Dental treatment after cardiac arrest is safe for the vast majority of survivors — and with a little preparation and good communication with your dental team, there is no reason why your oral health should suffer because of your cardiac history. If you have had a cardiac arrest, or have had an ICD fitted, you may be wondering whether dental procedures are still appropriate. The short answer is yes.

Tell Your Dentist About Your Cardiac Arrest History

The single most important thing you can do is make sure your dental practice has a complete and up-to-date medical history, including details of your cardiac arrest, any underlying diagnosis, your ICD if you have one, and all your current medications. A good dental team will use this information to plan your care appropriately. Carry your ICD identification card to every appointment — it contains the make, model, and settings of your device, which can be genuinely useful if any question arises about equipment compatibility.

What Dental Treatment Is Safe After Cardiac Arrest?

The following procedures are safe for patients with ICDs and are routinely carried out without any special precautions beyond informing your dental team:

Fillings, crowns, bridges, and veneers
Extractions and implants
Root canal treatment
Routine and deep scaling (hygiene appointments)
Dental X-rays
Curing lights (UV light used to set white fillings)
Pulp testers (used before root canal treatment)
Amalgamators (used to mix filling materials)
High-speed and slow-speed drills — you may feel some vibration, which is normal and harmless

Local Anaesthetic — the Adrenaline Question

This is one of the most common questions we hear from members, and the guidance has become more nuanced over time. Standard dental local anaesthetics contain a small amount of adrenaline (epinephrine) as a vasoconstrictor, which makes the anaesthetic work better and last longer.

For most cardiac arrest survivors and ICD patients, low-dose adrenaline-containing anaesthetic is considered acceptable and is generally preferable to adrenaline-free alternatives, which take longer to work and may require larger doses. The key principle is that the dental team should use the lowest effective dose and administer it slowly with aspiration to avoid inadvertent intravascular injection.

However, individual circumstances vary. If you have a known arrhythmia that is sensitive to catecholamines, or your cardiologist has given you specific advice about adrenaline, make sure your dentist is aware. A plain (adrenaline-free) anaesthetic is a safe alternative if there is any doubt, even though it may be less effective. Always discuss this with both your cardiologist and your dentist before your appointment.

Electromagnetic Interference and Ultrasonic Scalers

The concern about electromagnetic interference (EMI) between dental equipment and ICDs is real but has been significantly overstated in older guidance. Modern ICDs — those implanted after around 2000 — are bipolar devices with far better shielding than earlier models, and are considerably less susceptible to EMI than their predecessors.

Current evidence indicates that most dental ultrasonic scalers do not pose a significant risk to modern ICDs. There are two main types of ultrasonic scaler used in dental practices:

Magnetostrictive scalers — these use a magnetic field to generate vibration and are the type most associated with EMI concerns. Even so, current guidance suggests they are not generally contraindicated for patients with modern bipolar ICDs, though some caution is still advisable.
Piezoelectric scalers (Piezon scalers) — these use a crystal-based mechanism and generate negligible EMI. They are widely considered the preferred choice for patients with ICDs, and most modern dental practices will have one. It is perfectly reasonable to ask your hygienist whether they have a Piezon scaler.

As a general principle, the scaler tip should never be applied or draped across the ICD implant site — but this would be clinically inappropriate in any case. If your dentist or hygienist is uncertain, using hand scalers is a safe and effective alternative for the full appointment.

Anticoagulant Medications and Dental Treatment After Cardiac Arrest

Many cardiac arrest survivors are prescribed anticoagulants — warfarin, apixaban, rivaroxaban, or similar — which can affect bleeding during and after dental procedures. This is a separate consideration from the ICD itself and is something your dental team will want to know about.

For most routine dental procedures including extractions, current guidance in the UK recommends continuing anticoagulant medication rather than stopping it, as the risk of a cardiac event from stopping anticoagulation outweighs the risk of dental bleeding, which can usually be managed with local haemostatic measures. Your dentist should follow established guidelines on this and may liaise with your GP or cardiologist if needed. Do not stop any anticoagulant medication before a dental appointment without explicit advice from your prescribing clinician.

Antibiotic Prophylaxis

Patients with an ICD do not routinely require prophylactic antibiotics before dental treatment. There is no evidence that dental procedures increase the risk of device infection in ICD patients, and current UK guidance does not recommend antibiotic prophylaxis for ICD patients undergoing dental procedures.

This is different from the guidance for patients with certain heart valve conditions, for whom prophylaxis may still be indicated. If you have a valve problem as well as your ICD, check with your cardiologist whether you fall into that category.

Stress and Anxiety at the Dentist

Dental anxiety is extremely common, and for cardiac arrest survivors it can be particularly heightened. Stress and anxiety raise heart rate and can, in some individuals, act as a trigger for arrhythmias. A good dental team will be aware of this and should follow a stress reduction approach — clear communication, shorter appointments where possible, adequate anaesthesia, and a calm environment.

If you experience significant dental anxiety, it is worth discussing this with your dentist in advance. Sedation dentistry is available at some practices and may be appropriate for more complex treatment, though this would need to be discussed with your cardiologist too.

Electric Toothbrushes and Water Flossers

Electric toothbrushes are completely safe for ICD patients. Water flossers (oral irrigators) are also safe. Good oral hygiene is important for everyone, and particularly for those with cardiac conditions, as there is an established association between poor oral health and cardiovascular disease. There is no reason to revert to a manual toothbrush because of your ICD.

A Note on Smart Devices

This one is not strictly dental, but worth mentioning: modern smartwatches, fitness trackers, and some wireless earphones contain magnets that can, in some circumstances, affect ICD function if held very close to the device site. While the risk is low during normal use, it is worth being mindful of where you place devices that contain strong magnets relative to your ICD implant site. This is covered in more detail on our Electromagnetic Compatibility page.

If Your Dentist Is Unsure

Not all dentists see ICD patients regularly, and some — particularly in smaller practices — may be cautious about treating you or may ask questions you are not sure how to answer. This is not a reason to panic. A dentist who is uncertain and takes time to check is being appropriately careful.

If your dentist has specific concerns about your device, they can contact your cardiac device clinic or cardiologist directly for guidance. You can help by bringing your ICD identification card, which includes the manufacturer contact details. The ICD manufacturer’s patient support line can also advise on equipment compatibility with specific device models.

See also our pages on ICD and Electromagnetic Compatibility for more on living with an implanted device.