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Planning Joint Replacement Surgery? Check-in With Your Dentist First

Joint replacement surgery is a commonly performed surgery today. Seven percent of all joint replacement surgeries are revision procedures, meaning the surgeries have to be repeated. More and more, joint infections are becoming recognized as being one of the complicating factors in joint surgery failures, and new information is pointing to the systemic spread of periodontal bacteria through the bloodstream. Physicians and surgeons should work closely with dentists and dental hygienists to certify that periodontal disease is dealt with prior to joint replacement surgery, and vice versa.

Anyone considering a joint replacement should plan on a visit to a qualified dentist, beforehand. If at all possible, they should make sure their mouth is free of gum disease before they schedule for that new hip or knee. Otherwise, there is a risk the new joint will become infected.

It is commonly accepted in medicine that bacteria and infection in the mouth does not remain in the mouth, but spreads throughout the entire body. With periodontal disease, the bacteria that cause the disease travel from the infected gums, through the bloodstream, to every tissue in the body. Not only is this bacteria linked to heart attack, stroke, high blood pressure, diabetes, Alzheimer’s, lung and kidney disease, cancers and other disease states, it is very dangerous for those undergoing surgical procedures. There is no place in the body that is protected from the invasion of aggressive and injurious periodontal bacteria.  Additionally, infection anywhere in the body compromises the entire immune system.

Joint disease currently affects more than 20 million people in the United States. More than 1 million total joint replacements are performed every year, according to the American Academy of Orthopaedic Surgeons. With thousands of revision procedures performed, determining risk factors is prudent before surgeries are performed.  Deep infections of the joint replacements usually result in the failure of the new joint and create the need for extensive revisions, the AAOS says.

This concern is nothing new to medicine. In a 1994 article published in the British Medical Journal, Wirral University Teaching Hospital in Great Britain reported that the mouth was a principal source of bacterial infection in patients’ prosthetic joints.

When a joint surgery becomes infected, both patient and physician question, “Why?” Commonly, the surgical procedure went smoothly.  However, the patient feels warmth around the joint. There is continued pain and swelling with the joint remaining in a chronic state of infection. Oftentimes, retreatment is necessary.

Infection caused by dental disease, (typically periodontal infection), can be prevented if surgery is postponed until dental clearance is confirmed by a dentist skilled in a proper pre-surgical evaluation.

Without a comprehensive dental screening, there’s no way to confirm whether periodontal disease is present. In some people with very advanced levels of periodontal disease, the condition may be obvious—inflamed, bleeding gums tell the story. But even life-threatening levels of gum disease can remain an invisible health risk. Alarmingly, people with dental disease often have no symptoms until the disease is in its moderate to advanced stages.The effects of the bacterial infection are not necessarily visible on the outside of the gums, but hidden on the inside surface, adjacent to the root of the tooth. People typically have no idea they have the disease, yet it is rampant in our society.

Of all American adults, 75% have periodontal disease, according to the American Academy of Periodontology. A significant number of this population also seeks joint replacements. If current trends continue, 1.4 million knee replacements and nearly 600,000 hip replacements will be performed in 2015. By the year 2030, the total number of hip and knee replacements combined is expected to exceed 4 million, according to The Kaiser Permanente National Joint Replacement Registry.

The American Academy of Orthopaedic Surgeons and the American Dental Association recommend that people requiring joint replacement surgery receive a dental clearance prior to joint replacement surgery. Dentists can and should provide in-depth diagnosis and treatment for patients who are preparing for or who have already received joint replacement surgery, and to rovide a dental clearance prior to surgery.

In my experience, when the orthopedic surgeon is informed that our mutual patient has a serious level of periodontal disease, the surgeon is appreciative and always postpones the surgery, unless it is an emergency procedure.

Orthopedic surgeons typically follow the recommendations of the AAOP and have their patients take antibiotics prior to future dental appointments. It is important for anyone who has had joint replacement surgery to inform their dentist so he or she can collaborate with their physician on the appropriateness of antibiotic pre-medication prior to dental care.

By postponing joint replacement and seeking a dental examination and treatment first, individuals will have both a healthier mouth and improved recovery from joint surgery.  Since the body’s immune system is not compromised by dental infection, patients’ healing will be swifter, more uneventful and more predictable.  Most critically, their risk for serious joint infection is minimized, post-surgically.