Saturday, June 22, 2013

Can A Person With A Cardiac Pacemaker Have An MRI?

Can a person with a pacemaker have an MRI?

 I have had the need to research this question recently and, at the present time, the answer depends on several things that I will try to explain below:

Advances in technology and medicine have extended the life expectancy of our elderly population to an advanced age where many organs start to malfunction or fail, and the heart is no exception, so when the heart rate becomes too slow, cardiac surgeons install a pacemaker to give it a kick and increase the heart rate as needed. 

Pacemakers are commonly found in many of our senior citizens, and it is estimated that 75% of persons implanted with a pacemaker will need an MRI for some other part of their body.

Unfortunately, pacemakers are made of metal,  with metal leads and electronic components that are susceptible to electromagnetic fields and radiofrequencies, and MRI’s produce both of these which can cause a pacemaker to malfunction.

In the past, it was not recommended and adverse effects were seen such as misfiring and heating of the leads, so in order to be able to do necessary MRI’s in persons with a pacemaker, two things were developed:

  •  The MRI-Conditional Pacemaker, a new kind of pacemaker that can be scanned by MRI’s of 1.5 Teslas or less.

  • And a protocol for a “Safe Performance of Extra-thoracic Magnetic Resonance Imaging at 1.5 Tesla in the Presence of Cardiac Pacemakers in Non–Pacemaker-Dependent Patients”.

The protocol and guidelines to determine which patients can have an MRI and which should not is explained in more detail in this webpage from the Mayo Clinic:

 well informed MRI department should be aware of this information.

I hope this information may serve as a quick reference to those researching this topic.

West Palm Beach Dentist
Carlos Boudet, DDS, DICOI
1840 Forest Hill Blvd, Suite 204
West Palm Beach, Florida  33406
Phone: (561) 968 6022

Tuesday, June 18, 2013

Answers To Dental Related Questions

About three years ago, I started answering questions related to dentistry in Yahoo Answers.  Many of the questions are posted by children to chat among their piers, but occasionally I see questions that deserve an answer and I try to help with mine.
Here is the answer to a question that I recently responded to from a twenty seven  year old young man who is about to loose a retained baby tooth in the smile area, does not know if the permanent tooth will come in  and is wondering what can be done.
Below is the answer to this young man’s question:
Hi John,
If you are 27 and still have a baby tooth it means that the permanent tooth never formed or it is impacted, and it will not come out on its own.
The fact that the tooth is loose tells me that you will not be able to save it even if you wanted to.
You don't say anything about what your dentist has told you, so I am assuming that you don't go to the dentist.
Your options are
1- To close the space with orthodontic therapy (braces), ….
You can read the full post in Yahoo Answers here: Yahoo Answers .  Like I said, I have been aswering questions for about three years so if you have a dental related question, you may be able to find the answer already posted there.  If you cannot find your answer there, please don't hessitate to call our office at (561) 968 6022, or if you prefer you can ask your question inthe comment box below or e-mail us at and we will do our best to respond promptly. 

West Palm Beach Dentist Carlos Boudet, DDS, DICOI
1840 Forest Hill Blvd, Suite 204
West Palm Beach, Florida  33406
Phone: (561) 968 6022

Thursday, June 6, 2013

Crowns Or Veneers In The Esthetic Or Smile Zone

Once in a while, I see patients in my practice that have been treated by a dentist and present with crowns that have been poorly designed, and shaped in a way that does not have the right contours, dimensions, or proportions, and when these are in the smile zone they can make a person’s smile very unattractive.

Usually there is a reason why the restorations were made that way, for example, a person with spaces between the front teeth may feel uncomfortable smiling, and request crowns or bonding to close the spaces.  Here is where your dentist’s training and artistic ability come in.  Your dentist can analyze the size of your teeth and compare them to “golden proportions” that are well documented to be very esthetic and determine if the person can close the spaces by making the teeth bigger or if the teeth are big enough and the space closure needs to be done with orthodontics.  Attempting to close the spaces by making the teeth bigger when they are big enough already can be a disaster and create a result that is not pleasing to the eye.

Another reason that dental work in the cosmetic zone can look bad is when the dentist fails to take symmetry into consideration.  For example, a case where the teeth on one side are made to look larger than the teeth on the other side.  This is very noticeable if the teeth in question are the two upper front teeth.  They should be identical to each other, and if one is longer or wider, it is very noticeable.

Sometimes the person has had some teeth extracted, and there is a natural tendency for the teeth to shift to close the space.  When this happens in the smile zone the teeth show canting, or an unaesthetic inclination, and any cosmetic work needs to correct the canting for the work to look good.

These and many other problems can be avoided by good planning on the part of the dentist.  If the dentist is changing the shape or the length of the front teeth, or correcting cosmetic problems it is important to use the concept of prototype temporaries. By creating the temporaries to incorporate all the features of the desired final restoration, the dentist (and the patient) can see how the final restorations will look, and if there are any issues or problems, they can be corrected in  the prototype temporaries until an acceptable result is achieved. 

Utilizing prototype temporaries takes more planning, and work on the part of the dentist, but it is a necessary step when solving problems in the cosmetic zone.

 West Palm Beach Dentist Carlos Boudet, DDS, DICOI
1840 Forest Hill Blvd, Suite 204
West Palm Beach, Florida  33406
Phone: (561) 968 6022