Incidence of and Risk Factors for Failing Dental Clearance Prior to Hip and Knee Arthroplasty

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Authors: Tokarski AT, Patel RG, Parvizi J, Deirmengian GK.
The Rothman Institute at Thomas Jefferson University Hospital Philadelphia, PA

Title: Incidence of and Risk Factors for Failing Dental Clearance Prior to Hip and Knee Arthroplasty

Background: Although a direct association between preoperative dental infection and periprosthetic infection has not been established, it is common to screen for and treat dental infection prior to joint replacement surgery.

Hypothesis/Purpose: We seek to investigate the incidence of and risk factors for preoperative dental clearance failure in joint replacement patients.

Methods: Over a 1-year period, all patients scheduling joint arthroplasty completed a dental questionnaire developed by the authors. Data collected included patient demographics, past medical history, medications, tobacco and alcohol use, past dental symptoms, past dental history, dental hygiene practices, and frequency of dental care. The results of the preoperative dental visit were collected and classified as passed or failed based on the presence of active dental infection that required treatment prior to the dentist granting clearance. Using the data, we calculated the incidence of dental clearance failure and identified risk factors associated with failed clearance.

Results: 300 patients completed our questionnaire and were evaluated by a dentist preoperatively. 35 patients (12%) failed dental clearance and required a tooth extraction and/or root canal procedure. Risk factors for failed dental clearance included tobacco use (19%), poor flossing habits (36%); history of one or more tooth extractions (55%), older age, narcotic use (11%), and not visiting a dentist within 1 year prior to taking the survey (13%). Within our cohort, 90 patients had none of these risk factors, excluding age and poor flossing habits, with only 3 failing dental clearance (3%).

Discussion: Dental clearance failure is common prior to joint arthroplasty. We have identified 6 risk factors for failed dental clearance. Patients who lack 4 of these risk factors have a 4-fold decreased incidence of failing dental clearance.

Conclusion: Selective dental clearance based on patient risk stratification may be a reasonable approach to combating the costs associated with the process.