Preoperative Dental Screening And Treatment May Help Avoid Periprosthetic Joint Infection

“Bacteremia associated with dental pathology is a rare but serious causative agent of infections in total joint arthroplasty (TJA) patients,” said John W. Barrington, MD.

“Deep infections often necessitate additional care and extensive revision procedures that can cost approximately three to four times more than primary TJA.”

Bacteremia associated with dental pathology can lead to postoperative joint infection in TJA patients, often necessitating additional care and extensive, costly revision procedures.

Although some orthopaedists screen patients for dental pathology before scheduling their TJA, little is known about the incidence of dental pathology among TJA patients. Dr. Barrington’s longitudinal, population-based study identified a “shockingly high number” of patients as having dental pathology that required treatment before TJA could be performed to reduce the risk of postoperative joint infection.

No patients in the study developed acute postoperative infections, which Dr. Barrington attributes in part to a preoperative pathway that included dental screening and treatment. He presented the results of the study at the 2010 annual meeting of the American Association of Hip and Knee Surgeons.

Dr. Barrington reported that 23 of the 100 patients had active, untreated dental pathology that ranged from carious lesions (dental cavities) to severe periodontitis.

“To break this down further, in the 23 patients who had active dental pathology, 66 procedures were needed,” he said. “Patients who needed dental treatment had an average of three teeth that required treatment.”

Dr. Barrington asserted that “by utilizing dental clearance as part of a preoperative pathway, we saw no acute TJA infections.”

He pointed out that dental pathology is common in the general population of adults in the United States, according to National Health and Nutrition Examination Survey (NHANES) II and NHANES III data collected by the National Bureau of Economic Research.

“According to these data, an average of 17 adult teeth are missing, decayed, or previously filled in people older than age 65,” he said.

Dental pathology is even more common in those who live in skilled nursing facilities.

“It is also more prevalent in those with chronic diseases such as rheumatoid arthritis and diabetes mellitus,” he said. “A common pathway may be advanced age and decreased salivary production.”

Dr. Barrington recommends that all orthopaedic surgeons make screening for dental pathology part of their preoperative pathway, which he believes will help reduce the incidence of postoperative infections.

“My hope,” he said, “is that this study can help orthopaedic surgeons understand the scope of dental disease in the TJA population.”

Preoperative dental screening and clearance from a dentist as part of the preoperative pathway for TJA may reduce the risk of infection.

Dr. Barrington’s coauthor for “What is the True Incidence of Dental Pathology in the Total Joint Arthroplasty Population?” is Thomas Barrington, DDS.

By Jennie McKee, for AAOS Now.