Usually, yes, for ordinary dental work. Standard amalgam fillings, single-post dental implants and dental bridges are named as acceptable under certain conditions in NeuroStar's instructions for use, and BrainsWay excludes standard amalgam fillings from its metal warning. The real concern is different: conductive or magnetic metal implanted in the head or close to the treatment coil, and electronic implants such as cochlear implants, deep brain stimulators and vagus nerve stimulators. Tattoos and piercings are smaller questions with practical answers, covered below.
No article can clear you for treatment. Every TMS team screens with a written safety questionnaire, and the rules of the specific device being used are what decide. Use this page to know what to mention, what to dig out of your records, and why the team asks.
Why metal matters in TMS at all
A TMS coil sends brief, strong magnetic pulses into a small area of the scalp. Those pulses induce electrical currents in anything conductive nearby, which is how TMS works on brain tissue. The same physics can push on, heat or disrupt a metal object or an electronic device, which is why FDA's device guidance says failure to respect the metal rule "could result in serious injury or death."
The field fades quickly with distance. NeuroStar's manual notes that within 30 cm of the coil face the peak field can exceed 5 gauss, a common exclusion level for electronic devices. So the questions a screener asks come down to three things: what the object is made of, whether it is electronic, and how close it sits to where the coil will rest on your head.
Quick reference: common objects and what usually happens
| Object | Usual status | What the team will want |
|---|---|---|
| Amalgam ("silver") fillings | Acceptable under device conditions | Mention them; no records usually needed |
| Single-post dental implant, bridge work | Acceptable under certain conditions (NeuroStar) | Tell the screener what was placed |
| Braces, permanent retainers, crowns | Often accepted; not named in every device list | Case-by-case review |
| Earrings, nose and other facial piercings, hair clips, glasses, hearing aids | Removable, so not a barrier | Take them out before each session |
| Tattoos, permanent makeup | No data reported; no serious risk expected (IFCN) | Mention scalp or face ink near the coil |
| Aneurysm clips or coils, stents, bullet or shrapnel fragments in the head | Contraindicated on NeuroStar labeling | Operative records; usually rules out treatment |
| Skull plates or other surgical metal in the head | NeuroStar labeling says safety is not established | Operative records; device-specific decision |
| Cochlear implant, deep brain stimulator, vagus nerve stimulator | Contraindicated | Usually rules out treatment |
| Pacemaker, implantable defibrillator | Labeled warning | Cardiology input; device-specific decision |
| Programmable shunt valve | Considered safe by IFCN with a check | Valve settings checked after a session |
The rows below explain each one, with the source behind it.
Dental work: fillings, implants, bridges and braces
Teeth sit well below the area treated for depression, which is on the upper front of the head over the left prefrontal cortex. Both large U.S. manufacturers address dental metal directly. NeuroStar lists standard amalgam fillings, single-post dental implants and dental bridge work as examples of metal near the head that is "acceptable under certain conditions," with the conditions spelled out in its manual. BrainsWay says its Deep TMS should not be used with metal implants in or around the head, "except for standard amalgam dental fillings."
Braces and fixed retainers are not named in either list. Some hospital programs accept them outright; Sheppard Pratt's TMS safety page, for example, says "patients with braces and metal fillings are acceptable for treatment," and asks people with other metal in the mouth to discuss it with their doctor first. Because the device-specific answer can differ, expect the screener to ask what is in your mouth and to check it against the labeling of the machine they use. Magnetic dental attachments, such as some denture or implant magnets, deserve a specific mention.
Metal inside the head: clips, coils, plates and fragments
This is the category that most often rules TMS out. FDA's special-controls guidance says rTMS devices are contraindicated in people with "conductive, ferromagnetic, or other magnetic-sensitive metals implanted in their head or within 30 cm of the treatment coil." NeuroStar's manual gives examples: cochlear implants, implanted electrodes or stimulators, aneurysm clips or coils, stents, bullet fragments, jewelry and hair barrettes. NeuroStar's public safety page puts it more simply: treatment "should not be used with patients who have non-removable conductive metal in or near the head."
The research picture is more nuanced than the labeling. The 2021 International Federation of Clinical Neurophysiology (IFCN) safety guideline notes that titanium skull plates, rods and aneurysm clips do not appear to experience significant forces from TMS, because titanium is not ferromagnetic and conducts poorly. It also says implants in the head that are MRI-safe "are more likely to be TMS safe than those that are not MRI safe." Even so, a TMS team treating you with an FDA-cleared device works within that device's labeling, so if you have a clip, coil, plate or fragment in your head, assume the answer may be no and bring the surgical or imaging records anyway.
Electronic implants: cochlear implants, DBS, VNS and heart devices
Cochlear implants and brain stimulators
FDA's guidance lists "active or inactive implants (including device leads), including deep brain stimulators, cochlear implants, and vagus nerve stimulators" as a contraindication. Note the word "inactive": a switched-off device still has wires that can pick up current. IFCN states plainly that people with cochlear implants should not undergo TMS, and that in lab studies a coil 2 to 10 cm from a deep brain stimulator's pulse generator could cause malfunction, with permanent damage possible at 2 cm or less.
Pacemakers and defibrillators
Here the sources disagree, and it is worth knowing why. FDA's guidance treats pacemakers and implantable cardioverter defibrillators as a labeled warning rather than a contraindication, and it applies "irrespective of the distance from the treatment coil," including wearable defibrillators. IFCN is more permissive: it considers figure-8 coil TMS safe with pacemakers, VNS systems and spinal cord stimulators if the coil is not fired within 10 cm of the electronic components. For decisions about your own care, the labeling of the device being used is what applies. If you have a cardiac device, expect the TMS team to involve your cardiologist and to make a device-by-device decision.
