Impact of dental clearance on total joint arthroplasty: A systematic review

Abstract

Many orthopedic surgeons require that their patients obtain dental clearance before elective total joint arthroplasty (TJA). However, there is no consensus substantiating the practice. To this end, a systematic review on the prevalence of dental pathology in TJA patients, risk factors for failing dental screening, and impact of dental evaluations was performed. Literature was sourced from PubMed and Scopus databases. Six papers were sourced from the initial search, one study was extracted from the references of the original six manuscripts, and one new publication was retrieved from a second search conducted after the first. The prevalence of dental pathology ranged from 8.8% to 29.4% across studies. Two of four papers reported lower than average or improvements in post-operative infection with pre-operative dental evaluations while two found no such association. There is insufficient evidence to support universal dental clearance before TJA.

Femoral Neck Fracture in a Hemodialysis Patient after Liver Transplantation: A Case Report

“…The risk was high because the artificial materials inserted into the body during BHA and other arthroplasties are generally sensitive to infections. 19 , 20 ) Even caries of the teeth can cause SSI after an arthroplasty. 19 , 20 ) Revision surgery for infection after primary total hip arthroplasty (THA) reportedly increases the mortality risk during the first year after the second procedure.…”

“… 19 , 20 ) Even caries of the teeth can cause SSI after an arthroplasty. 19 , 20 ) Revision surgery for infection after primary total hip arthroplasty (THA) reportedly increases the mortality risk during the first year after the second procedure. 21 ) The indications for arthroplasty require discretion regarding the high risk of SSI, and appropriate preventive and treatment measures are also needed.…”

“…19,20) Even caries of the teeth can cause SSI after an arthroplasty. 19,20) Revision surgery for infection after primary total hip arthroplasty (THA) reportedly Fig. 3.…”

Evaluación odontológica preoperatoria para pacientes trasplantados, cardiópatas, oncológicos y con prótesis articulares de reemplazo.

“…La infección de las prótesis de reemplazo articular corresponde a una complicación no deseada que puede terminar en un fracaso terapéutico. Se han determinado factores de riesgo tales como un mal estado nutricional, hábito tabáquico, inadecuado control de la glicemia e higiene oral deficiente 23 . Los microrganismos que originan la infección pueden corresponder a una siembra del sitio quirúrgico o pueden provenir de sitios anatómicos distintos a través de la vía de diseminación hematógena 24,25 .…”

An Orthopedic Surgeon’s Dental Examination: Reducing Unnecessary Delays in Joint Replacement Surgery for Marginalized Patients in a Safety Net Hospital System

“…The potential for hematogenous spread of oral pathogens to seed the hip and/or knee before, during, or after surgery has led to the common practice of preoperative dental clearance, especially in high-risk populations [ 1 , 2 ]. Recently however, this practice has been questioned as current evidence linking oral infection and periprosthetic joint infection (PJI) remains inconclusive [ 3 , 4 ]. Despite this, poor dental health is still considered to be a modifiable risk factor critical to the success of TJA [ [5] , [6] , [7] ].…”