail: [email protected]
Endodontics Electronic interference with cardiac devices Background.—Cardiovascular implantable electronic devices (CIEDs) such as pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) produce electronic
258
Dental Abstracts
pulses to stimulate the heart and thereby regulate its rate. Electromagnetic waves emitted by electronic devices can affect how these cardiac devices function through
electromagnetic interference (EMI). Although today’s devices are well-shielded, dental and medical professionals know that magnetic resonance imaging machines and ionizing radiation devices should be avoided for patients with CIEDs. The endodontic office has a long list of electronic equipment that could interfere with CIED function. Although some of these devices have been studied to determine if they have this effect, others have not. In addition, factors that influence EMI effects have not always been included in the studies, nor have many investigations looked at the cumulative effect of multiple sources of EMI in the same environment as CIEDs. The production of EMI by endodontic equipment that affects CIEDs and related factors were investigated, also noting whether the proximity of the equipment to the CIED increased the interference. Methods.—The laser device, electronic apex locator (EAL), optical microscope, endodontic rotary motors, gutta-percha heat carrier (GH), gutta-percha gun, and ultrasonic device were tested next to CIEDs at various settings and distances. The CIEDs included a Medtronic PM, a Biotronik PM, and a Medtronic ICD. To simulate the electrical resistance of the body, the CIEDs were immersed in a saline solution. The electronic devices were tested in horizontal and vertical positions relative to the CIED components and in a dental chair to determine if the electromagnetic fields exert a cumulative effect on the CIEDs. Results.—None of the endodontic devices caused EMI with the Biotronic PM, but the Medtronic PM and ICD showed various effects related to the specific equipment, CIED sensitivity, and distance between the equipment and the CIED. The rotary motors, laser device, optical microscope, gutta-percha gun, and ultrasonic device produced no EMI with any CIED, so they appear to be safe. None of the devices produces permanent damage to the CIEDs, with the EMI found in the ‘‘background noise’’ category. The apex locators and GH produced EMI that varied depending on the type and sensitivity of the CIED as well as
the distance from CIED to the equipment. CIEDs with atrioventricular stimulation were used in this test; it could not be shown whether single- or dual-chamber devices were more susceptible to EMI. All of the apex locators caused EMI with the Medtronic PM set at its maximum sensitivity, with no effect at its minimum sensitivity setting. In addition, EMI was detected only when the dental equipment was placed horizontally to the components of the CIED, with no effect accompanying vertical placement. The tests were performed with the dental chair turned on, but all of the apex locators continued to cause EMI even after the chair was switched off. The GH had caused EMI with the chair on, but did not do so when it was turned off. Discussion.—Apex locators and GHs caused EMI with CIEDs that varied depending on distance, type of CIED, and sensitivity setting. As a result, endodontists should turn off electronic devices that are not necessary while treating patients who have CIEDs.
Clinical Significance.—The EMI caused by these endodontic devices was of a low level and produced no lasting effect on the CIEDs that were tested. However, to be safe, dentists should minimize the number of electronic devices that run during dental treatment of patients who have PMs or ICDs in place.
Dadalti MTS, da Cunha AJLA, Ara ujo MCP, et al: Electromagnetic interference of endodontic equipments with cardiovascular implantable electronic device. J Dent 46:68–72, 2016 Reprints available from PA Risso, 325, 2nd Floor Cidade Universitaria, Rio de Janeiro, RJ 21941-913, Brazil; e-mail: [email protected]
Antibiotic use Background.—The genetic changes that create drugresistant microbes have been linked to the excessive prescription of antibiotics by health care providers over the past decades. As a result, guidelines are being developed to indicate when antibiotics should and should not be prescribed for patients. These are evidence-based, relying mainly on randomized controlled clinical studies.
The indications for prescribing antibiotics for patients with endodontic infections to reduce pain were formulated from a systematic review of the literature. Methods.—An electronic search was conducted of the MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov databases, along with a hand search of the bibliographies
Volume 61
Issue 5
2016
259