Shunts
For pressure-programmable shunt valves used in hydrocephalus, IFCN says TMS has been considered safe but recommends checking the valve settings after a session. Bring your neurosurgery contact details to the consultation.
Tattoos, permanent makeup and piercings
Tattoos rarely change the decision. Some inks, including those used for permanent makeup or scalp micropigmentation, can contain iron oxide or other metal particles. IFCN notes that no data have been reported on scalp tattoos or permanent makeup, and that such ink may interact with the magnetic field "but with no risk to induce" a serious adverse event. In practice, mention any ink on your scalp, forehead or face so the team can take it into account.
The same guideline flags a small, practical point: eye makeup containing ferromagnetic particles may contribute to facial pain during frontal TMS. Many people simply come to sessions without eye makeup.
Piercings, earrings, hair clips, glasses and hearing aids are removable, and IFCN says conductive or magnetic objects worn on the head "should be removed if they can interact with the TMS magnetic field." NeuroStar's manual adds that once such objects are removed, treatment is not contraindicated. If a piercing cannot be removed, tell the screener before your first session, not on the day.
Is TMS screening the same as MRI screening?
The questionnaires overlap, but the two are different tests. An MRI scanner surrounds your whole body with a strong, constant magnetic field, so metal anywhere can matter. A TMS coil produces brief pulses concentrated near one spot on the head, so distance from the coil carries much more weight. That is why dental fillings that matter little for TMS still get asked about, and why a pacemaker in the chest gets special handling for both.
A clean MRI history is useful evidence, not a pass. As noted above, an MRI-safe head implant is more likely to be TMS-safe, which is a probability, not a guarantee. If you have had a brain MRI, bring the report and any implant cards; they help the team identify exactly what is in place. Some TMS programs also use MRI for targeting, which is a separate topic covered in how TMS targets are found.
How the screening works, and what to bring
Metal is one part of a broader safety review. FDA's guidance also asks for close monitoring of people with a history of seizure, stroke, head injury or other neurologic disease, or who take medicines known to lower the seizure threshold. Seizure itself is rare: in a survey covering 2012 to 2016, the rate within guidelines in people without risk factors was fewer than 1 per 60,000 sessions. The details are in TMS side effects and, for the full numbers, TMS safety and seizure risk.
Before your TMS consultation, gather:
- Implant cards for any device (cardiac, neurological, hearing, shunt).
- Operative notes for brain, ear, eye or skull surgery, including aneurysm repair.
- A note of any metalwork injury, such as welding or grinding fragments, or shrapnel.
- A list of dental work, especially implants, bridges and any magnetic attachments.
- Where any scalp or facial tattoos or permanent makeup are.
Hearing protection is part of every session regardless of metal. FDA guidance asks that patients wear earplugs or similar protection rated at 30 dB of noise reduction, because the coil's click is loud. The TMS preparation checklist covers the rest.
If metal rules out TMS
Being screened out of TMS does not mean you are out of options. Medication changes, psychotherapy, ketamine-based treatments and ECT all have different safety rules; ECT, for example, has its own, separate screening. The comparison of TMS and ketamine therapy and the broader TMS candidacy checklist are good next reads, and the TMS guide maps the rest. If you want to talk through whether TMS is realistic for you, start with the TMS therapy page.
Sources
- Class II Special Controls Guidance Document: Repetitive Transcranial Magnetic Stimulation (rTMS) Systems. U.S. Food and Drug Administration, 2011. fda.gov
- Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clinical Neurophysiology (Rossi et al., IFCN), 2021. europepmc.org
- NeuroStar System Instructions for Use (52-4US1E-030 Rev. F). Neuronetics, 2021. neurostar.com
- BrainsWay MDD Treatment Safety Information. BrainsWay, 2026. brainsway.com
- TMS Safety. Sheppard Pratt, 2026. sheppardpratt.org
- Safety Information. NeuroStar (Neuronetics), 2026. neurostar.com
- 510(k) K231926 and 510(k) Summary, NeuroStar Advanced Therapy System. U.S. Food and Drug Administration, 2024. accessdata.fda.gov
- Seizures from transcranial magnetic stimulation 2012-2016: Results of a survey of active laboratories and clinics. Clinical Neurophysiology (Lerner et al.), 2019. europepmc.org
FAQs
Can I have TMS with metal fillings?
Usually yes. NeuroStar lists standard amalgam fillings as acceptable under certain conditions, and BrainsWay names them as an exception to its metal warning. Mention them during screening anyway.
Do I need to take out my nose ring or earrings?
Yes. Removable metal on the head, including piercings, earrings, hair clips and glasses, should come off before each session. Once removed, they are not a barrier to treatment.
I have a titanium plate from old surgery. Is TMS out?
Possibly, but not automatically. Research suggests titanium plates experience little force from TMS, yet device labeling is stricter: NeuroStar's contraindication covers conductive metal implanted in the head near the coil, and its manual says safety has not been established in people with metal plates in the head. Bring your operative records so the team can check against the specific device.
Can I have TMS with a pacemaker?
It depends on the device and the TMS system. FDA guidance treats pacemakers and defibrillators as a labeled warning, and some manufacturers exclude them. Expect your cardiologist to be involved in the decision.
Will a tattoo burn during TMS?
The international safety guideline says no data have been reported on scalp tattoos or permanent makeup, and that ink containing metal particles may interact with the magnetic field but without a risk of serious harm. Tell the screener about any scalp, forehead or facial tattoos or permanent makeup.
