Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2019; 10(12): 416-423
Published online Dec 18, 2019. doi: 10.5312/wjo.v10.i12.416
Impact of dental clearance on total joint arthroplasty: A systematic review
Christopher Frey, Sergio M Navarro, Terri Blackwell, Carla Lidner, H Del Schutte Jr
Christopher Frey, Department of Orthopedic Surgery, Stanford Medicine, Redwood City, CA 94063, United States
Sergio M Navarro, Department of Surgery, Baylor College of Medicine, Houston, TX 77030, United States
Sergio M Navarro, Said School of Business University of Oxford, Oxford OX1 1HP, United Kingdom
Terri Blackwell, H Del Schutte Jr, Comprehensive Joint Program, Charleston Institute for Advanced Orthopedics, Charleston, SC 29464, United States
Carla Lidner, Dentistry, Orange County Dental Society, Orange, CA 92868, United States
Author contributions: Frey C and Navarro SM contributed to source collection, data extraction, statistical analysis, and initial manuscript drafting; Blackwell T and Del Schutte Jr H contributed to original paper ideation and final manuscript editing; Lidner C contributed to final manuscript editing.
Conflict-of-interest statement: No author has received grant support or research funding for this article. The authors have no relevant financial relationships to disclose. We confirm that this manuscript has not been published elsewhere and is not currently under consideration by another journal. All authors have approved the manuscript and are in agreement concerning its submission.
Data sharing statement: The authors collectively authorize the sharing of data from this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Christopher Frey, MD, Doctor, Department of Orthopedic Surgery, Stanford Medicine, 50 Broadway Street Pavilion C, 4th Floor, Redwood City, CA 94063, United States. chris1fr@stanford.edu
Telephone: +1-571-2253999 Fax: +1-650-7213470
Received: July 13, 2019
Peer-review started: July 16, 2019
First decision: July 30, 2019
Revised: September 8, 2019
Accepted: September 22, 2019
Article in press: September 22, 2019
Published online: December 18, 2019
Abstract

Many orthopedic surgeons require that their patients obtain dental clearance before elective total joint arthroplasty (TJA). However, there is no consensus substantiating the practice. To this end, a systematic review on the prevalence of dental pathology in TJA patients, risk factors for failing dental screening, and impact of dental evaluations was performed. Literature was sourced from PubMed and Scopus databases. Six papers were sourced from the initial search, one study was extracted from the references of the original six manuscripts, and one new publication was retrieved from a second search conducted after the first. The prevalence of dental pathology ranged from 8.8% to 29.4% across studies. Two of four papers reported lower than average or improvements in post-operative infection with pre-operative dental evaluations while two found no such association. There is insufficient evidence to support universal dental clearance before TJA.

Keywords: Total knee arthroplasty, Total hip arthroplasty, Total joint arthroplasty, Periprosthetic joint infection, Dental screening

Core tip: There is insufficient evidence to support universal dental clearance before total knee arthroplasty or total hip arthroplasty procedures for reducing periprosthetic joint infection, even for higher risk patients.