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Title Dental Procedures Do Not Raise The Risk Of Infection Of Prosthetic Hip Or Knee Joints
Clinical Question In a patient who has had prosthetic replacement of the hip or knee joint, does dental treatment increase the likelihood of prosthesis infection? Does antibiotic prophylaxis at dental treatment lower the likelihood of prosthesis infection?
Clinical Bottom Line Dental procedures do not raise the risk of infection of prosthetic hip or knee joints, nor does antibiotic prophylaxis for dental procedures lower the likelihood of joint infection.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19951109Berbari / 2010339 cases, 339 controls, all underwent prosthetic hip or knee replacementCase-Control
Key resultsPatients who had dental procedures without antibiotic prophylaxis were no more likely to experience joint infection than patients who did not have dental procedures. The adjusted odds ratio (OR) for prosthetic hip or knee infection was 0.8 (95% CI 0.4-1.6) in patients who underwent high-risk or low-risk dental procedure but were not administered antibiotic prophylaxis, and 0.6 (0.4-1.1) in patients who did not undergo a dental procedure. Furthermore, antibiotic prophylaxis for dental procedures did not lower the likelihood of later joint infection. OR with prophylaxis 0.9 (0.5-1.6), OR without prophylaxis 1.2 (0.7-2.2) 10.3% of the prosthetic joint infections were caused by microorganisms of potential oral or dental origin.
#2) 18591588Uckay / 2008HumansSystematic Review of weak evidence
Key resultsOf 144 articles meeting relevance criteria, 24 were case reports (7 reporting at least 3 cases), 23 prospectively studied post-dental-procedure bacteremia, and 35 were reviews. Twenty-seven of these articles favored pre-dental-treatment antibiotic prophylaxis, 11 reported no benefit, and the remaining 106 stated no clear position.
Evidence Search "Case-Control Studies"[Mesh] AND "Dentistry"[Mesh] AND ("Prosthesis-Related Infections"[Mesh] OR "Arthroplasty, Replacement, Knee"[Mesh] OR "Arthroplasty, Replacement, Hip"[Mesh]) NOT "Cementation"[Mesh]
Comments on
The Evidence
The Berbari study included 339 cases with prosthetic hip or knee infections and 339 controls without such infection; all were recruited from a single tertiary-care hospital in Minnesota. Sampling and measurement bias were minimized by capturing the dental chart information before the prosthetic joint infection occurred, and the dental record reviewer was blinded to subject’s case/controls status. Eighty-six percent of cases and 92% of controls were dentate. 57% of dentate cases and 47% of dentate controls had a high-risk dental procedure within the 2 year observation period. Personal oral hygiene practices and professional oral hygiene visits were comparable between groups. Periodontal pockets were not analyzed.
The Uckay article is cited because, although it summarized weak evidence, it was the only systematic review on this question that we could identify. The Berbari article should therefore take precedence.
Prosthetic joint infection is an uncommon event, occurring in about 1% of primary arthroplasties. A randomized controlled trial on this question would require an impracticable number of subjects. Therefore the case-control study is the strongest evidence that we have on such a question.
Applicability Subjects were from the midwestern USA between 2001 and 2006. Median age was 69.5 years (range 25.7-91.2) for cases and 71.4 years (36.0-94.8) for controls. "Case patients were patients hospitalized with total hip or knee infection. Control subjects were patients who underwent a total hip or knee arthroplasty but without a prosthetic joint infection who were hospitalized during the same period on the same orthopedic floor."
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Periodontics)
Keywords antibiotic prophylaxis, prosthetic joint replacement
ID# 2066
Date of submission: 07/07/2011spacer
E-mail curtisjg@livemail.uthscsa.edu
Author Joseph Curtis
Co-author(s) e-mail
Faculty mentor/Co-author S. Thomas Deahl, II, DMD, PhD
Faculty mentor/Co-author e-mail DEAHL@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Joshua Champion & Mitchell Murphy (San Antonio, TX) on 11/30/2017
A PubMed search in November 2017 yielded a systematic review by Sollecito 2014 (PubMed ID:25569493) which included an updated literature search while also including the previously cited evidence from 2008-2010. Collectively evidence supports the original conclusions of the CAT as well as the current published ADA guidelines in regard to not recommending generalized prophylactic antibiotics for patients with hip or knee joint replacement. Best practices continue to recommend extensive medical history review and holistic patient centered clinical decision making.

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