Oral health implications in total hip and knee arthroplasty patients: A review

Young, Joseph R.; Bannon, Annika L.; Anoushiravani, Afshin A.; Posner, Andrew; Adams, Curtis; DiCaprio, Matthew R.

doi:10.1016/j.jor.2021.02.021

Cited by 7 publications

(10 citation statements)

References 46 publications

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“…None of the reviewed previous studies, which focused on the detection of potential risk factors for PJI, addressed dental care as a potentially relevant factor. A recent review article by Young et al (2021) concluded that oral health plays a small but relevant role in the occurrence of PJI [ 16 ]. The oral cavity was found to be one source of hematogenous PJI [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Preoperative dental screening can reduce periprosthetic infections of hip and knee endoprostheses in the first month after surgery: results of a cohort study

Fenske,

Kujat,

Krause

et al. 2023

Infection

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Purpose The oral cavity and, in particular, potential oral foci might pose a risk of periprosthetic joint infection (PJI). The aim of this cohort study was to determine whether practical preoperative dental screening would reduce the prevalence of early PJI in the first month after surgery. Methods Patients attending a specialized endoprosthesis implantation clinic between 2018 and 2022 were recruited. Two groups were examined. The test group consisted of patients attending the clinic between 2020 and 2022 and who were referred to their family dentist using a standardized form. The comparison group consisted of patients who were treated in the clinic between 2018 and 2020. They were not referred to their family dentist. The two groups were compared for the prevalence of PJI. Univariate analysis followed by multiple logistic regression was performed to confirm risk factors for PJI in this cohort. Results 2560 individuals (test group: 1227, comparison group: 1333) were included. The prevalence of PJI was significantly lower in the test group (0.8% vs. 1.8%, p = 0.04). Multiple logistic regression with PJI as the dependent variable showed that a dental referral was a strong predictor of a lower prevalence of PJI (OR: 0.43, CI95 0.205–0.917, p = 0.03). Male gender was also strongly associated with a higher frequency of PJI (OR: 2.68, CI95 1.32–5.42, p = 0.01). Age (OR: 1.06, CI95 1.01–1.10, p = 0.01) and BMI (OR: 1.11, CI95 1.05–1.17, p < 0.01) had little effect on the risk of PJI. Conclusion Dental referral using a standardized form can reduce the prevalence of early PJI. Accordingly, orthopedists and dentists should collaborate in this practical way.

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Section: Discussionmentioning

confidence: 99%

Preoperative dental screening can reduce periprosthetic infections of hip and knee endoprostheses in the first month after surgery: results of a cohort study

Fenske,

Kujat,

Krause

et al. 2023

Infection

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“…It is indicated that a preoperative dental rehabilitation (clearance) and especially a postoperative dental maintenance after EP implantation is recommendable 17,34,55 . This has also been explained in recent review articles on implications for oral health care before and after EP 19,56 . However, there is still a lack of evidence in this respect, and considering the ambivalent prevalence of oral diseases and infections, the real value of those measures to protect EP health remains questionable.…”

Section: Consequences Of the Hypotheses And Discussionmentioning

confidence: 99%

“…17,34,55 This has also been explained in recent review articles on implications for oral health care before and after EP. 19,56 However, there is still a lack of evidence in this respect, and considering the ambivalent prevalence of oral diseases and infections, the real value of those measures to protect EP health remains questionable. Especially the definition of potential "riskprocedures" in dentistry is still a point of discussion.…”

Section: F I G U R Ementioning

confidence: 99%

The hypotheses of oral disease‐associated perioprosthetic joint infections to understand the role of oral health for endoprostheses ‐ a narrative review

