Sir, following a review of the literature and previous correspondence of Balfrey,1 Firth2 and Alexander,3 it seems clear that there is still confusion within the general dental community of the management of patients with implantable cardiac devices/pacemakers. A 2012 narrative review4 attempted to provide guidance on the matter. The article references that some common ultrasonic scalers and ultrasonic baths do produce electromagnetic interference and may pose a risk to patients. This is supported by the British National Formulary (BNF)5 recommending that 'some ultrasonic scalers, electronic apex locators, electro-analgesic devices, and electrocautery devices interfere with the normal function of pacemakers (including shielded pacemakers) and should not be used.' However in opposition, a review conducted by Trenter and Walmsley6 states that piezoelectric ultrasonic scalers are safe for use in patients with pacemakers.

Due to conflicting evidence on this topic it is the view of the authors that a review of the literature with cardiology specialist input is much needed in order to provide some clarity on the safe management of such patients.