Schmalz

Ziebolz

2023

Special Care in Dentistry

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AimsPeriprosthetic infections are a severe complication, causing enormous morbidity. The role of oral diseases in the development of such infections has been discussed controversially, showing a large discrepancy between prevalence of oral foci and infections of endoprostheses (EP). This narrative review aimed in explaining and discussing two hypotheses for the occurrence of oral disease‐associated EP infections.Methods and ResultsThe hypotheses include two mechanisms. (1) In case of an acute exacerbation during the early healingperiod after EP surgery (first 3 months). (2) Coincidental in the context of late EP infections (after successful initial healing), where an initial periprosthetic inflammation can be colonized secondarily by oral microorganisms. In both settings,oral foci are not primarily causative for EP infection, but represent an important reservoir for EP colonization, while the immunological conditions (locally and systemically) are crucial for the onset of an EP infection. As potential consequence, patients with risk factors should be orally rehabilitated prior to EP surgery. Usage of antibiotic prophylaxis during the first 3 months after EP implantation (initial healing period) might be considered, but has no reliable evidence. To avoid morbidity of patients, radical dental clearance is unfavorable for the respective patients.ConclusionAltogether, patients with EP should receive increased attention from the dental perspective alongside with dental preventive measures, because they show a high dental and periodontal treatment need.

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“…After the oral screening, patients could visit dentists to improve their oral status [22]. Moreover, if there is sufficient time until surgery, one can plan tooth extraction while considering the prevention of infective endocarditis and bloodstream disease [5,8,23]. A previous study reported that the reservoirs of oral infection should be removed at least two weeks before a surgical procedure [11].…”

Section: Discussionmentioning

confidence: 99%

“…Oral management during the perioperative period is considered important, mainly as a step toward preventing the development of postoperative complications, such as postoperative pneumonia, surgical site infection, and dental injury associated with anesthesia [1][2][3][4]. Moreover, recent review reports of patients undergoing total hip or knee arthroplasty with local anesthesia revealed that oral health assessment is important to ensure the elimination of oral infectious sources before elective joint arthroplasty [5]. During perioperative oral management, dentists remove the source of infection via procedures such as tooth extraction and periodontal treatment before surgery; dental hygienists educate patients to improve the oral health with an emphasis on motivating self-care.…”

Section: Introductionmentioning

confidence: 99%

Factors That Influence the Judgment of Oral Management Necessity in Preoperative Oral Screening

Kai

Tsukamoto

Urabe

et al. 2021

IJERPH

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Oral management during the perioperative period is important to prevent the development of postoperative complications. However, there are no unified systems to examine the oral status of patients and very few studies have focused on preoperative oral screening. In this study, we examined the oral status of patients who underwent oral screening at a University Hospital. A total of 1173 patients who underwent oral screening for perioperative management from April 2020 to July 2021 were enrolled. The subjects’ medical data were retrospectively extracted from the dental records, and finally, the data of 1081 patients aged ≥20 years were analyzed. Oral screening based on seven categories was performed by dentists or dental hygienists. Our cumulative results determined whether patients required oral management during the perioperative period. “Poor oral hygiene” was the most frequent category (24%) of all oral categories examined. Logistic analysis revealed that tooth mobility had the highest odds ratio (21.476; 95% confidence interval: 11.462–40.239; p < 0.001) for oral management necessity during the perioperative period. Our study suggests that poor oral hygiene is most frequently observed in preoperative oral screening. Moreover, tooth mobility in preoperative oral screening may influence the judgment of oral management necessity during the perioperative period.

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Oral health implications in total hip and knee arthroplasty patients: A review

Cited by 7 publications

References 46 publications

Preoperative dental screening can reduce periprosthetic infections of hip and knee endoprostheses in the first month after surgery: results of a cohort study

Preoperative dental screening can reduce periprosthetic infections of hip and knee endoprostheses in the first month after surgery: results of a cohort study

The hypotheses of oral disease‐associated perioprosthetic joint infections to understand the role of oral health for endoprostheses ‐ a narrative review

Factors That Influence the Judgment of Oral Management Necessity in Preoperative Oral Screening

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